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Showcase
Care on Wheels
Serving the healthcare needs of the poor is the objective
behind Mobile Health Unit, an initiative by the Andhra Pradesh Government and
HMRI with technical support from Satyam, Priti Pathak finds out
 To
bridge the yawning gulf between demand and supply in Indian healthcare, technology
has enabled new solutions such as telemedicine, and toll-free doctor on call
that can address healthcare problems at low cost and quickly. However, it is
well known that despite technological interventions, many pockets of our country
remain deprived of basic healthcare facilities.
To make healthcare facilities more accessible to remote villages of Andhra Pradesh,
the Government of Andhra Pradesh and Health Management Research Institute (HMRI)
have joined hands. They have designed and launched Mobile Health Units (MHU)
called '104 Mobile' which provide basic healthcare facilities. The technology-enabled
van offers a range of health services to villagers located beyond three kilometres
of the PHC.
Satyam is enabling much of the technology that drives this operation. Its engineers
designed the vehicles with rural India in mind and have established the infrastructure
to support a rapidly growing initiative.
Instigation
 "This
programme will cater to rural AP addressing maternal & infant problems
& chronic ailments"
- Dr Balaji Utla
Head, Health Management Research Institute
Andhra Pradesh
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 "The
MHU programme is a public-private partnership between the Government of
AP & Satyam"
- PK Agarwal
Principal Secretary
Health, Medical and Family Welfare
Andhra Pradesh
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In 2007, HMRI conducted secondary data research through which
they discovered that a large part of the population residing in the rural areas
of AP is deprived of the basic healthcare facilities due to proximity barriers.
Dr Balaji Utla, Head, Health Management Research Institute (HMRI), Andhra Pradesh
explains, "Information Technology allows the creation of an easily accessible
virtual platform which makes it convenient to deliver healthcare services. The
concept of '104 mobile' was thus designed with the objective of reaching such
people who don't have access to basic healthcare facilities."
The 104 mobile application services focus on pregnant women,
children below five years and people above the age of 40 years, offering them
nutritional supplements, height and weight check-ups, immunisation, ante natal
check-ups, ultrasound, drug distribution and treatment for chronic diseases.
"This programme is expected to cater to rural AP with regards to maternal
and infant problems as well as chronic ailments," shares Dr Utla.
A WHO study shows that of 35 million people who die from
chronic diseases, half of them are under the age of 70 years and half are women.
In October 2007, the HMRI research was followed by a proof
of concept to demonstrate that the proposal is fiscally sound, where they assigned
a van equipped with a team of trained paramedics and some essential medical
equipment like ultrasonography and facilities for blood/urine tests. The van
reached Khammam and Mahbubnagar districts in Andhra Pradesh, where the healthcare
services were offered to pregnant ladies and small children below the age of
fifteen years. This experimental project lasted six months, which gave convincing
results to the HMRI team, and they approached the AP Government with a plan
to establish the MHU.
Technical Ad-Van-tage
At present, there are 32 MHUs running within two districts of AP, namely Mahbubnagar
and Adilabad. These MHUs serve a population of about 3,000 over a period of
28 days. In this way each vehicle is able to visit approximately 56 villages
every month. The same vehicle visits each village every month, thus the fixed-day
approach enables the villagers to adjust their schedules to attend the MHU visits.
Residents of a particular village are informed via posters as to when the vehicle
will show up next time in their village. Each MHU includes a team of paramedics,
which include a pharmacist, a lab technician, three Auxiliary Nurse Midwives
(ANMs) of the AP Government and one computer operator.
When the MHU enters the village, it registers the target group by capturing
a photograph through a web-cam. The photograph ensures that the same person
is attended in the next follow up. Later, a thumb scan is also taken using a
biometric device and assigning him/her an ID card. Biometrics is used to identify
the input sample when compared to a template to identify a specific person by
certain characteristics. The van is equipped with applications that have the
details of the person specific to the location of the services using the upload
and download functionality through the connectivity manager. The new and updated
details of the person are uploaded to the central server everyday.
The vehicles are also equipped to carry various drugs and can store blood/ urine
samples for testing. They even feature a television set that can show public
health education programmes. The services offered by the MHU pertain to pre
and post natal checkups, height and weight monitoring, nutritional supplements
for mothers and children, basic blood and urine lab investigations and screening,
advice and medicine dispensation for chronic illnesses such as diabetes, hypertension,
epilepsy and anaemia.
In case of a seriously ill patient encountered by the MHU, an ambulance is summoned
via the Emergency Management and Research Institute (EMRI), and the sick person
is sent to the nearest Government hospital.
Ministerial Support
The operation has received significant support from the Andhra Government. "The
MHU programme is a public-private partnership between the government of Andhra
Pradesh (AP) and Satyam," states PK Agarwal, Principal Secretary, Health,
Medical and Family Welfare.
