Smart clinics and mobile units hold promise for the poor
Biocon’s elaj Smart Clinics aim to strengthen delivery of primary healthcare in India, by converting every phc into a comprehensive single point treatment centre, with systematic documentation of patient data to ensure continuum of care. eLAJ Smart Clinics combines a robust emr (electronic medical records) with diagnostics, to provide end to end services in phcs. In an elaj Smart Clinic, every patient’s records are digitised to ensure continuum of care. elaj comprises of three interconnected modules – registration, clinical consultation, and at the diagnostic centre. The electronic records captured are stored on a central secure server.
Members of the clinic staff are rigorously trained to register patients, measure vital parameters, record clinical consultation and diagnostic tests if prescribed. The diagnostic centre in an elaj Smart Clinic can perform up to 50 tests and results are available in under an hour. This makes the patient’s visit to the phc stress free and out of pocket expenses are also minimal since all services are free.
Biocon Foundation provides the elaj software, three laptops, a multi-parameter monitor, a bio-chemistry analyser, a haematology analyser, and all accessories necessary for the working of the system. Data from individual clinics or from groups of clinics is available to health administrators through live dashboards, which capture patient footfall, vital parameters, disease profiles of communities, and disease trends, and the dashboard sends disease notifications and alerts to the administrator. A total of 68,156 patients benefitted from elaj clinics in Rajasthan. The success of elaj in Rajasthan caught the Karnataka state government’s attention to partner with Biocon Foundation to set up elaj clinics in order to provide affordable healthcare services in rural areas in Karnataka. Since inception a total of 418,839 patients have been treated in elaj clinics in Karnataka.
The company plans to scale up elaj through public-private partnerships with different state governments. About 50 clinics will be installed by the end of 2017-18 and 100 clinics by the end of 2020. The company is working on a roadmap to institutionalise elaj in the government primary health care ecosystem.
Biocon also has a mobilehealth module (mHealth) where in community health workers are empowered with a mobile phone app, which is equipped with a decision-based algorithm to identify high risk group and to capture images of oral lesions and prevent oral cancer. The data is uploaded to remote specialists for recommendation and communicated back for necessary actions, like timely referral, biopsy or treatment with chemo-prevention medications.
Health on wheels
Asian Paints Mobile Medicare Unit (mmu) provides healthcare services to the poor and needy older persons in their vicinity. The unit reaches out to 10-13 communities identified through a need assessment study and provides required medical care each week regularly.
The team, consisting of Medical Consultant (mbbs), social protection officer, pharmacist and a driver, extends 70-80 treatments per day. Apart from regular medical services, special diabetes screening, dengue awareness camps and general health and hygiene awareness programmes (for the entire community) are also conducted.
The mmu in Sriperumbudur (Tamil Nadu) has positivively impacted he lives of the beneficiaries in and around the location. It has extended treatment to 28,124 elderly beneficiaries with various ailments, including treatment to 1,759 flood affected victims through eight general health camps during flood relied intervention at Chennai.
Eyesight was restored for 22 beneficiaries through free cataract surgery with intraocular lens surgery and spectacles to 134 beneficiaries. Disability Aids such as walking sticks and walkers were distributed to 60 needy elderly.
Awareness and sensitisation programmes have been conducted among communities about elders and healthy ageing and active living. Improved access to healthcare was created through networking with other health service providers, referral services to government hospitals and public health services for treating beneficiaries with chronic ailments.
The mobile medicare unit provides quality healthcare to poor and needy older persons having multiple health complications and needing continuous medical interventions. The company aims to increase the number of enrolled patients to a minimum of 1,200 in the next two years. It will identify four new locations with high need for health interventions and sensitise on health; organise special health camps in needy communities; partner with eye care hospitals and conduct free eye screening camps and cataract surgeries.
