The document proposes a proof-of-concept and pilot program for an integrated women and child health program using a community outreach model in Gajwel constituency, Hyderabad. The program would address critical gaps in healthcare access and services through three dimensions: 1) segmentation of populations to reach socially and economically vulnerable groups, 2) redefining intervention areas and care services, and 3) a care services continuum of screening, identification, referral, enablement and follow-up. The pilot would focus on women aged 15+, children aged 5-15, pregnant women, and newborns, providing services across primary care, reproductive health, eye care, oral health and more. It would employ community health workers and leverage ICT platforms

1. Integrated women and child health
programme: A community out
reach model
Overview of Proposal for POC and
Pilot at Gajwel constituency
Hyderabad, September 2014
For discussion purposes only

2. 1
Agenda
2.0 The context and objectives: POC and pilot for Gajwel constituency
3.0 The concept
2.1 Healthcare performance in Gajwel constituency
2.2 Critical gaps and potential services
4.0 Operationalization of the model
5.0 Project implementation and monitoring
6.0 Key outcomes of the POC and Pilot project
2.3 Potential services, components and beneficiary segments
3.1 Field activity plan
3.2 Service areas and execution map
3.3 Resource requirement
4.1 Timelines, action plan
4.2 Project Monitoring committee
7.0 Support from the Government of Telangana
1.0 Introduction
Contents of Detailed
presentation submitted
as a concept note for
approval by the State
Health Ministry - TS

3. 2
Opinion of
community
experts
Discussion
with key
stakeholders
Piramal HMRI
Research
Field Visits
Opinion of
internal
medical experts
Aug 11
2014
3 Shortlisted
themes
We Are
Here
6 Potential
themes
Potential healthcare pilot at Gajwel
Assessment of
potential
interventions
Today
The context: We have had iterative discussions with varied
stakeholders to arrive at potential healthcare concept for Gajwel
1. Women health
2. Infant and child health
3. Maternal care
4. Chronic condition screening
5. School health programme –JBAR CHIP
6. Drinking water

4. 3
In 66.67% of villages, Garbage is thrown in the vicinity of households: Sanitation issues
More than 95% of the people have to travel 5 KMs+ to reach a Public
Health Facility
Out of the above 95%, only 50% of the people have access to Public Transport
Qualified doctors are available in only 11.11% villages
Absence of JSSK 102 service and helpline prompts for dependence on 108 for transport of
pregnant women and sick new born
The context: Field survey & key observations

5. 4
The concept:
Integrated women and child health
programme through community outreach
model

6. 5
Healthcare reach Limitations of care reach (Secondary research)
 ~ 97% of pregnant women received
3 ANC check ups during pregnancy1
 Institutional delivery is ~ 77%2
 Functional 104, School Health CHIP
programmes
 Functional 9 PHCs, one CHC
 Only ~ 25% of the population has
access to specialist care4
 75% of the population need to
commute an average of 25 KMs to
access specialty care5
 Limited Specialist level screening to
identify high risk maternal cases
Source(s)
1,2 – NRHM MIS Standard reports – Maternal and child health Updated till 15 Sep 2014
4,5 – Field survey of Piramal HMRI
The healthcare performance on key indicators at Gajwel constituency
meets certain Indian health standards…..

7. 6
Current
Healthcare
Penetration
Population
reach
Condition
reach
• Socially excluded sections
• Economic vulnerable sections
• Demographic vulnerable
• Physical vulnerability
S
I
R
E
F
Screening
Identification
Referral
Enable
Follow up
• Gender based
• Age related
• Community based
• Endemic
• Acute & Chronic
… but saturation of healthcare at the last mile is only possible through
a three dimensional approach