Out of the total operational cost, 95 per cent is borne by the AP Government
and the remaining 5 per cent is handled by HMRI. The fixed capital cost is entirely
borne by the Government, including the running cost of the van and the salaries
of the paramedics allotted to the van. The expense derived on each van is approximately
Rs 20 lakh, and the overall cost in this operation adds up to Rs 2.21 crore.
Accredited Social Health Activists (ASHA) is a voluntary service initiative
of the Government engaged for implementation of various health related schemes.
The workers of ASHA are volunteers married into the village. Every village has
one ASHA worker, who is trained to meet the health related issues in their village.
Since each village will be visited once a month on a fixed day for a fixed duration,
ASHA workers circulate the schedule in advance. The ASHA workers efficiently
and effectively deliver the antenatal and postnatal services using the SMS application
on the mobile. These mobiles have been provided to ASHA for capturing the infant,
prenatal and postnatal information and delivering to the central server at HMRI.
The delivered information is analysed based on the algorithm, and alerts are
delivered to the ASHA worker to help her deliver health services.
| The state-of-the-art van is a blend of latest technology
and excellent designing which can reach the corners of the country
GIS The van is equipped with Geographical Information System
(GIS), an information system that allows capturing, storing, analysing,
sharing and managing data. Patient information is stored in the server
to be accessible later when the van visits the same place next time. This
technology uses digital information where a hard copy data is transferred
into a digital medium through the use of a computer aided design programme.
"Since the operation is conducted on a large scale to cover a major
part of the rural population, it is necessary to go with effective planning
to operate the van," says Dr Utla.
GPS
The MHU cannot be sent anywhere any time, thus
thorough planning and research is needed in order to ensure that they
deliver the services at the right time and the right place. This thought
process is practically supported by the Global Positioning System (GPS),
an application that provides reliable positioning, navigation and timing
services to users on a continuous basis. The user has to feed the longitude,
latitude, altitude and the time in the system and this would provide the
information of the location where the van is functional. This software
is designed to plan the route between two locations using a journey planning
engine specialised for road networks as a road route planner. This software
is installed in the central data server which keeps a track of the required
information. As a part of the operational structure, the van should not
travel for more than 50 km per day. The software allows the calculation
of the journey time.
Blood Bank Information System HMRI is in public private partnership with the Andhra
Pradesh State Aids Control Society (APSACS). Whenever blood is donated
at any of the hospitals the blood bank information is updated with the
blood details. So when there is a need of blood one can dial 104 and HMRI
can check the availability of the required blood. This system is aimed
at bringing in transparency and avoiding middlemen and the identification
of the donor. The system connects blood banks in a network through inventory
management system.
Other Services A health portal and e-learning are some other services
that enable training and sharing of information. Integrated disease surveillance
module is designed to monitor and trigger an alert for an epidemic outbreak.
Currently, it covers communicable diseases like cholera, typhoid, malaria,
tuberculosis and chronic diseases. The system collects data through Internet
and SMS by health workers and provides syndrome surveillance, lab data
surveillance and presumptive surveillance.
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Hurdles to overcome
As of now, the main hurdle faced by HMRI is reaching the entire target group.
As per the research done before executing the plan there was a set group of
people to whom the pre natal care was to be delivered. Due to the harvest most
of the women are not available when the MHU arrives at their village. So availability
of the target group to attend the MHU visits is a challenge. More research is
required to overcome this problem, thus ensuring that the MHU services reach
all the focus group.
Since the ASHA workers are located in rural areas, the problem is mobile phone
connectivity. In order to resolve this issue, HMRI is planning to introduce
radio-based phones. They are negotiating with the AP Government in this context.
"Another impediment is to have a team of consistently committed leaders
for the functioning of this operation," informs Dr Utla.
Future Plans
The motive of HMRI is to create a comprehensive virtual healthcare platform,
which is accessible, available and affordable. HMRI aims to expand the reach
of their services by increasing the number of MHUs. Further, the service will
deploy 475 vehicles and cover 50,000 villages in AP by the end of October 2008.
Apart from this, they are planning to collaborate with some private hospitals
in AP. They are also closely working with Satyam on ideas of tele-appointment
for the rural masses. It is well known that the poor do not have access to an
appointment system at the referral hospitals. '104' plans to mitigate the situation
by providing a tele-referral and appointment system to enable the rural patients
to access the referral hospitals so that they can avoid losing wages waiting
for an appointment or disappointment in not being able to access the hospital's
services when they reach them. The service will help the poor from losing wage-earning
days and waiting time for services.
Thus, HMRI is doing a commendable job to address the problems pertaining to
healthcare among the rural population in Andhra Pradesh. This mission is able
to reach the deprived sections. The MHU is the first step for achieving the
mission of HMRI. For them, the journey has just started and the determination
and dedication towards their mission might witness the rise of similar projects
in the near future.
priti.pathak@expressindia.com
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