2. Current Measures
• Expenditure on health,
3.9% of GDP
• 23,109 Primary Health
Centers catering to 6.5
lakh villages
• Low R&D expenditure, INR
1,150 crore (2011)
Need
• Accessibility
• Availability
• Affordability
• Technology
• Awareness
Healthcare Scenario
• Shortfall of 7,048 PHCs
• 8 beds/10000 people, 6
doctors/10000 people
(lowest in the world)
• No healthcare services to
50% of total villagers
• Shortage of over 60%
specialist doctors in rural
areas
• High MMR & IMR
2nd most
populous
country
70%
population
in rural
areas
27.5 % of
population
below
poverty
line
DEMOGRAPHICS
3. OUR TAKE ON THESE NEEDS!!
Mobile Hospitals
• Accessibility
• Availability
• Affordability
MedTech
• Affordability
• Technology
Interactive Voice Response System
• Technology
• Awareness
Health Campaigns
• Awareness
4. Total Mobile Subscribers in India= 900 million
Rural tele-density of India=40.23
User Calling on a
Toll Free No.
Automated Response Asking
for various symptoms
User Selects the
Symptom Option
Call transfers to a
clinician
Basic Consultation and
registration of disease
Follow up calls and
responses regarding the
Disease
IVRS Steps
Objective of the IVRS
• Disease Management
• Medication Tips
• Consultation on Health
issues
• Post Discharge Follow Up
• Survey
Instruments required at
village level
• Anaemia tester
• BP monitor
• Height and weight
measuring machine
• Blood sugar measuring
instrument
A10
0 B30 C15
D4
For the rural
population of
84 crores and
an average call
time of 3
minutes.
10,000
clinicians
required for
5 hours a
day job
approx.
Recruitment Analysis
For a sample of 100 people:
A – 30% require primary health care a day
B – 50% know about IVRS
C – 25% call as the rest found doctors.
D – Assuming that a person calls once a month.
33.14
62.28
111.63
190.88
273.54
323.27
0
100
200
300
400
2007 2008 2009 2010 2011 2012
Rural Mobile Subscribers
(in millions)
INTERACTIVE VOICE RESPONSE SYSTEM
From “TRIP” (Translating Research Into Practice) To “TPIR” (Translating Practice into Research (and evidence of value and quality)
5. Disease/Health Condition Intervention
Diabetes Weekly IVR messages following from previous checkup.
Pregnancy Daily SMS’s will be sent to the beneficiaries carrying useful IEC messages related to
maternal and child care.
Asthma 2-3 educational IVR calls separated by a month. Follow up support from a specialist nurse
once every two weeks with data collection provided over the phone.
Excessive alcohol use and smoking (a) Daily IVR to report alcohol consumption and other mood, health, and relationship
questions(b) Daily IVR and monthly feedback comparing drinking patterns. (c) 4 IVR
messages including an offer for call back from a smoking counselor
Depression self-help COPE*: A telephone‐based eight week self‐help program for those with mild to moderate
depressions. Uses cognitive‐behavior therapy (constructive thinking); assertive
communication; pleasant activities.
Hypertension Patient education followed by home Blood Pressure monitoring and report to an IVR
system 3-4 times weekly, followed by clinical pharmacist review and follow-up.
Mental health disorders A reciprocal peer‐support support program using a telephone platform.
An IVRS intervention model is proposed for the follow-up of patients diagnosed with one of the
following diseases or health conditions. People may offer to avail one of these services as well.
*Geist.J., Baer, L., Marks, I.,& Osgood‐Hynes,D. (1999) COPE program for depression. HealthCare Technology Systems.
INTERACTIVE VOICE RESPONSE SYSTEM
6. Based on 8 elements of primary healthcare
Education|Local disease control|Expanded immunization program|Mother &Child
health|Essential drugs|Nutrition|Treatment of minor diseases|Safe water supply & sanitation
Implications
1 bed/6798 people compared to 1
bed/450 people in other developing
countries
Less availability & accessibility
leading to high spending
THE SOLUTION !
