ASSOCHAM SummitChanging dimensions of Publichealthcare in India – harnessingICT enabled care delivery

New Delhi, June 4 - 2014For discussion purposes only

1

Agenda

A. Healthcare in India – An overview

B. ICT in healthcare

C. Piramal HMRI experience

D. ICT enabled care delivery – key attention areas

2

Government

Hospitals Beds Doctors

13,76,0132 1,01,523335,4161

(Hospitals availableincluding CHCs)

Private sector ~10,00,0006

1,2 .Govt hospital & beds information was given by the Union Minister of Health & Family Welfare Shri Ghulam Nabi Azad in written reply to a question in the RajyaSabha august2013; 3. indicates the Number of Government Allopathic Doctors and Dental Surgeons of 2011 India; 4. Per Private Healthcare Sector in India - A Framework for Improving theQuality of Care by PH RAO, where private infrastructure is 58% of total health infra in 2011- assumed the same 5. Assumed Pvt. Bed ratio is 0.82 and grew at 13% CAGR from2010- stats from McKinney report on Indian Healthcare 6. indicate the approximate allopathic doctors as on 2011, http://www.cehat.org/publications/ra01r6.html;7. http://www.ihs.com/products/global-insight/industry-economic-report.aspx?id=1065985237; 8. Worldwide spending on Healthcare report by Emergo Group;

~14,00,0005

India spends INR 33,700Cr7 on health healthcare (2014-2015) and the expenditure hasincreased by 94% vis-à-vis a decade ago8

The Public and private sectors invested in healthcare infrastructure andmanpower……

~58,0004

3Source(s):1.Worldwide spending on Healthcare report by Emergo Group; 2,3,4,5,6,7. WHO World Health Statistics 2013; Immunization coverage is the average % of Measles, DTP3,HepB3;NCDMR: Non communicable diseases mortality rates; CDMR: Communicable diseases mortality rates

148%

133%

94%

72%

138%

120%

112%

174%

Country and healthcare expenditureincrease from 2001-20111

MaternalMortality2

InfantMortality4

NeonatalMortality3

CD6ImmunizationCoverage%5

NCD7

…. but a lot more needs to be done

26 37

32 47

15 25

06 09

02 04

08 11

08 11

12 17

96

64

72

97

99

99

98

95

240

200

220

029

016

035

048

059

344

363

244

185

29

79

153

122

702

685

647

526

355

623

675

607

Bangladesh

Indonesia

India

Malaysia

S. Korea

Sri Lanka

Thailand

Vietnam

4

Beneficiary of healthcare

~31% of population withaccess to

• ~ 70% of care infrastructure

• 4 lakh doctors accross 120 cities1

• multiple formats of care delivery

~ 69% of the population with

• 30% sub centres, 36% PHCs2

functional

• limited available manpower3

only 24% of doctorsonly 47% of nursesonly 12% of specialist doctors

• # PHCs w/o a single doctor : 2,5334

Unaddressed and the underserved

…and a few realities need to be addressed..

Access to care: 31% of Indianpopulation outweigh the rest

1. http://www.moneycontrol.com/news/cnbc-tv18-comments/ims-survey-reveals-skewed-doctor-density-across-india_929890.html

2. McKinsey report on Indian Healthcare3. Why Are India’s Young Doctors Refusing To Serve in its Villages –

Yahoo News 23 Aug 20134. http://www.tenet.res.in/Publications/Presentations/pdfs/Healthcare_in

_India.pdf

5

ICT platforms can play a pivotal role in bridging the gaps

Re-

imag

ine

Re-

engi

neer

Incremental

Purposive disruption

Care Transparency+

Care Traceability=

Care Accountability

Efficiency

Effectiveness

Expansion of care availability

Reduction of care costs

Business model innovation

Benefit Change

The dual benefits of ICT platforms in healthcare

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Health InformationHelpline

Re-imagine thepurpose ofcommunication

Healthcare informationaccess 24 hours,365 days

Covered 416mnpopulation

Care advices providedfor 26mn incomingcalls

Mobile HealthUnits

TelehealthModels

Re- engineerthe services

GPS tracking andunique beneficiarytracking ensuredefficient care outreach

Covered 45mnpopulation

Addressed 13.5mncare seekers

Re-imagine the teleconference platforms

Specialist care and

second opinion access

Change Impact on Care delivery Outcomes (Inception – till date)

