Addressing Health @ Bottom Of Pyramid

Despite making breathtaking developments in the field of medicine, we are far from making its benefits reach the last mile. Health disparities remain painfully under-addressed almost across the globe.

Though there have been various attempts made globally to solve the problem of Access, Affordability, Awareness, Accountability and Adequacy of Healthcare Services, our efforts are still fragmented despite years of experimentation. Perhaps the lack of resources and collaborative teamwork with existing stakeholders in a complex system undermines committed people from achieving what is often intended.

Unlike other essential services, healthcare is multidimensional that needs re-engineering of entire ecosystem. Though it sounds like a mammoth task but we need to address major elements impacting healthcare "all at once", in order to create a successful healthcare delivery model that is sustainable, scalable and replicable accross geographical boundaries.

Our extensive field research has pointed us in the direction that our Rural Health Care Re-engineering efforts must include atleast 4 interdependant models that should be seamlessly integrated to achieve desired results. Each pillar of the model recognizes the value of collaboration, i.e. by pooling of expertise, fostering partnerships and sharing of resources, skills & experience wherever possible.

1. Service Delivery Model -

This pillar focusses on facilitating locally empowered and motivated agents of change that can deliver need based services in the village itself. These services should be designed on the basis of primary epidemiological data, address consumer preferances and offer a range of services which may be "Demand based" or "Protocol based". The services be broad enough to include preventive as well as therpeutic interventions, leveraging best of modern allopathic system and traditional alternative systems of medicine.

The components of service delivery are not only delivered in the field but also rely upon strength of established hospitals and Institutions. These could be partner hospitals at local district level as well as larger tertiary care facilities that have dedicated administrative, telemedicine and ambulance command center support.

Essential component of service delivery model is meticulous data collection and analysis that generates useful insights for planning of timely and appropriate interventions and to monitor progress. The program would develop in a constantly learning & evolving fashion.

The bed of this model essentially rests upon mutually supporting partner networks. No single player would have enough capability and resources to meet all the challenges at once. Like minded social entrepreneurs can share their strengths and contribute in collaborative fashion into a common platform. NGOs that work towards nutrition, sanitation, education, local empowerment, entrepreneurship and agriculture are indirectly contributing to improving health. Direct partnership can be as simple as doctors contributing their time online at their own convinience, or be large scale biotechnology, pharmaceutical and biomedical engineering companies contributing innovative solutions. Moreover, public health specialists, engineers, programmers, educationists, social activists, agri-business companies, Governments, funding agencies - there is scope for everyone to contribute "coherently" as team players.

2. Technology Model

The technology can enable a vast range of activities which were not possible in the past. The doctors can see the patients, interact with them and acquire relvant clinical information and even advise using Information & Communication Technology. The entire Medical Record can be maintained online in digital format and be interfaced with Hospital Information Systems, Financial Institutions and all other stakeholders.

3. Supply Chain Model

The doctor's prescription can reach the village in digital format but it is of no use unless it gets executed by either medication supply, sample testing, referral or emergency transportation. These products have to reach the consumer in timely manner, with accuracy and accountability. This pillar attempts to solve the problem of logistics - for making preventive and curative solutions, Medicines, Cheap Point Of Care Diagnostics, Health related products reach the last mile.

4. Financial Risk Pooling Model

All said and done, someone has to bear the cost of the service model. Either the Consumer bears it directly or someone else on his/her behalf. It may be Charity, Government, Risk pooling funds or Other mechanisms that bears the cost to make it sustainable. Innovations in financial model can ride on and support the innovations in abve 3 models.

Our vision is to let innovations in these diverse fields be synthesised and matured to achieve single common objective - "To make it possible for all human beings enjoy the fundamental human right to access healthcare when they need it and in cultually appropriate manner".

We have made a small beginning, you are welcome to join hands.

Tuesday, October 13, 2009

Sustainable clean drinking water services

Access to clean drinking water reamins a major challenge in developing world. Epidemics of ADD (acute Diarrhoeal Diseases) and other simple to treat/prevent water borne illnesses are letdowns for the 21st century medicine. It is not the creation of innovative solutions or treatments but ensuring uniform access to what we already have, that often gets overlooked. More than half of Indian villages have poor access to safe drinking water.It is not only the avalability of water (in many places it is a few kilometers of walk to a water source) but also contamination beyond critical levels of what is available. The contamination is not only by biological infectious agents but also chemical (heavy metals, pesticides and fertilizer residues etc.).

The public health initiatives in India have been trying multiple ways of ensuring this basic service and there are examples of success in larger towns but have failed in most rural communities. The villages that are closer to large water bodies are better in terms of availability. The digging of borewells and fixing of handpumps has worked for some other areas but dropping underground water tables and seepage of wastes into underground sources limit their value. It is not uncommon to see pepole bathing, washing their animals, clothes/pots being washed and open defeacation nearby, which contaminates most sources.

Depending on governments or international agencies to solve every problem is too ambitious hope. It is through local initiatives alone that some long term solutions can be envisioned.  These initiatves may invoke external support to become more comprehensive and subsidized in long run. Even government and philathropic agencies now expect local bodies (gram panchayat) to take leadership role with public funding support. But just constructing storage tanks, laying down pipelines is not enough (infact that is already done in many areas) but ensuring regular procurement, safe storage, filteration/purification to acceptable standards over a long term, is a skill that requires local capacity.

When we being creating local capacity it soon dawns that "everyones responsibility is no-one's responsibility". Taking theoritical approach to community empowerment and collaborative co-creation often fails to sustain after some initial victories, unless we loacte self motivated and well incentivised individuals who would drive it.

Sustained sourcing depends not only in locating/creating a source of water supply but also in ensuring recharging the source on an ongoing basis. Most programs ignore this repeated charging of water source, especially underground water which dries up eventually if not recharged.

Though it may be true that supply of safe drinking water from a community source solves problems to a certain extent, building up hygiene awareness and sanitation infrastructure in addition to piped water suppy gives best outcomes. However, it is a careful balance between the affordability of ideal solution with practicality of basics, at least in the beginning that supports a sustainable and evolving plan.

Partnerships and collaborations between parties sharing common interest to be forged that enables technology that harnesses the best out of a given situation. This collaboration should happen even before the local communities are approached. because once you have appropriate experts on board then solutions are easier to craft and implement. We would attempt this by involving organization offerring water management technology on one hand and a microinsurance company on the other because each has a motivation and interest. One has an interest in expanding reach and the other is motivated to keep people healthy. This deliberately keeps governments out of the picture at this stage. But can invoke some field assistance at a later point in time.

Next step would be locating and training a local enterpreneur who is willing to take up this responsibility to run water suppply as a method of his family's livelihood. It is by securing interests and creating job opportunites with a growing potential that would attract local talent. This would also be incentivised to align with local stakeholder's interests and conforming to a quality control program that is monitored centrally. Financial enablement of capital expense and ways of loan repayment can be worked out at reasonable terms.

Once these two anchors are secured then launching a cost effective and simple solution would become feasible in stagewise fashion.