Emergency help line for the rural life line

Presented By:Rajendra Narendra Nimje, IASDirector, Technical Education, Govt. of AP, Indiarajendranimje@gmail.com

Presented to:

Sri B.K. Chaturvedi, I.A.S.,

Cabinet Secretary, Govt. Of India

29thSeptember 2006 , Vigyan Bhavan,New Delhi

Backdrop.. Dec,2004

Observations on Emergency Services at Khammam District in AP

Many Casualties in Road Accident and Snake Bite Cases. Difficulties faced for Obstructed Delivery cases.

Most of the time delay attributed to late response from Medical machinery

Emergency services are not within the reach of rural poor.

Govt. has islands of health infrastructure.

There is a shortage of specialist doctors, blood & emergency medicines at PHCs and Area Hospitals.

Backdrop.. Dec,2004

Mostly the emergencies are simply escalated to the District Hospital consuming valuable time leading to more fatalities

Patients are taken to the private hospitals by their relatives or passerby – May save their life but will cost a lot on treatment cost which they can’t afford.

Communication to reach any hospital for emergency is not simple. There is no easy way to remember all landlines for all Hospitals and PHCS. There is no guarantee that the phone communication reach the duty doctor.

CHHATTISG

AR

H

EAST GODHAVARI

WEST GODHAVARI

KRISHNA

NALGONDA

WARANGAL

KHAMMAM (DIST)

ORISSA

KHAMMAM Profile

Population 25.62 Lakhs (2001)

Geographical Area 16029 Sq. KM (48% Forest)

Population Density 160/Sq.KM

Revenue Divisions 4

Mandals (Like Taluks) 46

Revenue Villages / Gram Panchayats

1239 Villages , 773 GPs

TSP mandals 29

Tribal Population 6.259Lakhs (Highest in AP)

PHCs/ Sub Centers 66 PHC, 592 Sub Centers

Hospitals 1 Dist, 2 Area,3-CHC, 11 Civil Hospitals,51 Pvt.

State Highways 2 No.

Medical & Health ProfileKhammam District , AP

KhammamMedical &

Health Infrastructure

APVVP Hospitals

DMHO control Hospitals,

PHCx

District Hospital , Khammam 250 Beds

Area Hospitals

BCM-100bd,KTG-100bd

11 Civil Hospt. 30

Bedded

Primary Health Centers

66No.

Sub-Centers

592

Medical Officer

Pharmacist, Staff Nurese

ANM, First Aid

KitsSpecialists, Operation Theatres,

Blood Bank

Specialists, OTs

3 CHCs - 50 Bedded

Private Hospitals

51

Project Objectives

To provide Emergency services on demand to rural poor with the available Government Health infrastructure.

To provide an opportunity to them to tap the emergency services with a simple toll free easy to remember number

To tap the specialist services at village / block level from private sector with no permanent infrastructure overheads.

Tracking of emergency till the services are delivered.

To build an accountability in the Government Sector on utilization of resources like ambulance, blood and doctor services.

Concept

Emergency Services are available to one and all accessible to remote and tribal areas

Easy to remember no. 102, toll free

HCC services are available round the clock.

Pooled resources : Government duty doctors, PHC doctors and Private specialists in various areas. Also the ambulance services and blood banks can be tapped from HCC.

…

His Excellency Sri Sushil Kumar Shinde,Governor of A.P., inaugurating HCC on 9th March, 2005

Features

Private sector specialist services available.

Single window transactions for the users.

Better decision making for duty doctors as they have chance to interact directly with patients/relatives in emergency situation

Total monitoring of situation at the initiation of each call

Three tier system to make effective use of the infrastructure and time saving

Indigenous user friendly software to pop up resources on receipt of the call.

Dial 102

Features

Software

Operator gets a popup on taking a call showing the area from which call is made.

It also shows the nearest ambulance, hospital and blood bank

Software

Operator then talks to the duty doctor by holding the caller and put them in conference if required. He then books a ticket in the name of Hospital and all details are entered for further monitoring

Brainstorming sessions with PHC doctors, IMA doctors, other officials in the district and BSNL officials for 3 digit toll free number

Health Call Center was launched in the District Hospital on 9th March 2005

1 server & Two PCs with UPS

4 lines exchange with hunting facility, call parks, call diverts etc. for connecting the needy to the doctors in real time.

