SwasthSevak Yojana

Team Anamya: Aditya Shrivastava Akshay Malhotra Apurv Swarup Joseph Sebastian Yeshwanth Reddy

Healing Touch Universalizing access to quality primary healthcare

The Current Rural Health Problem : India

Average distance traversed to reach a hospital by a rural Indian

70% 40%

20%

700 Million people do not have access to primary

healthcare

Rural India has :

Less than 20% of the population looking for healthcare ends up finding suitable

facilities

2.3 million deaths a year due to avoidable diseases

40% Doctor Absentee Rate in PHCs Low Per Capita (US $) Govt. Expenditure

on Healthcare

The SwasthSevak model is an initiative to reduce the deaths and harm caused by avoidable disease by enabling early and easy diagnosis delivered to the last mile.

Viability

Relatively variable and setup costs

Potential to leverage

economies of scale

Low operational costs

Revenue could cover operational costs

Beneficial to all stakeholders

Sustainability

Availability of Enabling Technology

Existing schemes NRHM RSBY

Concerns with Building a model

Key Causes

Lack of Accessibility to healthcare for the rural populace

Lack of medical and diagnostic infrastructure

Unwillingness of doctors to travel to rural areas

Inability of government schemes to cover the last mile

Scalability

Doctors in Remote location

Infrastructure Provider

Mobile Health Units

`

Patients & ASHA worker

SwasthSevak Model

Doctors can be stationed at

urban centers and still treat patients in rural areas

Removal of physical travel to remote locations eliminates inefficiencies

Can attract a wider pool of doctors including recent graduates and volunteers.

Student participation

Doctors

SwasthSevaks are trained

personnel They travel to the village where there is a requirement and delivers the service

They carry outt the diagnostic

tests and coordinate with the doctor

Mobile technology enabled

treatment delivery services

Delivery Infrastructure

Can now avail of primary

healthcare at their door step

Reduction in cost of healthcare due to elimination of transportation costs and costs late diagnosis

Better labor productivity due to lower incidence of diseases

Rural Poor

SwasthSevak Model

Enabling Infrastructure

Mobile device for connectivity Economical Diagnostic

technology like ReMeDi is available in the market for transmitting basic diagnostic result to remote doctor.

Lab in suitcase

Medicines

Power back-up/ Inverter

GPS

Camera/ recorder to transmit diagnosis

Vehicle with mobile diagnostic equipment

Receive request for diagnosis from

Asha Worker Transmit the request to the

mobile van responsible for that village

Monitor the total distance covered by the van, monitor the total trips to each village, verify the requests received and cases attended.

Maintain the inventory details of medicines in each van and instruct the replenish the stock to maintain minimum inventory

NRHM • Increased spending on health care

from 0.9% of GDP to 2-3% of GDP • Decentralization of Healthcare

services and impetus on correcting the deficiencies in the health care system.

• Insured of sum Rs 30,000 per BPL family

• Cashless coverage of health services, provision of Smart card for transactions

RSBY

Enabling Government schemes

Centralized Control Room

Operation Flow

All the villagers shall report any health problems every morning by 9am. Emergency cases are exempted from this, in that case the distress signal shall immediately be transmitted to the control room.

The control room compiles all the requests and provides the itinerary for the mobile van based on seriousness of the issues and operational efficiency.

Aim : To integrate primary and secondary health care for pro-active prevention of diseases

Significant improvement from present health systems only providing treatment after the diseases are detected. This will logically lead to reduction in tertiary health care requirements.

Strategy and Measurement Flow

Asha Worker compiles and sends the list of patients and seriousness of illness every morning before 9 am to the Control room. 1

Control room compiles requests for each mobile van and provides them with a daily itinerary. 2

Mobile Van confirms requests. 3

Control Room prioritizes on the basis of requests received and level of severity. It provides its itinerary to the Asha Worker to make the patients available. An automated system generates the most optimum route to serve maximum possible patients.

4

Mobile Van attends to the patients in a village. 5

Diagnosis reports are sent to the doctor on duty in the District Hospital. 6

Based on symptoms, the doctor responds with the required treatment and medication. 7

Organization Structure

National Level

Existing New

• Mission Steering Group • PM, Ministry of Health • Leverage Rashtriya Swasth Bima Yojna

State Level

• State- Health Mission • Headed by CM, Co chaired by Health Minister • State Secretary for Managing Operations

Control Room

• Directing operations of Mobile units • Point of contact for ASHA workers

Cloud Infrastructure

• Sourcing & Monitoring of Doctors • Quality control of prescriptions

District Level

• District Health Mission • Managed by District Magistrate's Office • Representative from department of Health & Rural Development

Seva Van Control Unit •Managing day to day operations

Social Audit Groups • Seva Van Control Unit

Estimated Cumulative Expenses INR Annual Variable Costs

District Level Variable Expenses/Year 717,600,000

State level variable expenses 117,000,000

834,600,000

Fixed Costs

District Level Fixed Costs 483,000,000

IT infrastructure 100,000,000

583,000,000

Estimated annual variable expenditure of 84 crores and initial setup cost 58 crores to be depreciated through five year

• Rs 50 to be collected through the OPD allocation of the RSBY scheme for rural Individuals

• Cashless transaction limits risk of pilferage and rent seeking behavior

Major Cost Heads INR

Vehicle 450,000

Mobile Device 10,000

ReMeDi 50,000

Lab in a suitcase 350,000

IT infrastructure 5,000

Revenue Model

If the scheme is successfully penetrated into the entire rural population, has the potential of preventing three deaths per 100 people treated, an estimated total of 5 lakh people a year.

Restricts escalation of preventable diseases through early diagnosis, thereby reducing the healthcare spending for the government.

Frees up infrastructure for secondary and tertiary care, will result in increase in quality of health care provided at the district hospitals.

Enables efficient utilization of critical scarce resources, e.g.: doctors through crowd sourcing.

Social audit shall ensure decentralization and empowers the local communities to ensure their own health care delivery.

Can potentially provide quality primary health care to the tribal and extremist affected areas if implemented through NGO’s which face little resistance from the extremists and are already working on various schemes.

Leverages the existing health care system to achieve universal health coverage with minimal addition to administrative complexity.

Key Advantages

• Pilferage of Medication

• Unauthorized Diagnosis

• Profiteering by the SwasthSevak

• Integrated Inventory management

• Social Audit

• Cashless Transfer

• GPS Monitoring

• Infrastructure (Roads, IT etc) • Availability of labor force (SwasthSevaks) : (Adequate number of male and female staff) • Willingness of patients to accept this model

Risks

Challenges

Checks & Balances

References

http://india.ashoka.org/fellow/sameer-sawarkar

http://www.ideasforindia.in/article.aspx?article_id=132

https://www.pwc.in/assets/pdfs/financial-service/Health_Insurance_Report_FV.pdf

http://www.ruralhealth.org.au/publications