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Healing Touch: Universalizing access to quality primary healthcare
Health on Wheels : MobiHeal
Team VincentIndian Institute of Technology Kharagpur
Gaurav Rungta Keshav Pratap SinghSunit Kumar Swain Ahmad FarazAnirban Majumdar
सरे्व सन्तु निरामयााः ।‘Let all be free from illness’
Rural Healthcare System In India
1 CHC
4 PHC
24 Sub
Center
Community Health Center(CHC)A 30 bed Hospital/Referral Unit for 4 PHCs
with specialized services
Primary Health Center(PHC)A Referral Unit for 6 Sub Centers 4-6 bed
manned with a Medical Officer In-charge and 14 subordinate paramedical staff
Sub CenterFirst point of contact between PHC and
patient manned with one Health Worker(F)/Auxiliary Nurse Midwife & one
Health Worker (M)
Community Health Center(CHC)Number of CHC : 4809Population / CHC : 1,73,235
Primary Health Center(PHC)Number of PHC : 23887Population / PHC : 34,876
Sub CenterNumber of Sub Centers : 148124Population / Sub Center : 5,624
Avg. Rural Area (sq. km) Avg. Radial Distance (km) Avg. number of Villages
Sub Center 21.05 2.59 4
PHC 130.54 6.44 24
CHC 648.43 14.36 133
As can be observed from the data in Table 1, the distance required to be traversed by the rural population to reach a medical facility is too high considering the lack of proper means of transport.
Table 1
India has a three tier system for providing quality health care to it’s rural population
Scenario Problem Solution Structure Impacts
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Rural Healthcare System In India
Scenario Problem Solution Structure Impacts
Fig 1 : Shortfall in number of ANM at Sub Center and Primary Health Centre
Fig 2 : Average rural population covered by a sub center
• About 75% of health infrastructure,medical man power and other healthresources are concentrated in urbanareas where 27% of the population live
• Only 10 % of the health budget allocatedfor rural areas
• 70% of families spend 60% of theirannual income on health
• 93% of the amount spent on primaryhealthcare is on curative and emergencycare
• Almost 80% of Indian states are laggingbehind in terms of primary healthcareinfrastructure and skilled workforce
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Problems Currently Faced In Primary Health Care
ProblemScenario Solution Structure Impacts
• Rural Areas face a scarcity of Emergency Medical services for common medical contingencies likesnake bites, pesticide poisoning, mechanical accidents etc.
• Inadequate number of Primary Health Centers [PHCs] and Sub Centers compared to the numberrequired for proper delivery of medical services
At present a PHC is supposed to cater to the medical needs of 24 villages with an average cumulativepopulation of approximately 35,000
• Lack of connectivity and inadequate transport facilities add to the difficulties to the rural residentsA rural patient on an average would require to travel more than 6 kilometers to reach the nearest PrimaryHealth Center
• Lack of skilled manpower in Primary Health Centers
A Sub Center is manned with 2 Health workers for an approximate population of more than 5000 people
• The rural health problems can attributed also to lack of health literature and health consciousness,poor maternal and child health services.
• The availability of drugs in PHC, Sub Centres remains a major concern for the Primary HealthcareSystem
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Proposed Solution
We plan to introduce a unique ‘Mobile Health Unit’ called “MobiHeal” per 3 subcentres. Therefore each MobiHeal will cover on average 12 villages spread over an area of 42 sq. KM.
What is ‘MobiHeal’ ?• MobiHeal is a ‘mobile health unit’ cum ‘ambulance’.• A motorized vehicle with sophisticated life support system for emergency situations which can be used by a trained ANM
as a moving clinic on daily basis.• A single solution to cater the most two important health problems of rural India – lack of emergency services and
presence of medical clinic at root level.
Apart from life support, proper medicine inventory will be managed in MobiHeal, also sample collections for tests etc can be done in it as well.
Staff requirements for MobiHeal: • One trained ANM/HW who can apart from giving basic prescriptions to the villagers can operate the life support system
in emergencies. • Two drivers: These two drivers will be working on shift to be available 24X7 on beat.
SolutionProblemScenario Structure Impacts
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Services
• The need: Presently there is no proper ambulance facilities in villages. Patients inemergency situations have no proper means of transport to reach the nearestCHC which is located on average 15 km away.
• The Impact: Due to availability of the ambulance at sub-Center level, thetravelling time to reach the patient reduces by a large amount. Availability of lifesupport will be vital for patients health before he reaches CHC.
Emergency service:
In case of emergency situations which requireimmediate medical attention, these lifesupport equipped ambulances will take thepatient to the nearest CHC directly.
• The need: Due to lack of proper modes of transportation, it is difficult for villagers(especially women and children) to go to nearest medical unit. Therefore often itis too late before they get proper medical attention.
• Impact: Through MobiHeal for the first time in history of India, medical facilitywill be available at village level. Now the villagers don’t need to travel to getmedical services, but the services are themselves coming at their door regularly.This will provide solution for diseases often neglected among the people as well.
Daily usability:
Bringing the PHC facilities to root level –MobiHeal will be used as a moving clinic andwill cover the 12 villages over 3 days.MobiHeal clinic will set itself up for 2 hours ateach village at a scheduled time and will becoming back to the same village every 3rd day.
SolutionProblemScenario Structure Impacts
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AwarenessThe personal on the unit will organize campson various topics like sanitation, AIDS, birthcontrol etc.