Saving our future
The Glenmark Foundation has impacted over 870,000 lives through various interventions in child health spread across the states of Madhya Pradesh, Rajasthan, Maharashtra, Himachal Pradesh, Gujarat in India and Nairobi in Kenya. Over 154,000 were children who were reached out to, to improve nutrition, immunisation and sanitation levels.
The foundation has undertaken several community programmes focussed towards reducing infant and child mortality among vulnerable population groups. Themed around ‘Healthier Children, Healthier World’, it works to improve child health by providing health education and awareness to mothers and caregivers with a focus on reducing malnutrition, increasing immunisation levels; and improving hygiene and sanitation conditions.
The target group for Glenmark’s interventions is adolescents, newly married, pregnant mothers, new-born and children. In order to maximise the scope and impact of its programmes, the foundation is associated with non-governmental organisation partners as well as existing government health mission programs.
A detailed research in the field of child health and its key findings directed Glenmark to initiate ‘Project Kavach’, its flagship csr programme. The aim of this programme is to reduce infant and child mortality in children up to five years of age. It systematically identifies target groups; educates and informs them about positive health seeking behaviour and introduces service delivery mechanisms that help in making an impact.
The foundation believes that the right impact can be made by staying with the woman from the time she is married to when her child is five years of age. Thus interventions are staged at each crucial phase of a mother and child’s life. To bring about substantial results, these initiatives are supplemented with additional measures such as Behaviour Change Communications.
Social behaviour change and building a scientific temper in the community on child health requires long term engagement to remove blind beliefs and unscientific notions associated with communities since generations. For instance, tribal healers and priests have significant influence on the Korku tribe (child health project in Madhya Pradesh) and play a vital role in healthcare of the community. As this community has not been scientifically oriented, many myths and traditions developed with regard to malnutrition care. The process of engaging community opinion leaders (like village heads, elders, tribal priests and quacks) has been challenging.
Various campaigns in the form of exhibitions, sensitisation and awareness programmes, poster displays, wall comics, focussed group discussions, role plays and street plays are employed to create awareness about issues on child health. The basic aim is to sensitise the community on health issues in such a way that they start adopting better practices for overall wellness.
Localisation of food and prioritising the community need for sustainability with participatory approach is challenging, which Glenmark’s partners are solving by interventions like backyard nutrition, millet farming, and backyard poultry and promotion of cooking healthy nutritious food with the available indigenous food.
Glenmark’s interventions have improved the lives of children and their mothers which in turn have helped supported communities to be healthier, stronger and better equipped to live happier lives. These interventions provided pregnant women and mothers of infants with targeted health-related information which has equipped them to take informed decisions for themselves and their family’s health, thereby reducing maternal and infant mortality and morbidity.
Glenmark has been able to transform anganwadis (day care centres) to model anganwadis making them child friendly, thus ensuring maximum attendance and tracking services such as supplementary nutrition and immunisation. In various communities Glenmark has played a role in ensuring complete immunisation of infants and children by creating customised calendars which track immunisation and distribute them to the local stake holders.
The promotion of backyard nutrition gardens and backyard poultry resulted in direct intake of micronutrients in malnourished children thereby improving their nutritional levels. The foundation has created a viable model of community-based malnutrition management.
Injurious to health
Bajaj Electricals aims to build awareness on preventive healthcare with a focus on lifestyle issues and addictive habits such as tobacco consumption. The focus of the programme is Anti-Tobacco Awareness amongst different vulnerable stakeholders and Tobacco Cessation for those already in the addiction. The company started the anti-tobacco campaign in May 2010 on Anti-Tobacco Day along with the Salaam Mumbai Foundation.
Bajaj Electricals realised that there was no tobacco users in the senior management, and the project thus got management support and worked effectively on the premise of ‘lead by example’. A direct contact approach was instituted where the cmd would counsel tobacco consuming
employees and keep a track and monitoring system.