MOBILE HOSPITALS-including basic facilities such as tents for
use as beds, equipment for detecting & treatment of various
diseases, sterilization, kitchen
MOBILE HOSPITALS
6.15 lakh
villages
• 1,23,563 Beds
• 4,566 Hospitals
• Population of 84 crore
• 32% of rural respondents
have to travel over 5 kms
(radius) to seek OPD
treatment
7. Frequency of van, on an
average of 4
days/village
Average 700-800
people/village
Each van reaches
~30,000 people/month
Example of
Madhya Pradesh
Rural Population-
44,380,750
Currently-1
bed/6796 people
37,552,943
people deprived
of this facility
This corresponds to
~1,200 vans
Requirement-3
specialist doctors(2
OPD+1 female), 6
nurses/ward boys
Net average cost
40 lakhs/van
Total cost 480
crore, ~0.17% of
total allocated
budget in 11th plan
Calculations done on following assumptions-
1) Availability of 1 bed/1000people
2) Doctors on rotation basis by collaboration
with private hospitals
Note- This can be expanded all over the country as per the
available budget which would help increase availability &
accessibility to a greater extent
8. TOUCHb
-40% pregnancy
deaths due to anemia,
affecting over 50% of
rural women
-Non-inavsive
diagnosis of anemia
with TouchHb under
Rs. 5
NEOBREATHE
-5/100 babies born
will not breathe at
birth (asphyxia)
annually
-520,000 die /get
disabled for life every
annually
-NeoBreathe –
effective neonantal
solution, requires
minimal training
3NETHRA
-Only 14000
ophthalmologists
practice in India, only
800 graduate annually
-Ophthalmologist to
patient ratio is 1:60000,
worse in rural areas
-3nethra: single,
portable, intelligent,
non-invasive, non-
mydriatic eye pre-
screening device that
can detect 5 major
ailments
Gluco Track DF-F
-The Gluco Track DF-F
non-invasively monitors
glucose level in blood
Innovation in non-invasive technologies that are affordable
AFFORDABLE & QUALITY CARE DELIVERY
9. Regulatory
Body
• Independent regulatory body for medical devices, device testing standards other than Central
Standard Drug Control Administration presently
Healthcare
Innovation
• Government-aided healthcare research in college programs. Examples include Stanford-India
Biodesign, Healthcare Consortium IIT Bombay
• Funding to healthcare startups from Department of Science and Technology
Non-
invasive +
low cost
Medtech
Eliminates of
need of
skilled
personnel
Suitable for
Screenings
camps
Affordability
Point of Care
application
with
immediate
results
29, 29%
20, 20%
8, 8%
7, 7%
17, 17%
19, 19%
Imports in Healthcare (India)
United States
Germany
China
Japan
Other EU countries
Other countries
Policy & Organizational Solutions
Imports constitute over 75% of the estimated
US$2.75 billion market
Reach of quality care only to urban, privately
operated hospitals
10. No awareness of symptoms and diseases- don’t know what ailment suffering from-leads to indecisiveness with regards
to solution|Most go undetected and then suffer from complications later on| leads to high cost for diagnosis| Basic
reason poor implementation of basic government healthcare facilities|We are focusing on model of ASHA and
improvements required to make it function properly|Re-examine responsibilities of ASHAs to streamline responsibilities
and maximize benefit .
Recruitment
• Insure community
involvement
• Ensure about awareness
of roles and
responsibilities
• Ensure enough no. of
ASHA for each village
Training
Induction training should be
decentralized to district
level
Provide ASHA with pictorial
job aids for each topic.
Revamp training for use of
medical kits
Implement ASHA radio an
innovation seen in Assam in
all states.
Incentives
• Provide them timely
compensation
• Consider providing
mobile ph. To increase
accessibility
• Increase compensation -
travel related expense
• Give incentives to
increase motivation
Supervision /Monitoring
• Assign supervisor for
monitoring of ASHA
Performance.
• Institute a formal review
process every six months
so that ASHA
performance is
monitored and tracked.
IMPARTING HEALTH EDUCATION
11. Hygiene
behaviour
Relevant features, behaviour and activities
Sanitation,
excreta
disposal
i. Location of defecation sites
ii. Latrine maintenance (structure and
cleanliness)
iii. Disposal of children’s faeces.
iv. Hand washing at the “critical times” times
v. Uses of cleaning materials
Water :
Sources
and Uses
i. Protection of water source
ii. Maintenance of water source.
v. Water collection methods and utensils.
vi. Water treatment at the source.
vii. Methods of transporting water
viii. Water handling in the home
ix. Water storage and treatment in the home
xi. Hand washing at “critical” times
xii. Washing children’s faeces
Xiii. Bathing (children & adults)
ix. Washing clothes
Food
(food
hygiene)
i. Food handling/ preparation
ii. Utensils used for cooking, serving food,
feeding your children, and for storing
leftover food.
iii. Hand washing at “critical “ times (before
handling food, eating, feeding young
children)
iv. Reheating of stored food before serving
v. Washing utensils
Environment
(Domestic and
environmental
hygiene)
i. Sweeping of floors and compounds
ii. Households-refuse disposal
iii. Cleanliness of food paths and roads
iv. Management of domestic animals (cattle,
dogs, pigs, and chicken)
According to the Census of 2001,
• Only 21.9 percent of the rural population in India had access to latrines
• UNICEF (2011) in a report mentions only 21 percent of rural and 54
percent of urban population of India having sanitation facilities
Which methods of awareness should be used to make people aware about
sanitations in rural areas?
18-22 years 23-27 years 28-35 years Above 35
Street play Male 25 25 5 1
Female 9 17 3 9
Public lectures Male 5 5 2 12
Female 4 16 0 20
Rally Male 5 2 3 10
Female 9 8 1 18
Pamphlet Male 2 0 2
Female 0 4 4
Based on the above study and a requirement for awareness to
improve primary healthcare across rural India, an awareness
information, education and communication program is suggested
beside.
HEALTH AWARENESS DRIVES
12. Wakar Amin et. Al, Effective awareness generation methods for
rural sanitation campaign: A study from a village in Haryana
Deloitte-CII, Medical technology industry in India
Androwich et. Al, Use of Interactive Voice Response Technology in Health
Care.
Implementing health care Reform policies in China- Charles W. Freeman
National Rural Health Mission- State wise Information
WHO- India Health Profile 2011
Stanford University mhealth reports- Mobile health without borders
REFERENCES