Indigenous Software developed to monitor emergency

Three trained operators round the clock

DMHO is the monitoring officer. Dist. Panchayat Officer is the consultant to provide administrative support.

Operating manual prepared and operators trained beforethe launch.

Beginning

HCC is funded by the European Commission through its Sector Improvement Program- II

Initially operators were engaged through the EC funds

Rotary Club of Khammam has come forward to take up the maintenance i.e. operators remuneration and Phone,elect bills etc.

Partners

Cost…

Infrastructure

a) P-IV server , 2 No. P-IV PCs. With UPS Rs. 1.80 Lakhs

b) Electronic Exchange for 4 incoming lines Rs. 60,000

c) HCC Software Rs. 1.1 Lakhs

d) Internal Wiring Rs. 10000

e) Partition/Furniture Rs. 1.2 Lakhs

Total : Rs. 4.8 Lakhs

Recurring Expenditure :

a) Operator remuneration Rs. 3000* 4 No. Rs. 12000 per month or Rs. 1.44 Lakhs per annum

b) Phone Bill Rs. 3000 to Rs. 4000 per month i.e. Rs. 40,000 per annum

c) Electrical Bill Rs. 2000 per month Rs. 24000 annum

d) Total Recurring cost : Rs. 2.25 Laks per annum

Emergency help line for the rural life line-Life Saving intervention

Emergency Services within the reach of the poorest and  available in the remotest areas.

Makes specialist emergency services available at Mandal and    Block levels where Government can’t attract specialist doctors even with higher pay package.

HCC keeps the track till emergency services are delivered.

Effective utilization of resources like ambulances , blood and other resources in rural areas. Govt. can think of cost saving on purchase of ambulances and operational costs.

Project triggers more institutional deliveries as obstructed labor cases are handled in time through HCC

Benefits

Nature of Call Cases Attended

Road Accidents 122

Snake Bites 87

Obstructed Labor 61

Heart Attacks 17

Poisoning 59

Others 77

Total 425

Progress

2006…

HCC -2006 Emergencies

0

5

10

15

20

25

30

35

40

45

Jan-06 Feb-06 Mar-06 Apr-06 May-06

Jun-06 Jul-06 Aug-06

No.

of C

ases

HCC -2006 Emergencies

Impact

HCC was useful in saving lives of the rural people.

Wide publicity through Gram Panchayats and Cinema Slides and Medical Machinery has increased the reach of HCC

Ambulances were effectively used

Private doctors responded to the calls and participated in HCC activities

Concept understanding problem with Medical & Health Department

Remedy : Brainstorming sessions held with medical staff at all levels

Private doctors association was a must and meetings held with IMA doctors. They agreed with a condition that their services will be available for the limited period and they should not be hold up unnecessarily

Initial Funding was a bit difficult though the amount requirement was small

Govt. of AP was briefed on the concept in Dec. 2004. It took some time to tap funds from EC-SIP II as the funds were tied up to other activities. Commissioner FW, Govt. of AP and SIP director at Delhi visited Khammam and funds were allotted.

Difficulties

Operational cost for HCC – Funding was an issue

Initial Funding for one year was tapped through EC-SIP II

Requests were sent to many NGOs to take up the project. Initially NANDI foundation of AP shown some interest but later they did not agree for taking up this project

Finally, Rotary Club of Khammam has came forward to take up the project and MOU was signed with them for operation of HCC

Teething troubles

Training and refresher courses conducted for Medical Officers

Regular monitoring meetings conducted at Collector level

Getting 3 digit number took some time from BSNL

Difficulties

Operators faced lot of difficulties

Good trained call center operators are not available at Khammam. We could not get them from Hyderabad though the distance is on 200KM

Call center operators were getting many calls of trivial ailments and the real emergency calls were much less.

Operator- Doctors lack of coordination

Other difficulties

Three tier structure was not well received. The operators and duty doctors found an easy route to send the ambulance from district hospital defeating the purpose of HCC

DMHO did not used the logs and reports to fix responsibility on the defaulting MOs and staff.

102 is not accessible from mobile – This technical hitch is being sorted out.

Difficulties

Health Call Center Project is easily replicable for any District in India

It needs very little investment for setting up and little investment for operation and maintenance

HCC is a Most cost effective health emergency intervention in India

It takes very little time to set up HCC and make it operational. Max. 3 months.

