Saturday, November 2, 2024

One Family’s Struggle is Changing Dialysis Care & Making It More Easily Available In Tier 2 & 3 Cities

When Prabhat Shrivastava’s father was diagnosed with chronic kidney disease (CKD) and advised to start dialysis, the family faced a significant decision. Residing in Jabalpur, Prabhat was disappointed with the available dialysis facilities in his hometown and encouraged his parents to move with him to Gurgaon.

This relocation took a huge toll on the family and led to many conversations around the lack of access to good dialysis care in India. As Prabhat discussed this with his father’s nephrologist, Dr Saurabh Pokhariyal, they knew that they had to address this gap. Another friend of Prabhat’s, Pankaj Tandon, a Chartered Accountant, joined them in their mission to make quality dialysis care accessible.

According to a government report, over 2.2 lakh patients are diagnosed with end-stage renal disease (ESRD) every year, leading to a demand of 3.4 crore dialysis sessions annually. The challenge lies in the insufficient number of dialysis centres across the country. Prabhat states that while there is a need for at least 15,000 dialysis centres across the country, only 5,000 exist, highlighting a critical need for more facilities. 

Founded in July 2017, VitusCare Medlife Pvt. Ltd aims to increase the number of dialysis centres in Tier 2 and 3 towns. Over the past six years, they have established 35 dialysis centres in seven states across North India, providing over 15,000 sessions per month.

‘The idea was very clear’: A vision comes to life

What really united the three founders was their shared background from Tier 2 cities. Prabhat, a lawyer from Jabalpur. Dr Saurabh from Dehradun with 18 years of experience, and Pankaj from Agra, a corporate finance expert, all recognised the pressing need for better care.

After moving his parents to Gurgaon in 2015, Prabhat started brainstorming possible solutions. 

“Moving my parents out of their comfort zone was not easy. I was shocked that I couldn’t find quality dialysis centres in Jabalpur, which is not a small city. I found people travelling 100 km daily for dialysis, and it was heartbreaking. While I could relocate my father, not everyone has that luxury,” shares Prabhat, CEO of VitusCare.

A VitusCare centre
A VitusCare centre

According to a Lancet report, almost 60 percent of patients on dialysis in the country have to travel over 50 km, and nearly a quarter live over 100 km away from a facility. Prabhat knew that the solution to this was providing quality care in the hinterlands. 

In 2017, he quit his job, and along with the other two co-founders, set up the first VitusCare dialysis centre in Aligarh. 

“The idea was very clear: we wanted quality dialysis therapy centres in cities which lack accessibility. Due to the distance, people often miss their dialysis sessions, leading to poor outcomes. In India, a CKD patient on dialysis lives, on average, for four years, while in the West, patients live for over 15 years. We need to improve outcomes for our country,” emphasises Prabhat.

Chronic kidney disease (CKD) affects a significant portion of India’s population, although the exact number of patients remains unknown.

Founders Prabhat Shrivastava, Pankaj Tandon and Dr Saurabh Pokhariyal (L-R)
Founders Prabhat Shrivastava, Pankaj Tandon and Dr Saurabh Pokhariyal (L-R)

“Dialysis is a vital treatment for patients with kidney failure, filtering waste products and excess fluid from the blood when the kidneys can no longer function properly. This life-saving procedure involves removing blood from the body through a needle, passing it through a machine to filter out harmful substances, and then returning the clean blood to the body. Typically, dialysis becomes necessary when kidney function declines significantly, reaching a point where natural filtration is insufficient to support the body’s health,” explains Dr Saurabh Pokhariyal.

While the problem of accessibility remains, the other concern is affordability. To provide dialysis at no cost, the Pradhan Mantri National Dialysis Programme (PMNDP) was rolled out in April 2016. The programme has two components: Hemodialysis (HD) services and Peritoneal dialysis (PD) services. Under the PMNDP, the government has set up 1,530 centres across the country, still leaving a significant gap.

“Key issues include high treatment costs, limited availability of dialysis centres, accessibility barriers for patients in rural areas, and a shortage of skilled healthcare professionals. Additionally, a lack of public awareness about kidney disease and dialysis options further complicates timely treatment,” adds Dr Saurabh.

Making Dialysis Convenient: How VitusCare works

VitusCare provides three forms of patient care: the in-centre dialysis model, where they set up centres inside existing hospitals in Tier 2 and 3 cities (95 percent of their centres), standalone centres where they open facilities in areas without hospitals, and at-home dialysis care.

Elaborating on their most popular form of care, the in-centre dialysis model, Prabhat shares, “We identify a space, develop and prepare it. We employ support staff in the centres. Using a hub-and-spoke model, we monitor all centres through our central team in Gurgaon. We have an operations team that monitors each centre, ensuring quality through strict SOPs.” 

VitusCare works on a box-in-box model.
VitusCare works on a box-in-box model

In this model, the company owns all the assets and directly manages the operations of the dialysis centre. “This model allows us to maintain stringent quality standards and ensure consistency in patient care across all locations,” adds Prabhat. 

The company has a clinical team, a biomedical team, administrative staff, a network of delivery therapists, nurses, nephrologists, operations teams, and teams that focus on increasing awareness.

Their mission is to bring dialysis centres near the patients’ home, minimising travel. 

VitusCare provides free dialysis for patients under the Ayushman Bharat scheme.

The problem with kidney disease is that it’s difficult to reverse. “Once the kidney has failed, it’s failed. You can’t cure CKD stage two or three,” says Prabhat.

Patients have two options: opting for kidney transplants or undergoing dialysis. The former is expensive and comes with the added problem of lack of donors. For most patients, dialysis becomes the only viable option to ensure a good quality of life.

“Missing dialysis sessions can lead to serious health complications as waste and fluids build up in the body. High potassium levels can disrupt heart rhythm and become life-threatening. Fluid overload may cause fluid retention in the lungs, leading to breathlessness, swollen ankles, high blood pressure, and even heart failure. Patients may also experience intense itching, extreme fatigue, and reduced appetite, further weakening their overall health. Regular dialysis is essential to manage these risks and maintain stability for those with kidney failure,” says Dr Saurabh.

Initially bootstrapped, the founders recently managed to raise a Series A round of investment.  

They currently have centres in Uttar Pradesh, Uttarakhand, Haryana, Himachal Pradesh, Punjab, Delhi, Rajasthan and plan to deepen their presence in these states. 

“The journey has been very satisfying and full of learning. We want to provide kidney disease patients with a better quality of life,” concludes Prabhat. 

Sources:
Renal failure deaths and their risk factors in India 2001–13: nationally representative estimates from the Million Death Study: by The Lancet Global Health, Published in January 2017.
Pradhan Mantri National Dialysis Program: by Ministry of Health & Family Welfare, Government of India

Edited by Arunava Banerjee, Images Courtesy Prabhat Shrivastava


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