8. 7
D
• SC,ST populations constitute ~19% of total population1 (18.58% SC; 1.36% ST)
• ~ 120 habitations of SC, ST communities2
• 95 is the number of households per habitation vis-a- vis the average of 472 for other communities3
• 535 population per habitat vis-à-vis 2112 population per habitat of other communities4
• High prevalence of school drop out (5-15 years range); as high as 50.43%5 among SC and
79.41%6 among ST
Demographics: SC, ST sections in Gajwel constituency
Key implications for healthcare models
Dimension -1: Segmentation of population highlights gaps of current
healthcare reach
• The SC, ST community population is highly fragmented and scattered
• Reach of traditional channels for healthcare delivery likely to have limitations
• The current design of Public health programmes (104, School CHIP under JBAR) experience
limitations to address the needs of diverse segments
Source(s)
1. Census 2011
2,3,4 http://indiawater.gov.in/IMISReports/Reports/BasicInformation/rpt_RWS_AbstractData_S.aspx?Rep=0&RP=Y&APP=IMIS
5,6. Source: DiSE data 2012-13(As on Sept-2012)

9. 8
Screening Identification Referral Enable Follow Up Closure
Gender based
care initiatives
(15+ years age)
Child health
(5-15 years)
Maternal care
Newborn care
Care Services Continuum
PotentialAreaofintervention
Dimensions 2,3: Redefine the areas of intervention and care services
to asses the gaps of healthcare execution
Areas of improvementAreas doing well Proposed areas of intervention from Piramal HMRI

10. 9
Beneficiary segment Segment scope
Overview of the
services
Potential number of beneficiaries
15 years+
75
(Especially SC, ST
adolescent girls &
women)
1. Health
awareness
2. Screening &
identification
3. Referral
4. Follow up
~ 26,000 women (SC,ST communities 15+
years)1
Programme @ Gajwel constituency
5-15 years
(Essentially school
drop pouts)
1. Screening &
identification
2. Referral
• ~ 9,000 school drop outs (SC, ST
communities)4
Programme @ Gajwel constituency
Pregnant women
for deliveries
Newborn check up
(Sick infants 0-30
days)
JSSK 102
Programme
• 6,024 women expected
pregnancies3
• 5,422 expected neonates4
Programme @ Gajwel, Siddipet,
Zaheerabad AH/CHNC jurisdiction
(Estimates in a year under the areas covered by
CHC/AHC @ Gajwel, Siddipet & Zaheerabad)
Women
Care
Children
The 3 dimensional analysis suggests the following beneficiary
segments and service areas of priority
1. Census 2011; 2. DISE data 2012-13(as on 30th Sept-2012); 3,4. CHFW, Govt of AP, 2013-14.
Pregnant
women &
newborn

11. 10
Women
Care
(15 years+)
• Pyoderma
• Scabies
• Ringworm
• Leprosy
• Eczema
• Pediculosis
• Xerophthalmia
• Bitot spots
• Conjunctivitis
• Refractive errors
• Squint
• Night blindness
• Cataract
• Reproductive tract
infections - screening
• Sexually Transmitted
Infections – screening
• Contraception
• ANC & PNC
• Pre Menopausal syndrome
• Unwanted pregnancies
• Senile vaginitis
• Uterine prolapse
Eye
Reproductive
& sexual health
Skin
Overview of service areas for women care segment at Gajwel
constituency
• Malnutrition, Anemia
• Hypertension
• Diabetes
• Breast cancer,
malignancy screening
• COPD
• Osteoporosis &
rheumatoid arthritis
• Hyper/hypo thyrodism
Primary
conditions
• Tonsillitis
• Ear infections
• Defective Hearing
• Otitis media
• Deafness
ENT
• Dental Caries
• Oral Ulcers
• Glossitis
• Cheilitis
• Angular Stomatitis
• Pyorrhoea
Oral

12. 11
Children
(5-15 years)
• Pyoderma
• Scabies
• Ringworm
• Leprosy
• Eczema
• Pediculosis
• Xerophthalmia
• Bitot spots
• Conjunctivitis
• Refractive errors
• Squint
• Congenital anomalies
• Night blindness
• Dental Caries
• Oral Ulcers
• Glossitis
• Chelitis
• Angular Stomatitis
• Cleft Lip & Palate
• Pyorrhoea/Periodontitis
• Tonsillitis
• Defective Hearing
• Ear infections
• Speech defects
• Otitis media
• Congenital Deafness
Oral ENT
EyeSkin
Overview of service areas for child care segment at Gajwel
constituency
• Anemia
• Malnutrition
Other medical
conditions