Infant immunizationVaccines will be available on the unit.Periodic checkups of infants and children prone to various diseases.
Pregnancy and related care Medical care for pregnancy and child birthAfter delivery care for both mother and child.
Birth Control ProgramSubsidised sterilization surgeries such as vasectomy and tubectomy.The facility will be available on the unit itself when the surgeon would visit the villages on decided dates.
Anti-epidemic programs• Act as the primary epidemic diagnostic and control
centers for the rural India.- They will identify suspected cases and refer for further
treatment.
Auxiliary Functions
The mobile unit will undertake the following additional services as well:
SolutionProblemScenario Structure Impacts
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Proposed Funding
Government Sponsored
- The government includes the program in it’s budget for primary health care.
- It sets up the centers at state and local levels and pays for the setup and operating costs.
Private sponsored
- Money is raised from private parties and philanthropists.
- The scheme is implemented by independent organizations or NGOs.
- Maintenance of the machinery can be done through insurance premiums using the concept of microfinance.
Project FundingSocial Impact Bonds-The money is raised from private parties and the results are monitored by the outcome funder.- As per results, the government pays the private investors with returns. If the project fails to deliver, it is not liable for any payment.- Work similar to the girl education bond created in Rajasthan.
Corporate Social Responsibility- With the new ‘Companies Bill’, the CSR money can be directed
towards this scheme from the companies.- Can include a portion of the CSR as return (say 7-8%) by the
government on successful completion of the project.- Creates a monetary incentive for the companies and the
government spends only a fraction that too only on successful projects.
Funding for the project can be arranged from different sources both public and private
StructureProblemScenario Solution Impacts
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State Head Office
Regional OfficesTechnical & Maintenance
Central Toll Free Helpline
Training Center Financial Division
Awareness CampsQuality ControlMobile units at Sub center level
• Responsible for training and recruitment of the employees
• Imparting skills which help in providing regular treatment as well as tackle emergency situation
• Proper maintenance of MobiHeal units and medical instruments
• Providing technical support to the whole organisation.
• Regional officeswill coordinate withtheir respective CHCsand work for smoothfunctioning of theorganisation.
• Toll free state helpline to provide quick response to emergencies.
• Manage the funds flow
• To audit the finances of the organisation
• Monitoring and eradicating the flaws of the system.
• Organizing camps with volunteer support
Proposed Organization Structure
StructureProblemScenario Solution Impacts
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• If we consider the cost of implementing the MobiHeal model over average area covered by CHC i.e. ~650 sq. km.
Fixed Cost: One Time Cost
Per CHC 8 MobiHeal units are required 25*8 lakhs Rs. 2 Crore
Variable Cost: Annual budget required
Staff: Drivers' Salary (Two Drivers per MobiHeal) Rs 5000 per driver/month Rs 9.6 lakhs
Skilled Medical Practitioner Rs 12000/month Rs 11.5 lakhs
Fuel Charges: Estimated fuel cost annually Rs 10 lakhsMiscellaneous Charges: Emergency medicalinventory Rs 3 lakhs
Maintenance of instruments & MobiHeal Rs 16 lakhs
Total Variable Cost Rs 50.1 lakhs
If its a private funded scheme, the annual variable cost can be covered by charging a nominal premium of (50.1 lakhs/1.72 lakhs) ~ Rs 2.5 per person per month, thereby establishing a self sustaining model.
StructureProblemScenario Solution Impacts
Cost Analysis 9
• Each CHC will cater primary medical facility to about 25villages under them with greater efficiency servingapproximately 170,000 people.
• The availability of staff per person will increase. Also the staffwill be present at their doorstep to fulfill their medical needs.
• The better utilization and reach of primary healthcare fundsto the grass root level through the proposed model.
• The emergency situations occurring in remote areas will betackled in a better way and in less time due to the fall intravelling time.
• The proposed model will increase the exposure of peoplewith the medical staff thereby improving the quality ofhealth.
• The major healthcare issues like the pregnancy, childimmunization , birth control, epidemic diseases, etc. will behandled in a better and professional way by reaching up tothe affected patient.
• Regular checkup and camps will instill a sense of healthcareawareness among the people of villages.
• Convincing the government/private bodies about
the feasibility of the project.
• Villagers may be skeptical to such a service and
creating trust among the people.
• Imparting skills to the people can be time taking
and may not produce desired result.
• Proper maintenance and inventory management of local storage centres.
• Ensuring that the ambulance and the toll free number at always in a working condition.
• Optimizing the travel route of the ambulance and the grouping of the villages.
Impacts
Challenges
ImpactsProblemScenario Solution Structure
Impacts and Challenges 10
• Bulletin on Rural Health Statistics in India (2005), Infrastructure Division, Department of Family Welfare; Ministry of Health & Family Welfare, Government of India.
• Calculation data taken from www.data.gov.in
• CURRENT HEALTH SCENARIO IN RURAL INDIA, Ashok Vikhe Patil, K. V. Somasundaram and R. C. Goyal; International Association of Agricultural Medicine and Rural Health and Department of Community Medicine, Rural Medical College of Pravara Medical Trust, Maharashtra, India.
• Indian Public Health Standards (IPHS) - Guidelines for Primary Health Centres Revised 2012. Directorate General of Health Services , Ministry of Health & Family Welfare, Government of India.
• National Rural Health Mission 2005–2012 –Reference Material (2005), Ministry of Health & Family Welfare, GOI.
References