The company succeeded in persuading employees to give up tobacco and Bajaj Electricals today has a 99 per cent tobacco free workforce. The company felicitated ‘tobacco quitters’ during common gatherings and asked them to share their experience to motivate others. The company kept this sustained approach till all the users gave up and became Anti-Tobacco Crusaders (atcs).
Through csr efforts the company is now engaging with diverse stakeholders to promote healthy tobacco-free living. Employees as atcs volunteer their time to reach out to different target groups such as schools, colleges, vocational institutes, office goers and village folk. They are equipped with basic knowledge, information and audio-visual material and passion in collaboration with knowledge partners like Salaam Mumbai Foundation and Muktangan.
To ensure that the company has a tobacco-free workforce, there are periodic awareness training programmes and support through de-addiction drives among tobacco users in the organisation. Since tobacco smoking is a personal choice, it is not enforced upon employees to stop usage, but to increase the level of awareness.
Community awareness was enhanced through the network of 1,000 dabbawalas who carried the message of No Tobacco to 100,000 office-goers. About 250 Mumbai police officials took a pledge to spread the message of the ill effects of tobacco among the community and their peers. Through mass community mobilisation in collaboration with Happy Street, 500 of the target population were enlightened by the awareness programme.
In financial year 2015-16, the company reached out to 13,790 individuals with direct contact through employee volunteering initiatives for colleges, schools, drivers, factory workers, during festivals and social platforms. Training programmes have been conducted for police personnel, drivers, conductors, and technical staff.
World’s largest service… for free
gvk emri claims to be the world’s largest ambulance service that is free of cost for the beneficiary. This initiative involves collaboration with various stakeholders like government, public and staff. The initiative is implemented under a public-private partnership model, drawing strengths of the professional partner and state government.
Emergency victim/attendant dials 108, at which point an emergency Response Officer’s screen helps facilitate and scope the emergency, as well as assign a strategically-located vehicle (ambulance, police or fire). The Emergency Medical Technician (emt) provides passionate pre-hospital care, while transporting patient/victim to the appropriate hospital for stabilisation. Emergency Response Centre Physician (ercp) advises patient care with the support of ero and emt to ensure optimal pre‐hospital care. A 48-hour follow-up is conduted wherein a team calls back beneficiaries to seek feedback on service quality, scope for improvement and also to understand the beneficiary’s condition/survival status.
gvk emri collaborates with institutes like Stanford School of Medicine, American Heart Association, American Academy of Family Physicians Carnegie Mellon University, Singapore Health Services, National Trauma Research Institute, Australia, 911 nena, Austin City ems, Geomed and phfi. It now has a footprint in 15 states and two Union Territories in India and two provinces in Sri Lanka, providing coverage to about 800 million people in these countries, through a team of about 45,000 people.
By 2020, the company plans to cover entire country and be able to service more people in neighbouring countries. It aims to build manpower strength of 100,000; provide preventative healthcare services in unserved or under-served areas through non-emergency health helpline supported by fixed day mobile health clinics.
Improving quality of tribal life
imfa’s project Arogyadhara provides access to primary healthcare services to control the spread of diseases and reduce child and maternal mortality rate in remote tribal areas — both through health services, and water and sanitation which is the foundation for good health. Community health services are provided through well-equipped dispensaries, and through free health camps in hard-to-reach areas to ensure diagnosis, treatment, referrals and preventive health care. The programme converges with the Department of Health & Family Welfare, Govt of Odisha for immunisation programmes. Social Behaviour Change Communication (sbcc) enables individuals, families, communities, and societies to improve their quality of life. Community-led Total Sanitation (clts) awareness building and training programme promote good health. imfa has also been building toilets in village and in village schools.
