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  • 1. Healing Touch: Universalizing access to quality primary healthcare HealthonWheels:MobiHeal Team Vincent Indian Institute of Technology Kharagpur Gaurav Rungta Keshav Pratap Singh Sunit Kumar Swain Ahmad Faraz Anirban Majumdar सर्वे सन्तु निरामयााः । ‘Let all be free from illness’
  • 2. 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 Center First 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 : 4809 Population / CHC : 1,73,235 Primary Health Center(PHC) Number of PHC : 23887 Population / PHC : 34,876 Sub Center Number of Sub Centers : 148124 Population / 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 1
  • 3. 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 health resources are concentrated in urban areas where 27% of the population live • Only 10 % of the health budget allocated for rural areas • 70% of families spend 60% of their annual income on health • 93% of the amount spent on primary healthcare is on curative and emergency care • Almost 80% of Indian states are lagging behind in terms of primary healthcare infrastructure and skilled workforce 2
  • 4. Problems Currently Faced In Primary Health Care ProblemScenario Solution Structure Impacts • Rural Areas face a scarcity of Emergency Medical services for common medical contingencies like snake bites, pesticide poisoning, mechanical accidents etc. • Inadequate number of Primary Health Centers [PHCs] and Sub Centers compared to the number required for proper delivery of medical services At present a PHC is supposed to cater to the medical needs of 24 villages with an average cumulative population of approximately 35,000 • Lack of connectivity and inadequate transport facilities add to the difficulties to the rural residents A rural patient on an average would require to travel more than 6 kilometers to reach the nearest Primary Health 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 Healthcare System 3
  • 5. 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 4
  • 6. Services •The need: Presently there is no proper ambulance facilities in villages. Patients in emergency situations have no proper means of transport to reach the nearest CHC which is located on average 15 km away. •The Impact: Due to availability of the ambulance at sub-Center level, the travelling time to reach the patient reduces by a large amount. Availability of life support will be vital for patients health before he reaches CHC. Emergency service: In case of emergency situations which require immediate medical attention, these life support equipped ambulances will take the patient 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 it is too late before they get proper medical attention. •Impact: Through MobiHeal for the first time in history of India, medical facility will be available at village level. Now the villagers don’t need to travel to get medical 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 and will cover the 12 villages over 3 days. MobiHeal clinic will set itself up for 2 hours at each village at a scheduled time and will be coming back to the same village every 3rd day. SolutionProblemScenario Structure Impacts 5
  • 7. Awareness The personal on the unit will organize camps on various topics like sanitation, AIDS, birth control etc. Infant immunization Vaccines 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 birth After delivery care for both mother and child. Birth Control Program Subsidised 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 6
  • 8. 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 Funding Social 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 7
  • 9. 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 offices will coordinate with their respective CHCs and work for smooth functioning of the organisation. • 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 8
  • 10. • 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 lakhs Miscellaneous Charges: Emergency medical inventory 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
  • 11. • Each CHC will cater primary medical facility to about 25 villages under them with greater efficiency serving approximately 170,000 people. • The availability of staff per person will increase. Also the staff will be present at their doorstep to fulfill their medical needs. • The better utilization and reach of primary healthcare funds to the grass root level through the proposed model. • The emergency situations occurring in remote areas will be tackled in a better way and in less time due to the fall in travelling time. • The proposed model will increase the exposure of people with the medical staff thereby improving the quality of health. • The major healthcare issues like the pregnancy, child immunization , birth control, epidemic diseases, etc. will be handled in a better and professional way by reaching up to the affected patient. • Regular checkup and camps will instill a sense of healthcare awareness 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
  • 12. • 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