Dialysis

Every year about 2.2 Lakh new patients of End Stage Renal Disease (ESRD) get added in India resulting in additional demand for 3.4 Crore dialysis every year. With approximately 4950 dialysis centres, largely in the private sector in India, the demand is less than half met with existing infrastructure. Since every Dialysis has an additional expenditure tag of about Rs.2000, it results in a monthly expenditure for patients to the tune of Rs.3-4 Lakhs annually. Besides, most families have to undertake frequent trips, and often over long distances to access dialysis services incurring heavy travel costs and loss of wages for the patient and family members accompanying the patient. This therefore leads to financial catastrophe for practically all families with such patients. With substantial gain in quality of life and extension of progression free survival for patients, families continue to stretch financially to make large out of pocket spends. It has been felt that both in terms of provision of this important life saving procedure and also for reducing impoverishment on account of out of pocket expenditure for patients, a Dialysis program is required. Hon’ble Prime Minister, in his address after the presentation by Secretaries Group on Health and Education, desired that a mechanism should be worked out to provide improved access to dialysis services. Accordingly, MoHFW with support from the National Health Systems Resource Centre (NHSRC) studied relevant models on Dialysis services being practiced under PPP mode. These included models of West Bengal, Kerala, Karnataka, Mumbai and Delhi NCR. Further, a consultation with experts in this field, experts from AIIMS & PGIMER as well as private service providers was held in the Ministry of Health & Family Welfare on the 16th Feb 2016 to discuss the modalities of envisaged program. Draft RFP and Service Level Agreement for the Dialysis in the PPP mode in the district hospitals were prepared and were shared with the states and valuable feedback was received. The Dialysis Program under Public Private Partnership was formally announced in the Union Budget 2016-17 by the Hon’ble Finance Minister. Solution Strategy: There are two main types of dialysis, which are hemodialysis and peritoneal dialysis. a) Hemodialysis (HD, commonly known as blood dialysis): In HD, the blood is filtered through a machine that acts like an artificial kidney and is returned back into the body. HD needs to be performed in a designated dialysis centre. It is usually needed about 3 times per week, with each episode taking about 3-4 hours. b) Peritoneal dialysis (PD, commonly known as water dialysis): In PD, the blood is cleaned without being removed from the body. The abdomen sac (lining) acts as a natural filter. A solution Section - I INTRODUCTION 2 (mainly made up of salts and sugars) is injected into the abdomen that encourages filtration such that the waste is transferred from the blood to the solution. There are 2 types of PD - continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD). CAPD needs to be done 3 to 5 times every day, but does not require a machine. APD uses an automated cycler machine to perform 3 to 5 exchanges during the night while the patient is asleep. Close medical supervision is not required for most PD cases, thus making it a feasible option for patients who may want to undergo dialysis in the home setting. Each treatment option has its advantages and disadvantages, which vary with the condition of the patient and presence of underlying diseases. It is therefore important for every patient with ESRD to discuss various treatment options in detail with his doctor before starting treatment. The majority of patients in India receive renal replacement therapy in hemodialysis center. The number of patients on Hemodialysis and the number of hospital based and free standing units is steadily growing. A dialysis unit delivers patient care, and has specific requirements of treated water, electricity, medical gases and waste disposal. It additionally requires accommodating all the workers involved in patient care, allow emergency procedures, permit adequate hygiene and maintenance of specialized equipment. The design and layout of a unit must take into account all the above features in order to function smoothly and prevent development of complications.

We have 6 dialysis machine and providing 2 shifts in a day for dialysis sessions.