Report: Evaluation of a Novel Community-based Chronic Disease Management Solution
Report Title:  Evaluation of a Novel Community-based Chronic Disease Management Solution 

  1. Sarang Deo (Executive Director, Max Institute of Healthcare Management & Associate Professor of Operations Management, ISB)
  2. Preeti Singh (Analyst, Max Institute of Healthcare Management, ISB) 
According to WHO, 39.5 million of 56.4 million global deaths in 2015 were due to non-communicable diseases (NCDs) such as cardiovascular diseases, cancers, diabetes, and chronic lung diseases. In India, NCDs account for 61% of the morbidity and mortality and is rising disproportionately in the low-income segments. Current health systems (both public and private) are designed primarily to address episodic/acute complications arising out of these conditions rather than managing these conditions over the long term to avoid such complications. The need for the hour is for interventions that can support in improving the diagnosis and management of NCDs.
In this report, we critically evaluated a social enterprise model (NanoHealth) that leverages a unique combination of community health workers called “Saathis” and a proprietary technology platform to facilitate early diagnosis and continuous management of chronic NCDs such as Diabetes and Hypertension. In particular, we investigated NanoHealth’s impact on health outcomes of its users by analyzing the operational and financial feasibility of its model using its operational data between March 2015 and March 2017.
We found that NanoHealth was successful in identifying undiagnosed and undertreated population at risk of developing diabetes, hypertension, or its complications. Twenty eight percent of the screened individuals were at risk of developing diabetes or its complications; 21% of whom had no previous history / knowledge about the disease. Fifty nine percent of the screened individuals were at risk for developing hypertension or its complications; 65% of whom had no previous history/ knowledge of the disease. Individuals, who enrolled on the NanoHealth plan and continued it for 12 months, experienced a significant decrease in fasting blood glucose (20.1mg/dL) and systolic blood pressure (9.2mmHg) compared to their baseline values. However, we found that significant improvements were needed both on acquisition and retention of customers to make the model financially sustainable; only 6.78% of the screened population was enrolled on the plan and of those, 57% users remained on the plan after 12 months.
Our findings lead to two levels of recommendations to improve the acquisition and retention of the users and achieve financial sustainability of the model. At an operational level, given that cost of community health workers is mostly fixed, NanoHealth should aim to improve their productivity (number of visits per day) and to appropriately allocate their capacity over initial screening and monthly monitoring visits. At a strategic level, public payers that internalize the cost of poorly controlled NCDs (e.g., CGHS and ESIS) should partner with NanoHealth and procure its services for their beneficiaries. Finally, state governments should consider integrating the proposed NCD programs under the National Health Policy 2017 with community-based models such as NanoHealth.

About NanoHealth:
NanoHealth provides proactive and continuous care for management of NCDs to low income families in the city of Hyderabad. It was founded in 2014 after the founders won the prestigious Hult Prize. In the last three years, NanoHealth has touched over 70,000 people and actively manages health of over 2000 users. NanoHealth operates in urban slums and their surrounding neighborhoods. The catchment population comprises individuals working as drivers, daily wage earners, domestic helpers, vendors and self-employed professionals in the unorganized sector of the economy. The average family income of its beneficiaries ranges between INR 15,000—INR 30,000 per month. Most people inhabit pucca houses with electricity and water supplies.
NanoHealth aims to improve the diagnosis and management of NCDs through: (i) trained and certified community health workers known as Saathis (meaning 'companions' in Hindi) and (ii) an integrated proprietary technology platform.

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