Healing Touch: Universalizing Access to Primary Healthcare

STUDENTS OF T. A. PAI MANAGEMENT INSTITUTE, MANIPAL

TEAM PATTHS

ASHWINI NAGARKATTI|HIMANSHU ARORA| PRATIK DUGAR | TUSHAR NAGALKAR | TRIPTA KAUR BATH

• Can a program address the identified theme in a creative way?Creative/Innovative

• Will a program addressing the theme be feasible given the resources at hand?

• Would the cost concerns outweigh the gains? Feasible

• Can such a program be successfully scaled to other target regions? Scalable

• Does the theme address the most important challenge that the country faces in the present scenario or does it address a generic problem?

Contextually Appropriate

• How much time would be needed for executing a program that addresses the theme? Time Factor

• Does the theme includes all groups or excludes some segments of society?Socially Inclusive

• Is the theme politically viable? Could it face the following challenges? Politically Immune

• Can a program addressing the theme be locally governed?

• Would it lead to decentralization of power? Locally Governed

• Will it be easy for such a program to get people’s support?

People Participation

• Will it lead to a situation where people would become self-dependent to such an extent that after some period, the program would no longer be necessitated?

Futuristic

BASED ON

THEME SELECTIONThe analogy of India’s current issues can be drawn to Sagar Manthanfrom Vishnu Purana which gave 14 jewels (themes)

Although each Jewel (Issue) had immense value, some were more important than the others

Healing Touch: Universalizing access to Primary Health Care

CURRENT SITUTATION

69% of India’s population inhabits rural areas, only 26% of doctorspractice there

Urban India’s physician density is 14 physicians per 10,000population, on par with many developed countries

Rural India’s physician density is 2 physicians per 10,000population

India faces 45% shortage of doctors in PHCs

India is called the TB and diabetes capital of the world

Funds allocation in India (1.04% of GDP)

Inconvenient / Number of PHC locations leading to accessibilityissues

In the 11th Five Year Plan, just 64% of the promised allocation of1.4 lakh Crores was spent on health

There is a vast disparity between the availability of urban and rural healthcare workers in India

Increasing the Reach

Lack of Expertise

Creating a Pull Factor

Tacking the financial constraints

C

H

A

L

L

E

N

G

E

S

Expanding the reach of

Primary Health care

Improving the quality of

expertise in the Health care

centres

Creating a Pull factor for the

Primary Health care centres

Improving the overall hygiene

conditions

PROPOSED SOLUTION

“SARVA SWASTHYA CHAKRA”

-meaning All round Healthcare of every individual in India can be initiated.

Objectives of

the chakra

1. Expanding Reach of the Primary Health Care Centres

In the current situation, the healthcare service is prevalent in India

as an alliance, using the market governance model; or the

partnership model. We need to create a community ecosystem

where all the parties work together to achieve a common goal.

• Increasing the number of Public private partnerships with the private hospital chains, NGOs

• This would increase the number of health care centres and doctors in an area

• Eg. The current PPP with the Piramal group

Public Private Partnership (PPP)

• Collaborate with IT centres present in village like cyber cafes, e-chaupals, sahaj centres etc to expand the reach of PHCs

• Collaborate with kirana and medical stores to organize immunization camps near a locality. These stores can also be used for spreading awareness by advertising weekly posters in the stores

Collaborate

• Have mobile vans which would visit to a locality once a week for regular check-ups

• Expand the scope of 24 x 7 helpline 104 to reach all the statesDoor-to-door service

2. Improving Expertise in Primary Healthcare

The PPPs with private hospital chains would bring in a lot of expertise of quality doctors and management team associated with them. A qualified doctor from such hospitals can be shared between 3-5 PHCs

Rural health workers can be trained to provide the first line of care

Owing to collaboration with existing IT centres like e-chaupal and sahaj centres, the rural health care workers can connect with expert doctors who can guide them via virtual mediums like skype etc.

Expert Medical Diagnosis systems can also be employed where computers can be used to solve problems that usually require human expertise. It would help in identifying diseases and describing methods of treatment.

