new directions in rural healthcare

New Directions in Healthcare

Nachiket Mor, Ph.D.Member, Board of Directors, ICTPH

OECD ConferenceNew Delhi, June 14th, 2011

About ICTPH

An action-research centre focussed on finding durable solutions to challenges of healthcare in Rural India

Set up by IKP Trust

Headquartered at IKP Knowledge Park, Hyderabad (200 acre R&D, Incubation Facility within the Genome Valley)

President: Dr. Zeena Johar

Chairman of the Board: Dr. Ramesh Mashelkar

Healthcare Challenges

Inadequate infrastructure

Low quality of care

Insufficient human resources

High out-of-pocket expenditure at point-of-care

Healthcare system not patient or wellness focussed

Need for policy level as well as field level innovations

ICTPH Research Focus

Infrastructure

Interventions

Human Resources

Financing

Desired Infrastructure

A well provisioned health-centre at 8,000 to 10,000 population level with ability to deal with a wide range of conditions

Technology to allow for:

Accurate diagnosis

Appropriate treatment

Quality control

Comprehensive enrolment and risk screening for landscape epidemiology and risk factor tracking

The ICTPH Approach

• Clear identification of service area

• GPS Enabled Android Mobile Phones

• Rapid enrollment and risk screening

• Geo-tagging

• 10,000 individuals in 7-10 days

Chelampatti

KarkaripattiAndipatti & Mudalipatti

Ayyampatti

Pachur

Kotaitheru

UppundarpettiThekku

Adanakottai

Geo-tagging and ID Card

Rural Micro Health Centre

One rural RMHC for 10,000 population

Vision, Dental, Cancer

Internet, Computers, HMIS

Blood collection

Drugs & Diagnostics

Haematology: Complete Blood Count (KX 21)

Biochemistry: Glucose, Lipid Profile, LFT, KFT (Chem 7)

Strip Tests: Malaria, Pregnancy, Urine

THERAPEUTIC ACTIVITY CLASS NUCLEUS MOLECULE FORMULATION STRENGTH

ENDOCRINE SYSTEM

Anti Diabetic Biguanide Biguanide Metformin HCl Tablet (500 mg)

Anti Diabetic Sulfonyl Urea Sulfonyl Urea Glibenclamide Tablet (5 mg)

Anti Diabetic Sulfonyl Urea Sulfonyl Urea Glimepiride Tablet (1 mg; 2 mg)

CARDIO VASCULAR SYSTEM

Anti Anginal Isosorbide trinitrate Tablet (10 mg)

Anti Hypertensive Calcium Channel Blocker Dihydropyridine Amlodipine Tablet (5 mg; 2.5 mg)

Anti Hypertensive Angiotensin II Antagonist Losartan pottassium Tablet (50 mg)

Anti Hypertensive Beta 1 Receptor Blocker Napthalene Atenelol Tablet (50 mg)

Diuretic / Anti Hypertensive Loop Diuretic Anthranilic Acid FrusemideTablet (40 mg); Injection (10 mg / ml)

Diuretic / Anti Hypertensive Sodium Chloride Symporter Benzothiadiazine Hydrochlorthiazide

Hyperlipidemia HMG-CoA Reductase Statin Atorvastatin Tablet (10 mg)

ICTPH Protocol Linked Essential Drug List (67 Single Formulations)

ICTPH Research Focus

Infrastructure

Interventions

Human Resources

Financing

Desired Interventions

Wide range of conditions

Standardised treatment

Rational prescriptions

Focus on risk factor management and early interventions

Patient removes footwear and enters RMHC

Guide-Patient Protocol

Is the patient a pregnant woman?

Physician-Patient Protocol

Yes

No

Diagnostic Tests

Procedures:•   Nebulisation• Suture• Suture Removal• Dressing (Minor/major)• Injections• IV’s

Consultation:1.Physical Examination

2.SOAP Methodology• Subjective• Objective• Assessment• Planning

ICTPH ApproachR

MH

C

Disease Management

Diagnostics

Screening

Vision

Dental

Interventions

Emergency Management

Physician-Patient Protocol

Allows heightened diagnosis of disease:

Standardized format - signs & symptoms, diagnostic tests, treatment, and prevention (specific to a disease/condition).

Pictures to allow visual confirmation

Physical assessment protocol allowing targeted disease & condition specific physical examination

Otitis Media

Risk Factor Assessment

Condition Management

Diseased

Risk Factor

s

Normal

Population

PISP

Infant Nutrition Supplementation

Is your child between 6-24 months old?

We recommend Sprinkles micronutrient powder

Unless you child has one of the following:

Acute infection Severe Anaemia Severe Acute Malnutrition

Iron (12.5 mg) Zinc (5 mg) Folic Acid (160 µg) Vitamin A (300 µg) Vitamin C (30 mg)

ICTPH Research Focus

Infrastructure

Interventions

Human Resources

Financing

Human Resources Challenge

Unwillingness to serve in rural locations

Inadequate supply of MBBS doctors

High salary & support costs

Poor quality of care

Recruit licensed Ayurveda and Siddha practitioners (BAMS, BSMS) Offer bridging certificate course in modern medicine Combine with a general induction program & soft skills training

ICTPH Approach

Clinical processes (HMIS, PISP & pre – consultation protocols), Basic Procedures

Physiology, Patho-physiology, Diagnosis & Standard Treatment Protocols

Pharmacology, Medication and Diagnostics and Procedures

Clinical Practice Gastro-intestinal Respiratory Cardio-vascular diseases Cancer Diabetes Dermatology Musculo-skeletal Ophthalmology Dentistry Diagnostics

Structured Environment

Certified Physician

Health Extension Worker

Real-time HMIS data entry

Real-time Centralised Audit

ICTPH Research Focus

Infrastructure

Interventions

Human Resources

Financing

Financing Challenge

Low levels of pre-payment

Entirely a fee-for-service model

Standalone insurance schemes such as RSBY are well run and therefore run the risk of:

Relative over-supply of higher levels of care

Not focussed on wellness

Expenditures could tend towards 100% utilisation

ICTPH Approach

HMO / ACO approach towards integrated primary, secondary and tertiary care

Strong focus on risk factor management and gate-keeping function at the primary care level

Move away from FFS and OOP to capitation and pre-payment models

Overall annual costs to remain below Rs. 1300 ($30) per capita per year (2.6% of GDP)

Thank You