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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’

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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

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• 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

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• 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


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