In India, the number of Chronic Kidney Disease Stage 5 (CKD5) patients exceeds 2 million, with their survival dependent on either a transplant or regular maintenance dialysis. Due to the challenges of transplantation, dialysis has become the primary method of survival for these patients. The prevalence of diabetes and hypertension in the population contributes to the increasing numbers of CKD5 patients, who rely on dialysis services provided by public, private, and trust centers across the country. Additionally, private dialysis chains operate within these models, extending the reach of dialysis treatment to remote areas.
However, despite the demand, only a small percentage of CKD5 patients receive maintenance hemodialysis, estimated at just over 20 million sessions per year across all centers. This falls significantly short of the recommended minimum of 3 dialysis sessions per week per patient, reflecting the inadequate delivery of required dialysis sessions in the country.
Patients face various challenges, including limited accessibility, affordability, and the lack of standardized quality protocols for lifesaving therapy. Some service providers compromise treatment outcomes and patient survival due to limited competence, skill, and commitment in delivering critical services. Additionally, inadequate patient awareness and knowledge about disease management compound the problem.
The industry also grapples with its own set of challenges, including the lack of standardized protocols, quality-based qualification criteria, and service level agreements with minimal or no mention of outcome parameters. This has resulted in a highly fragmented industry, allowing individuals with limited knowledge and low commitment to quality to become service providers. Furthermore, the cost of dialysis service continues to rise due to the import of dialysis machines and consumables, with limited local commercial production.
Government-related challenges include delayed payments from most government projects, which further shrink already small margins and raise questions about sustainability. The government is responsible for ensuring that all patients receive a minimum standard of dialysis quality and justifying the large spending of taxpayers’ money in public-private partnership programs. However, continuous monitoring of individual components of the dialysis service process presents its own set of difficulties.
To address these challenges, industry and government must work together to ensure widespread coverage for afflicted patients while also delivering desired treatment outcomes and improving survival and quality of life for patients. The state’s public-private partnership models, along with the central government-sponsored Pradhan Mantri National Dialysis Program, are facilitating the penetration of dialysis services in rural India, providing life-saving treatment to rural patients. However, delivering services that achieve the best possible patient survival is equally important.
Continuous patient education programs on disease management and the right to quality healthcare are essential for improving survival by monitoring the quantity and quality of dialysis for every patient. Implementing mandatory quality protocols related to service delivery, periodic audits by independent authorities, incentivizing local production of dialysis machines and key consumables, and incentivizing service providers to achieve quality parameters compared to global standards are critical initiatives.
A combination of such initiatives, executed relentlessly by both government and industry, will be the key to achieving ‘Atmanirbhar Bharat’ in dialysis delivery.
In conclusion, industry and government collaboration, along with the implementation of various initiatives, will improve the overall quality and access to dialysis services in India, ultimately benefiting CKD5 patients, improving survival rates, and ensuring quality of life.