It may not take much time to get the toll free number from BSNL for this purpose

Software customization may not be difficult.

HCC is scalable and it will work for Taluk, District or State as a unit equally well.

Replication

Recognitions

Health Call Center won the Bronze medal in9th national e-Governance conference held at Kochi in March

2006

Hon’ble Minister for PWD, Govt. of Kerala presenting a Trophy, medal and a Certificate to

Sri Rajendra Nimje for HCC project at Kochi on March 2nd 2006

Future

SP, Khammam is interested to use HCC for police emergency calls.

Fire service can be added to HCC

Plans are on to monitor epidemics, GE, JE cases

GPS to be installed on ambulances to monitor the physical location

Achievements of HCC are apprised to the Chief Secretary, Govt. of

AP for examination and replication

‘E-Immunization’ Incubated in my Fellowship at Stanford University and Piloted in Khammam district at Thirumalayapalem PHC.

Increases immunization percentage upto 90% by tracking each dose of immunization for each baby and also reducing burden on ANMs.

It bagged Silver Icon Award in 9th National e-Governance Conferenceat Kochi in March 2006

It won the ‘Social-e-Challenge’ Award in 2004 at Stanford University

http://www.immunizeall.org

Conceived by:

Rajendra Nimje, IASe-Initiatives

‘Parishkruthi’ means grievance redressal – It provides A ray of hope to the voiceless petitioners.

Parishkruthi has made the administration more responsive, effective and transparent.

It was nominated as ‘Finalist’ in the Stockholm Challenge Awards 2006 in Public Administration category.

More than 1,00,000 grievances handled through parishkruthi in last one and half years.

Conceived by:

Rajendra Nimje, IASe-Initiatives

http://www.parishkruthi.org

‘Giri-Pragna’ means Enriching Tribal Knowledge

Giri Pragna provides computer education and Computer Aided Education to 10,000 tribal students in remote areas of Khammam district.

The project is launched in September 2005

It was selected as ‘Finalist’ and the only entry from India in Education category for the Stockholm Challenge Awards 2006

http://www.giripragna.org

Conceived by: Rajendra Nimje, IAS

e-Initiatives

The initiatives are available at

www.khammam.com www.immunizeall.org www.healthcallcentre.org www.giripragna.org www.parishkruthi.org

Submitted By:

Rajendra Narendra Nimje, IASDirector, Technical Education, Govt. of AP

Ex-District Collector & District Magistrate, KhammamGovernment of Andhra Pradesh, India

nimje@ap.gov.in rajendranimje@gmail.comOffice: +940-23221511 Mobile 99491-02244

Thanks

New Developments in AP

EMRI- a non-profit organization of Satyam Group has started a similar initiative in AP in August 2005. It is called 108 Emergency service.

Any one can call on the toll free no. 108 and the call center will ensure ambulance immediately.

It operates within 20 Km radius of the town.

They invested Rs. 34 Crores for facility and Rs. 70 Crores for land

It is operational at 50 locations in AP

EMRI- has plans to operate in the rural areas but do not want to invest on Ambulances.

102 108

Emergency services for the rural & remote areas

As on today for urban areas and 20 KM radius

Effective utilization of available resources

New infrastructure for each areas of operation

Extremely small investment Huge investment & Infrastructure

Patient is treated at Govt. Hospitals/PHCs

Patient is treated at Corporate and Pvt. Hospitals.

Handles Only Medical Emergency (Police have already started 102 for Highway patrolling)

Handles Medical , Fire and Police emergencies

Private specialists handling emergencies in rural areas

Shifting to private hospital

102 Vs. 108

European Commission- SIP-II Budget for Khammam

All figures in Rs. Lakhs.

Filarial control – 7.28 Specialist Camps- 15.82

Indian System – 6.88 Directory 1.0

Mobile Traumacare-11.9 Emergency facilities- 25

Strengthening FRU-17.37 Left over DAP-I 18.22

Total Rs. 103.47 Lakhs

Rudrakshapalli Incident- 7 Butchered, 15 Injured near Satupalli Chattisgarh Blast by Naxals- Patients in BCM hospital Satupally Tractor Accident Kothagudem Bus Lorry Accident near Thallada

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