Author(s) & Country
Mr. Vishal Phanse; Dr. Shailendra Hegde; Dr. Ranga Prasad; Mr. Nitin Rathnam; Mr. Devesh Varma
Sub Category (Quality, Equity, Dignity)
Overview Paragraph (Max 150 Word)
Community health is one of the focus health segments of Piramal Swasthya. Through the community outreach program, we are delivering health services to more than 50 million beneficiaries across 14 states. This has been possible through partnerships with governments and corporates, and by leveraging technology. Governments acknowledge that the community outreach program complements the existing public and private health system by reaching the most unserved and underserved vulnerable sections of society. With an experience of operating large scale operations through mobile medical vans, we have achieved operational excellence and also documented the best practices. The Community Outreach program has two models. The Nurse led model called the “Sanjeevani Village Health Outreach program in Assam was started in 2011. The once a month, fixed date outreach initiative is operational throughout the state with 80 mobile medical units. The Doctor led model - Chandranna Sanchara Chikitsa in Andhra Pradesh was rolled out in 2016 which includes 292 mobile medical vans covering all 13 districts.
Piramal Swasthya also operates Mobile medical Units for multiple public and private sector organizations as part of their corporate social responsibility (CSR) interventions, in other parts of the country.
Reaching the unreached to deliver high quality preventive, promotive and curative health services through a community based approach using high impact solutions and by leveraging technology.
Background (Max 200 words)
India is a country of diversity and nearly 70% of its population resides in rural and remote areas with very limited or no availability of healthcare services. Distance to healthcare facilities, geographical constraints and tough terrain adds on to the challenges in providing healthcare in India. Community Outreach Program aims to alleviate this challenge, by providing healthcare to vulnerable sections of the community and tackling barriers faced by rural and tribal people in accessing primary healthcare very near to their places of residence. Piramal Swasthya started operating mobile medical units in the erstwhile combined state of Andhra Pradesh in 2007 and over the years there have been multiple improvements in the management of the MMUs. After the division of the state, Piramal re-engaged with the Government of Andhra Pradesh through a tendering process and started the Chandranna Sanchara Chikitsa community outreach program in 2016. The Government invested in the hardware cost (The vans, drugs and diagnostics). Piramal Swasthya manages the operations including the human resources and is paid by the Government on a per van per month basis. Each MMU has a pre-defined calendar and a route plan for delivering the services covering 2 villages and a population of 3000 each day on an average and 48 villages in a monthly cycle of 24 days. In Assam the community outreach program started in 2011. Each MMU is manned by a registration & measurement Officer, lab technician, pharmacist, auxiliary nurse midwife (ANM) and a pilot. Each MMU is equipped with a laptop loaded with the Village Health Outreach Program application software, biometric scanner, basic diagnostic equipment (Hemoglobinometers, Glucometers, Manometers, Digital BP), consumable to spot test random blood sugar, Urine albumin, hemoglobin etc. and medicines. In Andhra Pradesh there is a medical officer in addition to the above mentioned staff. The basket of services includes screening, diagnosis, treatment, and referral services for conditions under RMNCH+A, communicable and non-communicable diseases.
The objective of the Community outreach program is to improve the health status of the people in rural underserved and inaccessible areas through assured, free, predictable and high-quality preventive, promotive, curative healthcare services at their door steps.
2007 – 2019 (12 years)
Impact (2 paragraphs) - What is the demonstrated or foreseen impact of this intervention/action?
- Is impact at the individual or population level or both?
-- How is this impact measured? (national/sub-national/facility)
- How was the goal attained?
Piramal Swasthya has managed the Community Outreach programs in partnership with the Governments in two states – Andhra Pradesh and Assam.
Chandranna Sanchara Chikitsa, Andhra Pradesh – 292 Mobile Medical Units, 15373 villages (70% villages in the state of Andhra Pradesh covered), ≈17500 patients per day, 13 million consultations till end of Feb’ 19. According to the *Third Party Evaluation conducted by Tata Institute of Social Sciences (TISS) in 2018, through the program,
22% diabetic patients achieved better control of their blood sugar
18% hypertensive patients achieved improved control of their blood pressure
The out of pocket expenses for managing either diabetes mellitus or hypertension reduced from INR 396 to INR 80 per month
92% respondents were highly satisfied with the healthcare services
93.7% retention of old patients which shows the interest and belief of the community on the health service provision
Sanjeevani Village Health Outreach Program (VHOP), Assam - 85 Mobile Medical Units, 3,673 villages, 5000+ patients / day. The program has been operational from 2011. The Public Health Foundation of India (PHFI) conducted an external evaluation of this program in 2018. The report documented that
84% users had a blood glucose test at least once in three months
20% of all diabetic & hypertensive patients were first diagnosed at the Sanjeevani Community Outreach Program
94% reported that they preferred availing services in Sanjeevani rather than travelling to the Primary Health Centre.
The impact of the Community Outreach Program happens at three levels: individual, population and the health system.
For the individual, the program offers a once-a-month opportunity to address all his/her health care needs. People with noncommunicable diseases and pregnant and lactating mothers are the biggest beneficiaries of this approach. In a country with very poor doctor-population ratios, this approach is of great value and it also reduces the out-of-pocket expenses dramatically, both direct as well as indirect.
