INNOVATION VPiramal e-Swasthya

General Health Condition in IndiaIn 2002 investment in healthcare was only 0.9% of the total GDP. In 2003 the patients treated for malaria were 1.65 million, for leprosy there were 2.4 million people and there were 214 cases of polio. In 2001 India received $1,705 million as aid for the healthcare programs which were only 2% of the total healthcare expenditure by the government. But most of this money go into urban areas and only a small amount is used by the rural areas

Insufficient expenditure on healthcare

HEALTH CARE EXPENDITURE

Pharmaceutical DrugsHealth Services

75%

25%

Inadequate human resource

Density of Doctors per 1000

Density of nurses per 1000

0

5

10

15

20

25

30

GlobalIndiaSouth east asia region

14

6 5

28

1113

Fall of rural Health Infrastructure According to the recent National Rural Health

Mission report nearly 8% PHC don't have a

doctor while nearly 39% were running without a

lab technician and about 17.7% without a

pharmacist.

The PHCs are supposed to have one medical

officer supported by paramedical staff.

.While not a single PHC of UP's 3,660 PHCs have

either a labour room or an operation theatre.

The number stands at 208 labour rooms (13%)

Moreover there is a shortfall of 70.2% specialists

at the CHCs.

Rural-Urban imbalanceNHA(2004-2005) Report Government expenditure on family welfare and

other heakth services

RURALExpenditure

of 52,970 million rupees

URBANExpenditure of 92,408 million

rupees

Piramal e-SwasthyaVISIONTo Democratize Healthcare

MISSIONTo provide reliable, high quality and affordable primary healthcare to no-doctors zones of Rural India

GOALTo enable services in 100000 villages by 2013

An initiative by Ajay G Piramal Foundation and a subsidiary of Piramal Healthcare. Inception in 2008Offers a Scalable and Sustainable breakthrough in healthcare delivery models at rural level.Developed in partnership with Prof. Nitin Nohria of Harvard Business Model.Uses innovative approaches of healthcare delivery like Telemedicine, Clinical decision support systems and village based health entrenpreneurs.

ObjectivesPiramal e-Swasthya attempts to make affordable healthcare accessible to India’s rural communities using technology through a sustainable and scaleable service model

AFFORDABLE HEALTHCARE

oUse of TechnologyoSustainable Service Models

eSwasthya Working ModelLocal literate women (Piramal Swasthya Sevaks) are recruited undergo a rigorous training programme in which they are trained to collect simple diagnostic information, preventive medicine, first-aid and customer service.

These women are given a medical kit, marketing material and a mobile phone. They are then assisted in setting up a tele-clinic (Piramal e-Swasthya Centre) at their own homes.

Villagers who feel ill come to the Piramal e-Swasthya Center or are visited by the Piramal Swasthya Sevak. After talking to and examining the patient, the health care worker communicates this diagnostic data through a cell-phone to a centralized call centre.

At the back end, a call centre worker enters the information provided into a simple e-diagnosis system, which generates an automated response with the recommended prescription and treatment. Doctors manning the call centre also validate this.

The total treatment costs between Rs.30 - Rs.50 depending on the medical condition.  The Piramal e-Swasthya Centre is also a village level pharmacy stocked with medicines necessary to fill the basic prescriptions recommended by the call centre. If the ailment appears serious, the call centre recommends that the patient visit a secondary or tertiary healthcare facility immediately.

The healthcare worker also conducts preventive health workshops, which generate awareness about issues such as sanitation, nutrition and first aid.

Working Model

Approving doctors

Differentiation

Parameter Quack Pvt Clinic E-swasthya

Treatment of time Immediate Delayed ImmediatePractitioner Qualification Unknown Doctor Doctor+CDSS

Treatment Quality Questionable High High

Medicine Quality LowPharmacy Dependent High

Patient Care None Low High

Cost of ServiceAffordable to high High Affordable

Loss of time Minimal High Minimal

Strengths & Challenges of the Program

STRENGTHS

Quality treatment at doorstepEasier Access to a doctorNo spurious drugsHigh Quality treatment at affordable ratesStrong social impact by giving employabilityLong term scalability & Sustainability

Infrastructure issues in rural areasUnavailability of skilled human resource at remote areasRecruitment of PSS is a long drawn processLow MarginsLow income for PSS

CHALLENGES

Telemedicine & CDSSThis innovation in service removes the distance

barrier in rural healthcare through cutting edge

technology.