The Ila Panda gynaecology ward constructed at district hospital in Angul provides pre- & post–natal care for women, in partnership with the Odisha government. A Public Private Partnership with National Health Mission (nhm), Odisha ensures 24×7 ambulance services – ‘Janani Express’. With ngo Pathfinder International the company has undertaken training of ashas, anms and awws on safe delivery practices.
imfa found the biggest challenge was myth and misconceptions and social taboos among tribal communities that prevented them from accepting medical interventions and adopting ideal health behaviour practices. To address these issues, the company built trust by involving members from their communities to create awareness on modern day health practices & safe sanitation practices. Another serious challenge was to stop people from open defecation – an age-old habitual practice. This was addressed by continuous training and awareness sessions on behaviour practices.
Annually, 80,000 people of 200 villages have access and avail primary healthcare services from the dispensaries. Since 2011, till date, 485,595 villagers have directly benefited from dispensaries. About 3,000 people (annually) avail of prevention and primary health care services through health camps in hard to reach tribal areas. About 37,790 households have access to safe drinking water through installed tube wells with overhead tanks with piped water supply. Another 4,500 households have access to toilets with water supply.
In health, the company plans to expand by adding more medical clinics. In water and sanitation, toilets and water sources continue to be added, to increase coverage on safe sanitation practices.
For mothers and daughters
Jindal Steel & Power’s Kishori Express (adolescent girl anaemia control project) and Vatsalya project (a maternal child development project) are being implemented through the government’s Women & Child Development Department, Health & Family Welfare Department, School & Mass Education Department at Angul & Tensa in Odisha, Tamnar in Chhattisgarh, Jereldabaru in Jharkhand. Maternal child health projects like Kishori Express (mobile healthcare van) and Vatsalya have been able to bring about positive changes in the lives of women and children through various preventive health care services.
Project Vatsalya tries to address health nutrition issues of both mother and child, and the project is driven by trained community lady health volunteers, who act as change agents to pursue the population stabilisation approach. The Kishori Express, an adolescent girls anaemia control project, is implemented in 321 villages of two blocks of Angul district of Odisha. The project took healthcare, hygiene and awareness to the doorsteps of the adolescent girls (would be mothers) by trained service providers in customised vehicle that was not only equipped to run the online quiz on life skills, but also with facilities of counselling on nutrition, menstrual hygiene and anaemia control measures.
Project Vatsalya, a maternal child health project started with Tamnar and replicated to Jeraldaburu and Tensa locations. The Wadi development project of Tamnar, Chhattisgarh (tribal livelihood project) has been scaled up from 250 families to 500 families and it has further potential to scale up in tribal areas.
Till March 2016, the Kishori Express customised vehicle, equipped with an lcd screen, trained staff, sanitary napkins, haemometer, hand-washing kits, IFA tablets, iec materials has done 85,851 injections through 2,319 visits to the beneficiaries resulting in 94 per cent reduction in severe anemic cases & 35 per cent reduction from moderate anemic cases.
Under Vatsalya, pregnancy registration has increased from 51.25 per cent to 99 per cent; anc check-up increased from 13 per cent to 98.25 per cent in five years. About 65 per cent of mothers consumed 100 ifa during pregnancy which needs to be taken up to 100 per cent. Institutional delivery increased 47 per cent to 86.66 per cent.
Exclusive breast feeding has increased from 34.2 per cent to 90 per cent, which results in strengthening child immunity and improves growth. Child immunisation increased from 57.2 per cent to 93.26 per cent. About 62 per cent adolescent girls use sanitary napkins (earlier the tally was negligible) and all children are taught to wash their hands with soap and water after defecation and before eating.
The Kishori Express is an integrated vehicle that touches the lives of not just adolescent girls, but also boys through hand washing sessions and routine immunisation. It also touches pregnant women through Village Health Nutrition Days with staff sharing the day with ICDS and the Health Department in delivery of services.
The Vatsalya programme is proposed to be replicated across units of jspl and plan to use lady Village Health Volunteers (vhvs) as resource person in health programmes run by other csr units. These vhvs have the potential to form an ngo to work in health sector either with government/ ngos which is being worked out.