13. 12
• Free referral pick up and drop for pregnant women
• Safe transport for sick newborn (up to 30 days)
• Referral transport to higher care institutions per case is basis
• Timely reach to hospital/home
• Mitigate risk due to delayed transportation
• Encouragement of institutional delivery
• Referral transportation in hygienic environment
• Improved care access during pregnancy for deliveries
• Increase in institutional deliveries
• Assurance of neo natal care access (30 days from day of birth)
The concept
The benefit
Potential impact
Project area
• Siddipet Mandal (Area Hospital area only)
• Zaheerabad Mandal (Area Hospital area only)
• Gajwel Mandal (Under CHNC area only)
JSSK 102 concept to aid referral transport for the pregnant women
delivery and check ups for sick new born: An overview
Pregnant
women
Sick
New born
(0-30 days)

14. 13
The plan proposes to implement the pilot programmes at 5 locations
across Medak district
Medak district: Proposed areas of pilot implementation
Siddipet
Gajwel
Jagdevpur
• JSSK 102
Zaheerabad
• SC, ST Women care
• Children care (5-15 years)
• JSSK 102
• JSSK 102
• SC, ST Women care
• Children care (5-15 years)Toopran
• SC, ST Women care
• Children care (5-15 years)

15. 14
Community
Door to
door
Women
Children
Pregnant
women
Monitoring and
coordination platforms
ICT Platforms Service tracking cell
Tertiary care
Facility/TMC
CHC
Diagnosis
facility
The project to employ an outreach model with a centralized
monitoring leveraging ICT platforms
JSSK 102
GNM
PHC
Medical
Practitioner

16. 15
Kondapak
Jagdevpur
Gajwel
Wargal
Mulugu
Toopran
Field operations & monitoring
• Gajwel block accounts for 23% of SC,ST
women
• ‘Complete and move to next’ model;
programme to commence at Gajwel block
• Gajwel is divided in to 4 sub regions
• 7 teams to be deployed in total
• 4 GNM per each team and a doctor on
case is basis
• Gajwel to act as a local monitoring office
• Ahmedipur PHC to be connected to
Hyderabad for Telemedicine
SC,ST population concentration Community to PHC
PHC at Ahmedipur
Operationalization of Women and child care programme
Block map of Gajwel constituency

17. 16
A case in point: Project Shruthi to address preventable hearing
disability
POC in partnership with Medtronic at Hyderabad
Decreased cognition & learning
Decreased life & social skills
Social exclusion
Exclusion from livelihood
Economic dis-advantage
Social exclusion
Decreased family interaction
Increased dependency –
low self-dignity
Social exclusion
Hearing Disability… An Unseen Burden
Create and manage a self-
sustaining ecosystem for
awareness, diagnosis,
treatment and rehabilitation
of ear diseases in
underserved patients in
developing countries

18. 17
Awareness, Screening, Diagnosis, Counseling, Facilitation, Treatment , Follow-upIntervention:
Medtronic Shruti – HMRI Hyderabad Proof of concept
Intervention across care continuum leveraging pioneer
MICT platforms*
*Medical Internet Communication Technologies

19. 18
Medtronic Shruti – HMRI Hyderabad Proof of concept
Project areas and impact
• Vulnerable population in Hyderabad
(population at slums, below poverty line etc.)
• 70,000 population – Target coverage
• Universal door-to-door screening
• Beneficiaries - All age group and gender
Project area: 6 communities in GHMC
Project reach
Project outcomes (As on date)
• 30,000 population screened
• 6,000 with ear problems identified
• 2,000 with critical ear issues identified
• 500 patients registered for treatment at ENT
• Developed extended care @ 3 Charity
hospitals

20. 19
Piramal Swasthya is a registered non-profit organization based in Hyderabad, Telangana State. Piramal Swasthya is supported by Piramal
Foundation and works towards making healthcare accessible, affordable and available to all segments of the population, especially those most
vulnerable. In order to achieve this goal, Swasthya leverages cutting edge information and communication technologies to cut costs without
compromising quality as well as public-private partnerships to scale its solutions throughout India and beyond.
Swasthya envisions a future in which all vulnerable groups have the necessary information to make informed decisions regarding their health
and affordable, available and accessible high quality health infrastructure to support the realization of those decisions.
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