Piramal HMRI made attempts to leverage ICT enabled care deliveryplatforms

Screening / diagnosisof at least 5 chronicconditions

Care in neighbourhood to2Lac rural population

7

• OS neutral applications

• Patient UID

• Drug tracking application

• Point of care diagnosis –‘Dox in Box concept’

Piramal HMRI Experience: Key ICT platforms and applications

Tele-health

Health Information Hotline

• VOIP protocol neutralapplications

• Digitized disease algorthirms

• SMSplatforms forprescription

Mobile Health Units

• GPS tracking

• Patient UID and finger prints

• Drug tracking systems

• Human reosurce attendancetracking applications (Androidbased)

• Video based learning platforms

• Digitized learning content (selflearning)

• Voice based learning

Virtual learning platforms

8

Piramal HMRI Experience: A snapshot of ‘on the ground’ care delivery

A Mobile Health Unit passing through difficult terrains toaccess beneficiaries in Assam

A pregnant woman receiving medical advice via teleMedicine in Adilabad, Telangana

Pregnant women board ‘Mobile Unit to reachtelemedicine centre for consultation in Andhra Pradesh

Trained executives attend to basic healthcare queries in ahot line centre in Hubli, Karnataka

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What facilitating role should policyaim and in what direction

What integrated framework is requiredto manage the overall ecosystem

What new integrationapproaches need to be developed

Where is the unused potentialand how to unbundle

Which components need support

How will the human resourceshandle ICT platforms

What areas of skills/training need tobe developed

GovernanceMonitoring & evaluationLegal, technical frameworks

Mobile networkInternet connectivityData compatibility

Device manufacturersTech. playersTelecomNetworkersImplementersFinancersProviders

DoctorsNurses, ANMParamedicsHealthcare workers

Critical factors for success of ICT enabled healthcare delivery: Ourobservations

What hybrid and innovativemodels need to be developed/deployed

How to speed up projects/players fromsuccessful pilot to scale

What optimum mix and scale need to bedeveloped for reducing costs

10

ICT Policy for Healthcare ?

- Remote health monitoring- Tele health - tele-diagnosis, tele-radiology, tele-prescription- Standardization of devices used for POC diagnostics- Standardization of guidelines for POC diagnostics- Communication protocols for monitoring devices- Interoperability and output guidelines for monitoring devices

ICT infrastructure ?

- NOFN at Block level and Gram Panchayat- 2G, 3G availability in hinterland when Urban areas

gear up for 4G

Where is India on the critical factors?

How can other partners collaborate with Governmentto augment care delivery?

- Role of industry- Leveraging execution strengths of PnPP

How can we enhance the capabilities of manpowerto handle ICT enabled care delivery ?

- Building new work force- Models to build the capabilities

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1. Telemedicine Act

2. National standards & State guidelines• Electronic records

• Standardization of devices (POC/rapid diagnosis)

• Clinical data mgmt., data compliance & integrity

3. ICT infrastructure• Rural focus

• Unbundling and optimal use of existing infrastructure

4. Healthcare delivery model (esp Primary healthcare)• Focus on PnPP models for primary care delivery

• Single window clearance for healthcare PnPP projects

• Level playing/preferential access for pioneers during RFQ/Bidding

5. Fostering innovation• National level fora/platforms to contextualize new ICT platforms for care delivery

• Pioneers/inventors/industry to get a representation in planning and execution of new models

• National seed funding for ICT enabled healthcare pilot programmes

6. Capacity building of Health human resources (esp. last mile health workers)• State level platforms (with industry participation) to train manpower

• ICT enabled care delivery leveraging e-learning, voice based learning, podcasts etc.

Key areas of ICT enabled care needing attention

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Piramal Swasthya is a registered non-profit organization based in Hyderabad, Telangana State. Piramal Swasthya is supported by PiramalFoundation and works towards making healthcare accessible, affordable and available to all segments of the population, especially those mostvulnerable. In order to achieve this goal, Swasthya leverages cutting edge information and communication technologies to cut costs withoutcompromising quality as well as public-private partnerships to scale its solutions throughout India and beyond.

Swasthya envisions a future in which all vulnerable groups have the necessary information to make informed decisions regarding their healthand affordable, available and accessible high quality health infrastructure to support the realization of those decisions.

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