Towards a healthier community
Dr Reddy’s Laboratories’ csr programme chip aims to improve the health of the community around its units in three districts of Andhra Pradesh and Telangana. The initiative aims at improving health in general and maternal, and child health in particular, through a systematic health services approach.
chip is implemented in partnership with Nice Foundation. It covers general healthcare services in specific blocks of three districts (Nalgonda, Vizanagaram & Srikakulam) with a focus on improving maternal health and combating infant and child mortality. Implemented in partnership with Nice Foundation Hyderabad, it addresses basic support for ante and post-natal care, safe delivery and infant care, primary immunisation of children by the age of one, for safe motherhood and increasing the child survival rate. Through its mobile health vans it reaches out to the community with a Fixed Day service and also makes referrals as appropriate.
chip serves the community through 196 clinics, covering 145 villages and impacts a population of 214,000. Dr Reddy’s and Nice Foundation review the health indicators and have found that outreach has increased and maternal and child health have improved.
The programme has given insights into cultural aspects affecting health. For example the community provides less attention to an expectant mother, with a previous history of bearing a female child. Consistent engagement with the community, commitment to the regularity of service, longitudinal patient data, and understanding the cultural setting of expecting mothers has helped in achieving the health outcomes.
chip has demonstrated the results of its well-designed approach to the provision of last mile health services. Based on the evidence of success and sound notes on programme design, Dr Reddy’s Laboratories and Nice Foundation have plans to promote the same model to the state governments. This can allow the governments’ health delivery systems to implement the solution on a larger scale.
Accessible and affordable
Piramal Swasthya believes in making healthcare accessible, affordable and available to the population, especially those most vulnerable. The company offers three services that integrate with the government
network in providing clinically-validated services.
The Health Information Helpline (hihl) is a health contact centre that aims to address minor ailment load on the public health system. Any citizen can avail of medical advice, counselling services, request directory information or lodge a service complaint against any public health facility at the cost of a phone call. hihl provides basic medical advice 24×7 and counselling services. The platforms support the government’s frontline programmes like Mother & Child Tracking System (mcts) and hiv/aids counselling.
Piramal Swasthya’s tele-medicine service bring specialist healthcare services to remote areas. The focus is both on beneficiary and the doctor delivering accessible and affordable care by providing specialists with an electronic health record of each patient. The company deploys this technology in far flung areas thereby virtually connecting doctor and patient, and reducing the need for highly skilled health workers where they are scarce.
Mobile health services tackle barriers accessing primary healthcare in rural India. Piramal Swasthya’s mobile medical units (mmus) act as force multipliers to existing primary health care centres. These vans are equipped with technology, medical devices, medicines, health workers and visit even the remotest of villages. The mmus are staffed with paramedics, doctors who can identify, screen, diagnose, refer, monitor and treat select diseases and minor illnesses.
Piramal Swasthya has served more than 83.4 million beneficiaries till March 2017. More than 43 million beneficiaries have been provided validated health advice through remote health advisory and intervention services. Nearly 980,000 mother and child beneficiaries were tracked and provided advice as part of mcts call centres. About 38 million beneficiaries have been delivered health facilities at their doorstep through community outreach programme. About 170,000 beneficiaries have been provided specialist consultation through telemedicine services.
The company’s current focus areas are reproductive, maternal, newborn, child and adolescent health and non communicable diseases like diabetes and hypertension. Its aim is to be an expert in maternal and adolescent health and reduce the maternal mortality rate by 30 per cent and infant mortality rate by 20 per cent in next three years.
The Adani group’s Suposhan project works around reducing the occurrence of malnutrition among children. The company adopts a community-based approach and tries to identify and address malnutrition across age groups to prevent it from affecting any particular section of society. Efforts have begun to show results and the company has a three-year target to reduce malnutrition in children by 95 per cent.
One of the project’s primary objectives is to create a pool of resources, in the form of Sanginis, at the village level who help the company inch closer to its goal of eliminating malnutrition and anaemia by educating villagers about the methods, means and significance of good nutrition. They essay the roles of enabler and facilitator to eliminate and curb malnutrition with specific strategies to tackle food deprivation, poverty, and gaps in nutrition delivery circle.