Retired doctors can be engaged to advise the general public about first line of care through the 24X7 helpline

3. Create Pull factor for Primary Health Care

GAMIFICATION - which would use game mechanics in a non-game context to increase user-engagement at PHCs. This can be done by

• Organizing fair (mela) and plays (nukkadnatak) near the PHCs with a health related theme

• Attaching a badge value to getting a health check up done, like “I did a checkup today” badges or stamps

Organizing movie screenings to spread awareness about health care

Distributing pamphlets and taking up slots on radio

To create a pull factor, we can use

An Illustration of gamification using a simple game Bingo:Sensitize the community on the benefits of regular health checkups and primary careProvide villagers with bingo cardsAsk questions pertaining to preventive measures of healthcareThe Bingo cards would be containing answers to the questions instead of cardinal numbersSeveral declared winners would be required to go to the PHC for collecting goodies

ImpactA Pull factor is created at the PHC, and the villagers can be attracted for a health check up, thereby providing preventive care

4. Improve Hygiene Conditions

The collaborations with Kirana and Medical stores can be used to advertise about improving hygiene and its positive implications

Tie up with schools and colleges to organize programmes and introduce health awareness related subjects.The corporates can also be engaged for performing their CSR activities with the Sarva Swasthya Chakra campaign

The melas and Nukkad Nataks organized can also be used for spreading awareness by having health based themes

Water purifying medicines must be provided for free or at very cheap rates in areas where there is a threat of water borne diseases

Install dustbins at various places in villages to reduce garbage spillage in the area

Pest control at regular intervals at key places like marketplace, panchayat chowks etc.

Providing cash awards/recognition to the cleanest locality/house in the area

FINANCIAL ESTIMATIONS The proposed project is expected to be a PPP. The bulk of the financing would be done by the Govt. and the remaining by the

Private player

Additional funding can also be generated from NGO’s, Individual donations through online or Govt. offices

To attract donations, famous personalities like Filmstars, cricketers, politicians etc. can be invited for various events like fair,

marathons etc.

Cost

Pre - operating cost

Operating Cost

1. Project Coordinator (1/5 time Physician) : Rs. 2,00,000

2. Paramedic/Computer Operator : Rs. 1,75,000

3. Nurse/medical assistant : Rs. 1,50,000

4. Lab Technician : Rs. 1,00,000

5. Transportation : Rs. 50,000

6. Consumables : Rs. 45,000

7. Miscellaneous (promotional and others) : Rs. 5,00,000

Total operating cost per annum per PHC : Rs. 12,20,000

1. Improvements on PHC’s : Rs. 4,00,000

2. Solar Panels and batteries : Rs. 3,00,000

3. Computers and Printers : Rs. 75,000

4. Testing Equipments : Rs. 2,00,000

5. Medical Supplies, Stationery etc. : Rs. 75,000

6. Furniture and Fixtures : Rs. 50,000

Total per PHC : Rs. 11,00,000

IMPACT AND REACH

Potential to cater the needs of 800 Million Indians in rural India

Reduction in Death Rate to 6 deaths / 1000 population

(estimation)

Addition of trained medical staff and doctors

at PHC

Technical competence of the volunteers to do basic

diagnosis

Ancillary Impact: Increased Employment due to

professionals required at PHC’s

Improvement in hygiene conditions: reducing

diseases and pressure on hospitals

Net Reduction in Government spending

Step forward towards the dream of HEALTH FOR ALL

CHALLENGES AND MITIGATIONIMPLEMENTATION RISK

• Project not accepted by the Govt.• Lack of technical Expertise• Lack of capital for the project

SUSTAINABILITY RISK

• Project unable to meet its objectives• PPP not feasible

CHALLENGES

• Project should be attractive for the private players and the Govt.

• Adequate training and Development for staff

• Inadequate availability of resources ( both capital and human resources)

MITIGATION• To develop a self generating model wherein

certain minimal amount of money is taken as “fees”. Collaboration of Central & State Govt. with private players can also play a key role.

• Outsourcing IT Infrastructure, training & development programme to 3rd party vendors.

• Creating awareness and participation at school & college level through summer camps, social service programmes etc.

REFERENCES http://www.giveindia.org/c-56-health.aspx?gclid=CMzkk7Ths7kCFQkF4godBF0ACQ

http://www.hmri.in/where-we-work/maharashtra.html

Document relating to PHC proposal submitted by The George Foundation, written by Abraham George and Rajan Gupta

http://www.healthissuesindia.com/2013/07/01/interview-of-professor-jacob-john/

“PRIMARY HEALTH CARE IN INDIA” by Mr. Somnath Roy, Director, National Institute of Health and Family Welfare, New Mehrauli Road, New Delhi

http://www.it.bton.ac.uk/staff/lp22/cs237/cs237medicalxsys.html

http://archive.ispub.com/journal/the-internet-journal-of-medical-informatics/volume-5-number-2/developing-an-automatic-diagnostic-system-driven-by-consumer-generated-health-care-data.html#sthash.ffCl7gFq.dpbs

http://www.isical.ac.in/~sushmita/paper/fexpsys.pdf

http://www.who.int/bulletin/volumes/86/1/08-010108/en/index.html