PSS uses mobile to dial up the Nucleus, a

telemedicine call centre manned by paramedics &

doctors.

Paramedics receive the calls and enter information

into web based Clinical Decision Support

System(CDSS). This has been developed with TCS.

CDSS is state-of-the-art clinical diagnosis platform

that automates the generation of provisional diagnosis

and prescription.

Doctors review CDSS generated diagnosis.

Prescription communicated to the PSS over the

phone and SMS and she dispenses medicines from the

kit provided.

Piramal Swasthya Sahayika(PSS)

Promoting Health Entrepreneurship and Woman Empowerment.PSS recruits and trains and deploys village based women health entrepreneurs, Piramal Swasthya Sahayikas, who enable healthcare access to rural patients.eSwasthya centre is set up in her own homePSS undergoes a 5 day training programme on how to conduct basic health service, use digital equipment, handle mobile usage, accounts and counsel patients.PSS gets 20% of the consultation fees.A field supervisor appointed by Piramal oversees the PSS

Sandbox

eSwasthya -Sandbox

Global Scale

The eSwasthya model of

healthcare can be scaled up

even on a global platform.

The CDSS technology can be

used at any level along with

telemedicine.

Social Equity Focus

Eradicates the distance

between good and reliable

healthcare and rural

patients.

Makes access to

healthcare affordable

Healthier rural population

Empowerment of women

under PSS.Environmental SustainabilityThe eSwasthya model does not hinder the principle of

environment sustainability.

Transparency in TransactionsUnder the aegis of Piramal Healthcare, the reputed pharma major, eSwasthya maintains fair accounting practices.

New Price – Performance LeveleSwasthya provides affordable medical services which range from 30rs to 50rs, depending on the type of treatment.At this low price quality is also mantained.

Rule of Law – Individual RightsPiramal eSwasthya promotes the lawful practice of medical services.It helps in eliminating quacks and maintaining the authenticity od healthcare services in rural lands.

SANDBOX continued

Growth

2008Starts pilot and operational formats across villages of Rajasthan and Tamil nadu

2009Awarded ISO 9001:2008 Certification for its Quality Manageme-nt Systems

2011>eSwasthya steps into first phase of scaling up and will design models in partnership with government, NGO and private players>Given treatment to over 40,00 patients, trained 200 health workers,employed 150+ people and continues to operate in 50 villages

Piramal-Asha Model:Way forwardFirst partnership model that Piramal eSwasthya is

launching in 2011.

Objective is to enable Government(NRHM) appointed

ASHA Sahyoginis to provide telemedicine services in their

villages.

PPP model with district administrations to enable ASHA

volunteers work as PSS and leverage benefits of ASHA

model an contain its limitations.

Pilot project launched in Churu district aministration,

Rajasthan for 100 villages of Tarangpur block.

Benefits of Piramal-ASHA modelBENEFITS TO eSWASTHHYA• Overnight

scaling upto lakh villages with multiple PSS options in each

• Reduction in manpower requirement and infrastructure

• Government indemnification against legal issues

BENEFITS TO VILLAGE• Availability of

quality medicne at doorstep

• Access to qualified doctor

• Realistic first service point for all Piramal Care needs within villageB

BENEFITS TO ASHA/GOVT.• Load on govt.

infrastructure reduces.

• Operational management expertise from private players

• Potential to abolish quackery

Impact

QUALITY HEALTHCARE ACCESS IN RURAL AREASHelps in removing QuackeryHelps in improvement in general levels of health in rural areas

RURAL ECONOMIC DEVELOPMENTWage earners eliminate the loss of daily wages due to time consumed in travelling to cities for treamentSavings from travel costs and high medical fees charged by private players

WOMAN EMPOWERMENTThrough training of PiramalSwasthya Sahayikas rural women are enabled to earn a living as PSS get 20% of consultation fees

BRIDGING THE URBAN-RURAL DIVIDE IN HEALTHCARE FACILITIESThrough Telemedicine technology and systems like the CDSS, Rural India can share same medical facilities as in urban areas at their doorstep

Thank You

TEAM SCAMPERSomya BhargavaShaurya Bhushan TyagiSonali AbrolSukesha Sajwan