Adolescent girls and women are the prime focus because of the ignorance prevalent regarding women’s health, as well as malnutrition being an inter-generational problem. The project has identified and helped 604 severely malnourished children in the age group of 0-5 years to receive proper nutrition and become healthy. The project has also identified 2,300 moderately malnourished children (mam), and worked towards reviving their health and physical well-being. Under the Suposhan initiative, 1,605 pregnant women were screened and provided with preventive and curative support.
The ADCR of health
Mobile 1000, an initiative of Wockhardt Foundation to provide rural primary healthcare to the villages of India, has taken shape from the dire need and lacunae of the poor healthcare delivery in India. It envisages the setting up of and operating of 1,000 mobile medical vans to provide primary healthcare to rural India. Each van is equipped with a doctor, driver and co-ordinator. The van is equipped with medicines, healthcare equipment, and consumables. It covers the adcr formula of healthcare delivery – awareness, diagnosis, cure and referrals.
Mobile 1000 is an iso-9000 approved model that addresses an emergency. Till date, 1.8 million patients have been checked and treated by 108 Mobile 1000 vans.
ADITYA BIRLA GROUP
The Aditya Birla group has a healthcare programme that treats over a million patients at 5,000 medical camps and the company’s 20 hospitals, annually. More than 1,200 children have undergone cleft lip surgery. About 50 deaf and mute children (0-5 years) underwent cochlear implant surgery. This was a life changing experience for the children as they can now speak and hear.
Over 5,000 physically challenged persons have been provided with artificial limbs making them self-reliant in Karnataka (Harihar 3,000 persons) and at Lucknow (Jagdishpur). This is done in collaboration with the Bhagwan Mahavir Viklang Sahayata Samiti.
The company has helped immunise 70 million children against polio over the last seven years. For the last three years, they have been working with Rotary International on non-resurgence of polio.
The Aditya Birla group’s Mother and Child Healthcare projects serve 100,000 women and their children every year. Another project – Village Social Entrepreneurs – in healthcare covers around 300,000 people at 100 locations in four states (Andhra Pradesh, Kerala, Haryana and Uttar Pradesh).
The company is also engaged in a project with the Vision Foundation of India to provide sight to 6,600 nearly blind people. Additionally, cataract surgeries were carried out for 5,000 people through plant teams, in tandem with the government.
Towards tuberculosis control under the Revised National Tuberculosis Control Program (rntcp), the group caters to 5,000 patients and administers the drugs under dot (Directly Observed Treatment). The company’s hiv/aids Awareness programmes reaches out to 30,000 people annually.
shudhu-Water Purification Tablets is the Wockhardt Foundation’s initiative to provide clean drinking water to Indian people. One shudhu tablet can purify up to 20 litres of water in 30 minutes and prevents all communicable water borne diseases like jaundice, diarrhoea, dysentery, cholera, polio, giardia, etc. shudhu has benefitted over 10 million people by giving them access to clean potable water.
Reaching remotest rurals
Nhpc runs spandan, a healthcare outreach programme that is being implemented in the rural areas of Assam to ensure health benefits across all age-groups amongst the remotest of populations through deployment of Mobile Medical Units (mmus)/vans. nhpc launched this programme on 25 February 2016 at the Dhemaji district. psmri (Piramal Swasthya Management and Research Institute) is the implementation partner for the programme. A total of 20 mmus have been deployed across five districts of Assam. These reach out to the so-far unattended masses in the remotest locations of the above districts where gaps exist in terms of medical facilities and its outreach to the intended beneficiaries. spandan aims to enhance, augment and supplement community wellbeing services as a whole. It aims to reach out to the “last person” through tailored and synchronised health services. Looking at the success of the programme, there are plans to scale up this initiative.