In my earlier life, while working as an IT engineer/consultant, I
had a chance to work on a unique project commissioned by Kerala Tax
department. The state’s vision of a more transparent process that
yielded better results was a wonderful testimony to what IT can do,
provided one has the vision for it.
Last week, I had an opportunity to observe another such visionary initiative in the Indian state of Andhra Pradesh: HMRI. I visited a village to see the operations in person, and then had a subsequent chat with the management folks at HMRI.
So
what is HMRI and what makes this project unique? To set the context, I
have to explain the state of healthcare in India, and rural healthcare
in particular. I am going to talk about the facts as I got them.
So
consider this: We have a population of about 1.1 billion. Assuming 4
visits to a doctor per annum we generate a demand of 4.4 billion a
year. How many of this can be catered to? At an estimate (HMRI
figures), only about 0.5-0.6 billion is catered to by the public
healthcare, another 1.0-1.1 billion by the private sector. So, there
are between 2.8-3.1 billion who are treated by unqualified
practitioners, or not treated at all.
While I wrap my head
around these staggering numbers, I also ponder on the why. Of course,
in many regions/states in India, it is the general apathy and
corruption in the public sector. This coupled with the lack of the
right incentives for health care personnel to go to the villages,
should explain some of these stats.
Then how are we to
achieve universal healthcare? Aha, that is where HMRI steps into the
picture. The central idea is based on factual observations about the
healthcare demand cycle. A majority of the visits to healthcare
professionals are routine ‘reassurance’ visits that can be catered to
by registered trained nurses, a few need the attention of a qualified
doctor, and a very few are emergencies. So, HMRI was initiated. It has
two central lines of operation: A toll free hotline (104), and a
contingent of mobile vans.
I observed both the operations at
first hand. First the village where the van was stationed for the day.
It was indeed very interesting to see the villagers being taken care of
– registration (state of the art, using biometric software), initial
height and weight check up, then BP then other tests if so needed, and
even a pharmacy counter. The efficiency of the whole operation was
astounding! And it is free! A van rounds up a village once a month, and
for up to 8 hours for a population of 8K. This is especially useful for
routine care (as in pre-natal), and chronic ailments. Serious cases are
referred to either emergency care or sent on to a doctor. Considering
that many of these villages did not have access to any medical facility
ever, this once a month is a blessing!
Even more interesting
were the phone operations. The call centers handles a volume of as much
as 27K valid calls a day, and caters to people in AP region in 3
languages: Hindi, English, and Telugu. Amazing! People can call in and
get advice on problems ranging from acne to severe trauma, and get
counseled by qualified professionals. It surely doesn’t get any better
than this. And free!
So how does IT come into picture? Aha,
thought you would never ask! Whether it is the mobile van or the call
center, the data are fed into a sophisticated database and help with
trend watching and predictions. The data also help fine tune the
algorithms that aid call center operators. And, of course, the IT
artifact is hard to miss, the scale of operations, the supply chain,
and data analysis would have been hard to do without IT.
In
the end, however, IT has been an enabler, no more. It takes vision to
get this going. It takes innovation to come up with this novel approach
to universal healthcare.
Good job HMRI!
Written by Prof. Nishtha Langer on her blog.