In my earlier life, while working as an IT engineer/consultant, I had a chance to work on a unique project commissioned by Kerala Tax department. The state’s vision of a more transparent process that yielded better results was a wonderful testimony to what IT can do, provided one has the vision for it.
Last week, I had an opportunity to observe another such visionary initiative in the Indian state of Andhra Pradesh: HMRI. I visited a village to see the operations in person, visited the call center, and then had a subsequent chat with the management folks at HMRI.
So what is HMRI and what makes this project unique? To set the context, I have to explain the state of healthcare in India, and rural healthcare in particular. I am going to talk about the facts as I got them.
So consider this: We have a population of about 1.1 billion. Assuming 4 visits to a doctor per annum we generate a demand of 4.4 billion a year. How many of this can be catered to? At an estimate (HMRI figures), only about 0.5-0.6 billion is catered to by the public healthcare, another 1.0-1.1 billion by the private sector. So, there are between 2.8-3.1 billion who are either treated by unqualified practitioners, or not treated at all.
While I wrap my head around these staggering numbers, I also ponder on the why. Of course, in many regions/states in India, it is the general apathy and corruption in the public sector. This coupled with the lack of the right incentives for health care personnel to go to the villages, should explain some of these stats.
Then how are we to achieve universal healthcare? Aha, that is where HMRI steps into the picture. The central idea is based on factual observations about the healthcare demand cycle. A majority of the visits to healthcare professionals are routine ‘reassurance’ visits that can be catered to by registered trained nurses, a few need the attention of a qualified doctor, and a very few are emergencies. So, HMRI was initiated. It has two central lines of operation: A toll free hotline (104), and a contingent of mobile vans.
I observed both the operations at first hand. First the village where one of the vans was stationed for the day. It was indeed very interesting to see the villagers being taken care of – registration (state of the art, using biometric software), initial height and weight check up, then BP then other tests if so needed, and even a pharmacy counter. The efficiency of the whole operation was astounding! And it is free! A van rounds up a village once a month, and for up to 8 hours for a population of 8K. This is especially useful for routine care (as in pre-natal), and chronic ailments. Serious cases are referred to either emergency care or sent on to a doctor. Considering that many of these villages did not have access to any medical facility whatsoever, this once a month is a blessing!
Even more interesting were the phone operations. The call center handles a volume of as much as 27K valid calls a day, and caters to people in AP region in three languages: Hindi, English, and Telugu. Amazing! People can call in and get advice on problems ranging from acne to severe trauma, and get counseled by qualified professionals, including psychiatric advice for suicide cases – which they follow diligently up! It surely doesn’t get any better than this. And free!
So how does IT come into picture? Hah! Thought you would never ask! Whether it is the mobile van or the call center, the data are fed into a sophisticated database and help with trend watching and predictions. The data also help fine tune the algorithms that aid call center operators. And, of course, the IT artifact is hard to miss, the scale of operations, the supply chain, and data analysis would have been hard to do without IT.
In the end, however, IT has been an enabler, no more. It takes vision to get this going. It takes innovation to come up with this novel approach to universal healthcare.
Good job HMRI!
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