Express Public Health Awards 2016, held concurrently with Healthcare Sabha, recently honoured several public and private organisations for their excellent work to improve the public health sector in India. Piramal Swasthya Foundation won the Jury Choice Award for Corporate Contributions to Public Health at the event for their Asara Tribal Health Program. Col Kanwar Badam, VSM Head, Piramal Swasthya Foundation, divulges more details of the project, its impact, their other initiatives in the public health space and the way forward to revolutionise public health in India, in an interview with Lakshmipriya Nair
Congratulations on winning the Jury Choice Award for Corporate Contributions to Public Health at the Express Public Health Awards 2016. What are the plans for this project in the next two years? How do you plan to scale it up?
The Asara project in Araku (Andhra Pradesh) is the flagship project of our NGO which is fully funded by the Piramal Foundation. The uniqueness of this project lies in the fact that it is an outreach programme to provide comprehensive integrated mother and child care in extremely difficult areas of habitation in the tribal belt. Currently, our team of paramedics cover about 180 habitations on motorcycles and on foot to reach the last mile through dense forests and mountains to serve the tribal communities in Araku mandal. Paramedics are provided with tablets for registeration and maintaining electronic health records. They are equipped to conduct field level diagnostics, identify high risk pregnant women and recommend cases for specialist consultation through the telemedicine centre established by us. Our intervention in the last few years has positively influenced the causes of morbidity and mortality in pregnant mothers and reduced the maternal and infant mortality to almost zero level. We intend to scale up our model to the neighbouring mandals which are inadequately equipped with maternal care facilities and have higher maternal mortality rates. In the next five years, we plan to reach about 5000 + pregnant mothers requiring antenatal care for facilitating safer deliveries and reducing maternal and infant mortality.
What is the model used for deploying this project? How do you measure its efficacy?
Asara Tribal Health Program is an integrated model focused on reducing maternal mortality rate (MMR) and infant mortality rate (IMR). It comprises an outreach programme, specialist consultation through telemedicine centre, diagnostics, counselling service, distribution of medicines and transportation of pregnant women. Paramedic staff are trained to counsel and develop health seeking behaviour in the tribal population besides building relationship/ networks with the ASHAs/ ANMs, anganwadi workers and community leaders. Group behavioural communication sessions are held to educate them on healthy practices to be followed during and post pregnancy. High risk pregnancy cases are identified for special care. Referral cases are transported to telemedicine centre, where they receive the specialist consultation. The emphasis is on ensuring that all pregnant ladies go through minimum three antenatal checks leading up to institutional delivery.
We have succeeded in identifying and managing 2000 + high risk cases over a period of five years. Our sustained efforts and commitment has increased institutional deliveries from 18.53 per cent to 61.09 per cent. Out of 61.09 per cent, 97.1 per cent of these women have delivered healthy babies with weight >2.5 kg (at birth) with no maternal deaths in the last two years. All these indicators are very encouraging and describe the efficacy of our programme.
Which are the other projects handled by Piramal Swasthya in the public health space? Which state governments/ government organisations are you partnering with for these projects?
We are running various health service lines in India in partnership with the state governments under the PPP model. These are health information helplines (universally accessible health information by a phone call), telemedicine services (connecting patient to specialists in remote locations), mobile medical units (MMU), medical van services to interior villages and primary health centres (PHC). As on date we have presence in 11 states and partnership with state governments in nine states (Assam, Arunachal Pradesh, Jharkhand, Chhattisgarh, Maharashtra, Himachal Pradesh, Rajasthan, Andhra Pradesh and Karnataka) for running various health services. Besides this, we are also partnering with international NGOs and public/ private and MMU-based health service under the CSR initiative with the public/ private sector
What are the major challenges in the Indian public health space? How does Piramal Swasthya playing a role in mitigating some of those gaps?
Increasing population, rising life expectancy, increasing burden of non-communicable diseases and higher costs for medical care pose big challenges in the public health space in the country. At over eight per cent GDP growth in recent years, India is one of the fastest growing economies in the world in terms of GDP and is expected to be the third largest economy by 2050, but India’s total expenditure in healthcare as a percentage of its GDP is still one of the lowest in the world. Lack of a holistic approach, absence of linkages with collateral health determinants, inadequate infrastructure and human resource especially the doctors, lack of commitment, accountability and financial muscle are some of the challenges in Indian public health space.
Piramal Swasthya brings in commitment, dedication and determination to deliver at the last mile despite challenges. We leverage on Information and Communication Technology (ICT), use telemedicine to facilitate the provision of specialist care reaching remote corners of our country, reduce beneficiary out of pocket expenses and their footfall. Above all, it is our strong commitment, belief and passion towards the cause of delivering quality health services to the most underserved people of our country. Since 2007, Piramal Swasthya has served 67 + million people in the country, providing primary and preventive care through various health service lines.
PPPs in healthcare have seen mixed success in India. How has the PPP model worked out for Piramal Swasthya? Based on your experience, what can be done to create more workable synergies between public and private stakeholders in healthcare?
The delivery of quality healthcare is a universally complex and challenging task. By our commitment, credibility and quality of service we have successfully built synergies with various state governments. However there is a need for state governments to undertake Information, Education and Communication (IEC) activities more extensively for full optimisation of various health services provided by the state through the PPP model. States must also involve participation of communities and facilitate linkages with health workers like ASHA and ANMs for better co-ordination and monitoring of pregnant ladies and neonates.
The big sore point in working with the state government is non-clearance of bills in a regular and time bound manner. The billing cycle in most cases is on a quarterly basis and realisation of the same on an average takes up to 45 days. This implies that there is a requirement of huge corpus to sustain operations for four to five months without any realisations from the state. Besides this, there is a lot of documentation to be put up with our invoices which makes it cumbersome. Much of our effort goes into collecting receivables instead of focusing totally on beneficiaries. The states must devise systems to address this problem realistically. A provision should be introduced to make advance payment up to 50 per cent in the beginning of the billing cycle to the service provider.
Any new projects in the offing? If yes, please elaborate on them.
Our new projects are as follows:
Integrated Software Application: In Telangana, a proof of concept (POC) is being tried out for an integrated software application in which a unique identification is created for each beneficiary. This data is uploaded on the server and is available at multiple service points e.g. MMU/ telemedicine centre/ PHC. The beneficiary can appear either at MMU/ PHC/ tele-medicine centre however his electronic health record (EHR) will be available at all service points. Beneficiary will be tracked based on the unique identification number at any of the service platforms. This will ensure better tracking of pregnant women and non-communicable diseases cases.
Saturation model in Karnataka: In Karnataka, a saturation model has been proposed where Piramal Swasthya will be made responsible for the complete health apparatus of the state at the primary level in a limited area of a mandal/taluk. All the health services e.g. MMUs, telemedicine centre and primary health centres in that area will be managed and monitored under our supervision to capture hundred percent pregnant women and NCD cases. Leveraging technology and introducing efficient protocols in running various service health lines in the limited area and population, our intervention is expected to bring in more efficiency and accountability which can be assessed with impact measurement over a period of time.
Both the above POCs are going to be replicable and scalable once the results are measured in terms of reduction in MMR, IMR and NCD cases.