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  1. 1. SwasthSevak Yojana Team Anamya: Aditya Shrivastava Akshay Malhotra Apurv Swarup Joseph Sebastian Yeshwanth Reddy Healing Touch Universalizing access to quality primary healthcare
  2. 2. The Current Rural Health Problem : India Average distance traversed to reach a hospital by a rural Indian 70%40% 20% 700 Million people do not have access to primary healthcare Rural India has : Less than 20% of the population looking for healthcare ends up finding suitable facilities 2.3 million deaths a year due to avoidable diseases 40% Doctor Absentee Rate in PHCs Low Per Capita (US $) Govt. Expenditure on Healthcare
  3. 3. The SwasthSevak model is an initiative to reduce the deaths and harm caused by avoidable disease by enabling early and easy diagnosis delivered to the last mile. Viability  Relatively variable and setup costs  Potential to leverage economies of scale  Low operational costs  Revenue could cover operational costs  Beneficial to all stakeholders Sustainability  Availability of Enabling Technology  Existing schemes  NRHM  RSBY Concerns with Building a model Key Causes  Lack of Accessibility to healthcare for the rural populace  Lack of medical and diagnostic infrastructure  Unwillingness of doctors to travel to rural areas  Inability of government schemes to cover the last mile Scalability
  4. 4. Doctors in Remote location Infrastructure Provider Mobile Health Units ` Patients & ASHA worker SwasthSevak Model
  5. 5.  Doctors can be stationed at urban centers and still treat patients in rural areas  Removal of physical travel to remote locations eliminates inefficiencies  Can attract a wider pool of doctors including recent graduates and volunteers.  Student participation Doctors  SwasthSevaks are trained personnel They travel to the village where there is a requirement and delivers the service  They carry outt the diagnostic tests and coordinate with the doctor  Mobile technology enabled treatment delivery services Delivery Infrastructure  Can now avail of primary healthcare at their door step  Reduction in cost of healthcare due to elimination of transportation costs and costs late diagnosis  Better labor productivity due to lower incidence of diseases Rural Poor SwasthSevak Model
  6. 6. Enabling Infrastructure  Mobile device for connectivity  Economical Diagnostic technology like ReMeDi is available in the market for transmitting basic diagnostic result to remote doctor.  Lab in suitcase  Medicines  Power back-up/ Inverter  GPS  Camera/ recorder to transmit diagnosis Vehicle with mobile diagnostic equipment  Receive request for diagnosis from Asha Worker  Transmit the request to the mobile van responsible for that village  Monitor the total distance covered by the van, monitor the total trips to each village, verify the requests received and cases attended.  Maintain the inventory details of medicines in each van and instruct the replenish the stock to maintain minimum inventory  NRHM • Increased spending on health care from 0.9% of GDP to 2-3% of GDP • Decentralization of Healthcare services and impetus on correcting the deficiencies in the health care system. • Insured of sum Rs 30,000 per BPL family • Cashless coverage of health services, provision of Smart card for transactions  RSBY Enabling Government schemes Centralized Control Room
  7. 7. Operation Flow All the villagers shall report any health problems every morning by 9am. Emergency cases are exempted from this, in that case the distress signal shall immediately be transmitted to the control room. The control room compiles all the requests and provides the itinerary for the mobile van based on seriousness of the issues and operational efficiency. Aim : To integrate primary and secondary health care for pro-active prevention of diseases Significant improvement from present health systems only providing treatment after the diseases are detected. This will logically lead to reduction in tertiary health care requirements. Strategy and Measurement Flow Asha Worker compiles and sends the list of patients and seriousness of illness every morning before 9 am to the Control room. 1 Control room compiles requests for each mobile van and provides them with a daily itinerary. 2 Mobile Van confirms requests. 3 Control Room prioritizes on the basis of requests received and level of severity. It provides its itinerary to the Asha Worker to make the patients available. An automated system generates the most optimum route to serve maximum possible patients. 4 Mobile Van attends to the patients in a village. 5 Diagnosis reports are sent to the doctor on duty in the District Hospital. 6 Based on symptoms, the doctor responds with the required treatment and medication. 7
  8. 8. Organization Structure National Level Existing New • Mission Steering Group • PM, Ministry of Health • Leverage Rashtriya Swasth Bima Yojna State Level • State- Health Mission • Headed by CM, Co chaired by Health Minister • State Secretary for Managing Operations Control Room • Directing operations of Mobile units • Point of contact for ASHA workers Cloud Infrastructure • Sourcing & Monitoring of Doctors • Quality control of prescriptions District Level • District Health Mission • Managed by District Magistrate's Office • Representative from department of Health & Rural Development Seva Van Control Unit •Managing day to day operations Social Audit Groups • Seva Van Control Unit
  9. 9. Estimated Cumulative Expenses INR Annual Variable Costs District Level Variable Expenses/Year 717,600,000 State level variable expenses 117,000,000 834,600,000 Fixed Costs District Level Fixed Costs 483,000,000 IT infrastructure 100,000,000 583,000,000 Estimated annual variable expenditure of 84 crores and initial setup cost 58 crores to be depreciated through five year • Rs 50 to be collected through the OPD allocation of the RSBY scheme for rural Individuals • Cashless transaction limits risk of pilferage and rent seeking behavior Major Cost Heads INR Vehicle 450,000 Mobile Device 10,000 ReMeDi 50,000 Lab in a suitcase 350,000 IT infrastructure 5,000 Revenue Model
  10. 10.  If the scheme is successfully penetrated into the entire rural population, has the potential of preventing three deaths per 100 people treated, an estimated total of 5 lakh people a year.  Restricts escalation of preventable diseases through early diagnosis, thereby reducing the healthcare spending for the government.  Frees up infrastructure for secondary and tertiary care, will result in increase in quality of health care provided at the district hospitals.  Enables efficient utilization of critical scarce resources, e.g.: doctors through crowd sourcing.  Social audit shall ensure decentralization and empowers the local communities to ensure their own health care delivery.  Can potentially provide quality primary health care to the tribal and extremist affected areas if implemented through NGO’s which face little resistance from the extremists and are already working on various schemes.  Leverages the existing health care system to achieve universal health coverage with minimal addition to administrative complexity. Key Advantages
  11. 11. • Pilferage of Medication • Unauthorized Diagnosis • Profiteering by the SwasthSevak • Integrated Inventory management • Social Audit • Cashless Transfer • GPS Monitoring • Infrastructure (Roads, IT etc) • Availability of labor force (SwasthSevaks) : (Adequate number of male and female staff) • Willingness of patients to accept this model Risks Challenges Checks & Balances
  12. 12. References    