For the population, the approach serves as a platform where a basket of services can be provided, depending on community needs. While, the focus is on noncommunicable diseases and pregnant and lactating mothers, our experience shows that the MMUs offer a wonderful means to attach outbreaks and disaster situations.
For the health system, this approach offers an opportunity of continuous and regular monitoring of high risk cases, thereby helping reduce the occurrence of complications as well as early detection of complications, in turn leading to reduced burden on the health care system.
What did you do? (Max 300 words)
Primary healthcare focuses on addressing reproductive maternal newborn and child health issues and communicable and noncommunicable diseases. Government is the most important player in Public Health in India but there are gaps that need to be plugged which includes innovation, accountability, monitoring and evaluation and capacity building. Therefore, it is imperative to forge partnerships both with the Government as well as with other private organizations.
Community Outreach Program aims to alleviate the challenges of Primary Healthcare in India through a community-based approach. Partnerships with various States Governments and Corporates / International Organizations help deepening the traction with the community by ensuring connect with last mile beneficiary.
As part of the fixed day mobile outreach, mobile medical vans equipped with medical devices, medicines manned by a doctor and paramedical team visits a community/village at a regular frequency. People with illnesses, and even those without any obvious illness approach the van. The doctor or Nurse examines the patients and gets required blood and urine tests done and the details of the patients are entered in the Electronic Health Records in real time. The patients are examined, tested, diagnosed, treated, and counseled (regarding diet, exercise and follow up). Electronic medical records are maintained to store patient data which makes tracking of referral linkages and end-to-end tracking of patients’ treatment journey very easy. This in turn has an impact on improvement of healthcare indicators of the communities.
These Mobile vans are deployed in villages which are more than five kilometers away from a public health facility, thus the program supplements and complements the existing public healthcare delivery system. Each beneficiary is provided a Unique Identification Number and Electronic Health Record is created, which immensely helps in clinical management of diseases and conditions.
Community Outreach Program - Service Flow at Mobile Medical Unit
What worked well?
(1 paragraph) - What were the “best practices” that can be applied elsewhere?
The schedule design of service delivery was best suited to cater to the growing challenges in the healthcare delivery. This section highlights some of the best practices that were followed to ensure an effective and efficient service delivery mechanism
The Community outreach health program was set in place to ensure accessibility of primary healthcare services to the target population/community. The strategic location of the service points was planned to reach those untouched by a primary healthcare center.
Having a doctor in the mobile medical van, added value and hence ensuring that there is a system to ensure that there is always a list of doctors as buffers to replace an absentee doctor.
The outreach program involves working closely with the district and village level healthcare administration and also with the ASHA, Anganwadi workers and ANMs on the ground. A concerted effort was made to involve the community in delivering these services and that is the hallmark of a good community outreach program.
The trained and professional staff of the MMU helped in capacity building of the front-line workers by involving them in processes like community mobilization, organizing health and awareness camps, data-sharing, tracking referral cases.
Regular updates to the district level administration helped them with preparedness and taking informed decisions thereby ensuring that processes like procurement, delivery, logistics of supply chain, human resources, other funding process and necessary communication material is available.
Well organized and efficient fleet management systems, well defined SOPs, real-time monitoring and outcome orientation ensured continuity of service delivery.
Technology was used extensively, not only to collect patient data but also to manage the operations efficiently. Use of the right technology ensured that program delivery was done as per the defined processes and standards. Real time dashboard, online GPS tracking of vehicles and biometric attendance are the unique features of this program.
The program can easily be customized as per the geographical challenges or need of the community ensuring the replicability of this program across various set ups. Dedicated program for truckers, cancer screening program, outreach through boat clinics, integration with telemedicine, doctor led/nurse led models are few examples of such customizations.
The Community Outreach Program is a platform that can be integrated with other existing services. This is done in a holistic manner by connecting the patient with required service in the loop via patient specific care and providing end-to-end care. For instance, a patient with high risk of non-communicable disease can be connected with the NCD cell or 104 Health Information Helpline (HIHL), a pregnant woman can be connected with 102 service, and emergency cases linked to 108 National Ambulance Service.
End-to-end tracking of patients’ treatment journey has a positive impact on improvement of healthcare outcomes.
What did not work well?
The model works in close collaboration with Government Systems. The drugs are supplied by the public health department and there are instances when some drugs are not available which does not go down well with the patients. Linkages with secondary and tertiary care centers is another area, where patients referred from the mobile medical unit do not receive the desired attention and treatment alienating them further from the services. Integration of services with other existing government programs is one of the area which requires attention. Further connections of these patients with existing government initiatives like the Ayushman Bharat scheme, Atal Amrit Yojana and Matritva Vandana Yojana etc. would enhance the impact of the program.
Next steps (limit 3 bullets) - What are the next steps to build on the action?
Explore opportunities to complement / link the Mobile Medical Units with the Health and wellness centers to provide comprehensive primary healthcare.
Linking the MMU IT platform with the IT system being designed for the Health and wellness center and interlink all Mobile Medical Units intervention across the Country.
Integration with other existing programs under the national health mission
Expansion across the Aspirational Districts
Further information -Provide references/links to useful documents and websites
Figures: Limit to max 2
Snapshot of Community Mobilization Process