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Saturday 24 November 2012

The Real India-mHealth & beyond Part 3


Tuberculosis- TB is caused by a bacterium, Mycobacterium tuberculosis, that the WHO says infects one third of the world’s population. Between five and 10 percent of infected people develop the disease and become contagious at some point in their lives. (For those with HIV or AIDS, however, the rate is much higher.)

The Bigger problem- India is the highest TB burden country with World health Organisation (WHO) statistics for 2010 giving an estimated incidence figure of 2.3 million cases of TB for India out of a global incidence of 9.4 million cases. The WHO statistics also show that India is 17th out of the 22 high burden countries in terms of TB incidence rate. The estimated TB prevalence figure for 2010 is given as 3.1 million. It is estimated that about 40% of the Indian population is infected with TB bacteria, the vast majority of whom have latent rather than active TB.
Compliance issues in Treatment- To treat TB, the WHO recommends the so-called DOTS (Directly Observed Treatment Short-course) strategy, where patients take medication under supervision from health staff. Daily supervision of treatment is too demanding for most of our patients and instead implements self-administered therapy with patient education and support to ensure adherence. In many countries affected by conflict, access to health structures is limited for the population. Conflict interrupts travel and makes people fearful of leaving their shelters to seek assistance. It can also lead to the collapse of existing health systems.In India in 2010 292,972 people needed TB re-treatment because of initial treatment relapse, failure or default.

In Focus- Operation ASHA

Operation ASHA is a registered non-profit that has taken TB treatment to the doorsteps of 5.37 million individuals living in disadvantaged areas. It operates in over 2,053 villages and slums in six states spread across India and Cambodia. The effort is self-sustainable and is using technology to reach out to millions everyday.

Establishing Centres- Operation ASHA establishes tuberculosis (TB) treatment centers within existing community locals (for example, strategically placed shops, homes, temples, or health clinics). Under the World Health Organization’s Directly Observed Therapy (DOTS), patients must take their medicines under the supervision of a health care worker. The model is designed to help patients procure their medicines conveniently without wasting time, spending money on transport, and losing wages. This also drastically reduces the effort, time and money that patients have to invest in taking their medication, which is key to ensuring that patients complete the entire course of treatment.

Training- Operation ASHA trains community members (often former patients) to become tuberculosis health workers who are responsible for identifying new patients, ensuring adherence to the drug regimen, and carrying out regular educational campaigns. Operation ASHA works closely with the Government of India, who provides them with free medicines and diagnostic services. After a center has been established for two years, the government provides a grant for every patient cured, making OpASHA’s centers financially self-sustaining.

Building Compliance through technology- Ensuring patient compliance is important because of the threat of multi-drug resistant tuberculosis (MDR-TB), which has become one of the world’s largest public health issues. Resistant strains of the disease can take up to two years to treat (in comparison to the standard 6 month regimen). Second line medicines have more severe side effects and can also cost 50-200 times more. Such unrealistically high costs are essentially a death warrant to those below the poverty line. To combat the rising MDR-TB epidemic, OpASHA launched eCompliance, a biometric initiative in collaboration with Microsoft Research, which uses fingerprint scanners to track patient visits.


The system consists of three parts: 
  • a netbook computer, 
  • a USB fingerprint reader (from Digital Persona), 
  • and a GSM modem that uploads the visitation logs (via SMS) to a central location. 


Patients scan their finger every time they take medication, and these logs are visualized in the central office to monitor medication delivery. Missed doses trigger an SMS notification to managers, who ensure timely supervision or counseling to the patients and health workers involved. The health worker is then required to do a follow-up visit within 48 hours to deliver the medicines and supplementary health education. 

These home visits are also confirmed by biometrics. Currently the terminal is used daily in over 40 treatment centers, spanning Delhi, Mumbai, and Jaitpur; Operation ASHA is aggressively expanding the deployment to over 225 centers around the world. To date, the technology has enrolled about 2,700 patients and logged over 50,000 supervised doses. The biometric records are used to automatically generate reports to the government and other stakeholders.

With the help of eCompliance, Operation ASHA has reduced its default to 1.5%, which is much lower than other institutions. The cost of treating a patient for the entire therapy of is US $50.


References/Credits:

TB statistics of India- TB India 2011 Revised National TB Control Programme Annual Status Report, New Delhi, 2011 www.tbcindia.nic.in/documents.html#

Doctor without borders- http://www.doctorswithoutborders.org/news/issue.cfm?id=2404

Operation ASHA- http://www.opasha.org/



Saturday 10 November 2012

The Real India- mHealth & beyond (Part 2)


Read The real India- mHealth and beyond- part 1 here



Doctor on Call Services-
Rural India- The Doctor to patient ratio in Bihar is 1:3500, which is far behind the national average of 1:1700. Bhore committee, set up to recommend improvements in the Indian Public Health system, had suggested a ratio of 1:1000. It is felt that without addressing this problem, all promises made by the state government will remain a distant dream. 

There are around 30,000 registered doctors in the state – both government as well as those engaged in private practice. The condition is more or less same in the state of AP (Andhra Pradesh)  as well. In AP, around 6 lac (6,00,000) people go untreated every day.

Mediphone- A great example of 3 different stakeholders joining hands across the value chain in India. Medibank (Australia) ties up with Religare Technologies (A Fortis Company) and Airtel for launching the service to provide Medical prescription in less than $1 across India.

