Affordable Best Services in Healthcare- India Perspective

Affordable Best Services in Healthcare- India Perspective

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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.

 Picture1 (1)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 Inde-health-pointia- 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.

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.

Airtel-MedifoneMediphone– 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.

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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