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Trained manpower – a challenge for CKD patients

Aseem Garg
Wednesday, July 27, 2022, 08:00 Hrs  [IST]

Chronic diseases are rampant in today’s fast-paced world, and kidney failure is one such disease which is causing morbidity and mortality across the globe. With an increase in ailments like diabetes and hypertension, the instances of kidney disease are rising swiftly. In India itself, CKD-caused deaths rose from 0.59 million to 1.18 million from 1990 to 2016, and the number is growing steadily. While it is difficult to ascertain the number of patients suffering with kidney disease due to the country’s vast population, it was estimated that 1 in 5 adults have CKD in India.  

Amid a staggering rise in cases, we have seen the need for dialysis skyrocket. The Indian dialysis market is growing at a rate of 31 per cent in India, compared to a meagre 8 per cent in the rest of the world. This has led to an urgent need for trained manpower to lead high-quality dialysis treatments across the country. The growing need for care providers begs the questions – do we have enough trained manpower in the country?

Access to CKD treatment in India
According to recent surveys, India has around 2600 nephrologists, 4000 dialysis centres and 28000 dialysis machines. Most of these are concentrated in metro cities and are predominantly a part of the private sector. While the need for dialysis and CKD treatment is increasing, there is a painfully large gap in the healthcare workforce.

To put it honestly, India has one of the lowest nephrology workforces across the world. At 2600, there are about 1.9 nephrologists per million population. There is also a widespread shortage of nurses and technicians for CKD patients. With a lack of doctors, there are many dialysis centres that are run and overseen solely by technicians. Nephrologist visits are few and far between.

Apart from doctors, dialysis centres also require workers for sanitation, cleaning machines, reprocessing the machines, and renal dietitians, who are not available in adequate numbers in various set-ups. Due to a manpower crunch, several centres witness nurses and technicians working interchangeably to provide dialysis to patients.

As per the present infrastructure, the need for dialysis centres is less than a quarter met in India. Considering these statistics, it is not surprising that access to high-quality healthcare for CKD patients is poor, especially in the country’s rural regions. Unfortunately, it is predicted that the nephrology workforce will not be able to keep pace with the growing cases over the coming decade, further exacerbating the issue.

Apart from a shortage of doctors and staff, CKD patients are also faced with barriers such as high costs of treatment and travelling long distances to find dialysis centres. Medicines to manage CKD are also not readily available to patients outside of big cities.

A lack of awareness about the disease also leads to adverse outcomes, since CKD is largely asymptomatic and requires proper screening to detect the disease. Targeted screening and education drives are crucial to bridge this gap and make sure that people who are at-risk or already suffering from the disease have access to specialist.

Boosting accessibility to healthcare for CKD patients
An efficient and adequate workforce in nephrology is critical to meeting the rising disease burden in India. Trained physicians and non-physician staff are the cornerstone to building a sufficient workforce for CKD patients. However, it is impossible to scale up the workforce immediately to meet the current requirements as training programs last years. Creating more training programs will help CKD patients in the long run. There are many training and upskilling programs available that can help to overcome the challenge of reduced trained staff for dialysis patients. The DCDC Academy of Healthcare, for example, runs a dialysis training course in partnership with the Association of Healthcare Providers (AHPI) and the Indian Medical Association (IMA), besides other reliable online certificate programs to train dialysis technicians.

Many new companies are working with a public-private partnership model as a feasible and faster solution. The Pradhan Mantri National Dialysis Program singularly focuses on PPP initiatives to make high-quality treatment available in the remotest parts of the country. By partnering with private sector healthcare institutions, CKD patient care can be brought to district hospitals and provide access to patients in the underserved rural regions. Currently, under the Pradhan Mantri National Dialysis Program, medical human resources, dialysis machines, and dialyzer are provided by the private partners, while the responsibility of space, water supply, and power are on the state government at district hospitals.

Simply put, world-class treatment options can be introduced in tier II, III and IV areas. They can also offer state-of the art infrastructure, virtual consultation with renowned nephrologists, and flexible dialysis options for patients. Another benefit of such a partnership is that it reduces the cost of treatment and minimizes out of pocket expenditure of patients, thus improving their quality of life.

With access to new advancements in nephrology, such treatment facilities can also offer haemodialysis and peritoneal dialysis services at the patient’s home, thereby nullifying the need to travel long distances to avail treatment. Moreover, home dialysis set-ups do not require close medical supervision and it can give patients the independence and freedom to undergo treatment even when trained staff and nephrologists are not readily available. The treatment can simply be carried out by a technician, a family member, or the patient themselves. Since home dialysis treatments are done more frequently, they take less time to complete and contribute to the patient’s quality of life. With the help of telemedicine, kidney patients can access high-quality, affordable care without travelling long distances. Over time, automated patient support at home will improve. Like in all other sectors, Virtual Reality (VR) headsets can allow for interactive patient training in the preferred local language, making remote care a pleasant experience.

There is mounting evidence that home dialysis patients live longer than those who get treated at external facilities. Home training requires one to two months of education and training for the patient, and usually a care partner. Such home treatments come handy when there are restrictions on travel or on social contact like during the peak of the pandemic lockdowns.  Many patients are happy with the greater flexibility and time-saving offered by home dialysis. Studies show that more the patient takes ownership and responsibility of his/her treatment, better are the results - as patients get more aware of what’s happening during dialysis. Moreover, such set-ups are an optimal solution for CKD patients in India while the country’s trained manpower crunch is overcome. Even though, there may not be enough doctors for now, there can be high-quality treatments and virtual consultations, available at any time the patent needs. Most importantly, there can still be hope and a happy, enriching life for CKD patients across the country.

(The author is founder of DCDC)


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