Service positioned for:
1. Middle class population especially in Tier 1 cities where access to health information is there but people demand convenience and don't wish to drive down to a clinic for trivial issues especially in the wee hours. Hence Consumer is willing to pay for a service where he can get OTC prescription over the phone for conditions like stomach ache, Headache and food-allergies.
2. Population in Tier 3 cities where access to health information is not much, there are myths around certain conditions, patients need second opinion and counselling to make informed decisions and where acute health services aren't available 24X7. Hence Consumer is willing to pay for a service where health specialists can help understand these conditions and available treatment methodologies better.
3. Home bound and elderly population that needs long term continued care and attention.

Service is now evolving to:
1. Set up Helplines in conjunction with state governments for rural people as well as for the under-served across India.
2. Develop mHealth apps for mobile phones for population that wish to browse, read and understand health information and then impart it to the whole community (like Aanganwadi, ASHA workers). Also, develop apps for premium smart phones.
3. Provide Health classifieds services "Healthline 24X7" for finding the right doctor say 0.5 miles away from your house, look for a clinic that accept credit cards and Paediatric doctor who does home visits.

STARTUP Idea- By 2020, it is estimated that depression will be the second biggest cause of morbidity after heart ailments, as it triggers various other diseases by lowering immunity and increasing malignancy. Unfortunately, in India, people don’t take the disease seriously and it goes untreated in almost 80-90 per cent of cases due to stigma, myths, and lack of awareness. Even though crores of rupees have been sanctioned for National Mental Health Programme, the money does not reach where it should because of corruption. 90% depression cases stay untreated in India. We need a dedicated HELPLINE for supporting depressed patients in India today.

Potential: There is a great potential for this. Depression is the most common mental ailment after anxiety disorder afflicting around 15-20 per cent of the population. An estimated 75 per cent of people who commit suicide are found to be suffering from depression. With treatment, 70-80 per cent of depression cases can be cured. If neglected or left untreated, depression increases steroid levels, which in turn reduces immunity, decreases bone mineralisation leading to osteoporosis and early arthritis. In the long run, it increases the risk of malignancy, heart attacks, and decreases the chances of recovery from chronic and cardiac ailments by 2.5 to 3.5 times.

To be continued..........Ideas welcome...........


Friday 2 November 2012

The real India- mHealth and beyond ICT


After spending 20 days on-ground with PHCs and while supporting some of the major initiatives in India, I was tempted to do some cut-throat analysis. I realized that 25% of the total Income generated in India is in the hands of mere 100 rich families. What's more! this huge gap is increasing day by day. After independence, the valley has only widened up between the rich and the poor and the growth that we envisage is still miles away from the hands of a common man.


Photograph courtesy @Shashwat Nagpal
Over 72%  (that would be over 620 million) of India’s population lives in its 638,588 villages. It is hard to believe but in India, a common man is most indebted to healthcare after dowry. Most families earn less than $1/day and some of the major initiatives by NGOs suffer as there is so much distrust about Government policies and efforts in the country.

In villages, healthcare in India still starts from Security, clean drinking water, better sanitation facilities and good roads. Then comes the demand for basic access to healthcare. ...

There is 1 doctor per 1000 people, but there are 3.3 million NGOs, i.e. 1 NGO per less than 400 people in India. As per 2011 stats (World Bank), the % of GDP contributed to healthcare in India is 4.2. We are laggards and countries like Afghanistan (7.8%), Yemen Rep.(5.2%), Uganda (9%), Nepal (5.5%) are doing much better than us. The count of NGOs is many times the number of primary schools and primary health centers in India. My intention here is not to blame the Government here but to help understand the ground realities better.

Most of India’s estimated 1.2 billion people have to pay for medical treatment out of their own pockets (That is more than 80% of the total health expenditure as per 2011 stats) . According to a report by the Federation of Indian Chambers of Commerce and Industry- Less than 15% of the population in India today has any kind of health-care cover, be it community insurance, employers’ expenditure, social insurance etc. One of the major reasons that India’s poor incur debt is the cost of health care. Ajay Bakshi, a good friend and CEO of Max Healthcare mentioned, "We charge our patients about $400 to $500 per night in our hospital. But rather than treat one million customers at this rate, how do we instead treat 100 million customers at $10 per patient? The move from a high-ticket, low-volume operation to a low-ticket, high-volume operation is very difficult. Nobody in our industry knows how to do this.”

The question hence is, Can mHealth bring down healthcare costs? Is it a far-flung reality for the common man or feasible? The answer is YES. Here I am mentioning one such Case study that will help us understand the revolution mHealth can bring to India's otherwise waning healthcare system.


E-HealthPoint- E-Health Point combines water and wireless to provide healthcare in rural India- E Health Points (EHP) are units owned and operated by Healthpoint Services India (HSI) that provide families in rural villages with clean drinking water, medicines, comprehensive diagnostic tools, and advanced tele-medical services that bring a doctor and modern, evidence-based healthcare to their community. They provided 4 basic things:
1. Rural broadband
2. Good telemedical software
3. Modern point-of-care diagnostics mobile diagnostics
4.  Cheap water treatment

This is a for-profit social enterprise. They pay their doctors about 30,000 INR per month.  They pay their village health workers as well.  They pay their unit staff that they hire and train from the village.  They also re-cover those costs with patient fees.That's what's amazing - that they were able to do a reasonably good service, in an area where there wasn't any, and make enough to cover their costs.  That's what's revolutionary - that it's sustainable.

To be continued..Ideas welcome..If you wish to share your views via our questionnaire, Take our Survey http://www.surveymonkey.com/s/88HTCN2


References: http://data.worldbank.org/indicator/SH.XPD.TOTL.ZS
http://www.indianexpress.com/news/first-official-estimate-an-ngo-for-every-400-people-in-india/643302/1
http://www.telecomtv.com/comspace_newsDetail.aspx?n=49444&id=e9381817-0593-417a-8639-c4c53e2a2a10
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