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.

Friday, September 9, 2011

Financing of healthcare

Having been associated with the development of this healthcare delivery model from its inceptions, I feel there is still a great distance we all have to travel to achieve the ideals we all aspire for. We have seen value of insurance coverage in many instances as life saving for poorer patients but I agree that there are inherent risks in models like Arogyashree as they incentivise intervention while distracting the focus from primary care.
There is little doubt that treating disease (which we call “demand based service” – where the sick person demands from healthcare providers) becomes more and more expensive at each rung of primary, secondary and tertiary setting. Even more importantly prevention or early intervention (which we call “protocol based service” – where the provider has to follow an agreed protocol) reduces cost at each step. The assumption with managed care models is they would promote the latter approach. There is much to be argued, both, for and against managed care models (as practices in developed countries) because virtually nothing can compensate distorted human values. Does choosing one model over the other compensate for tilted power scales, biased prescriptions and misaligned incentives? We still have the opportunity of learn from the west (of good that is achieved) and not repeat the mistakes they have made before engineering our interventions.
Whether demand based or protocol based, delivering care at grassroots level, in a timely, appropriate and guideline driven manner is not an easy task. Planting a "biologically engineered exotic tree” of western medicine in wild rural Indian climate requires a lot of tendering care. Coping with skill gaps, evidence gaps and resource gaps requires constant innovation and acclimatization to local environment, just like a “wild bush” does. I continue to wonder, how the hybrids will evolve, and how "cross pollination" (of ideas) would influence their future appearance.

Being a great advocate of keeping people healthy within their communities, I continue to be inspired by the value of traditional wisdom hidden within the powerful Sanskrit word "swa-stha" which means 'established within oneself' (swa = self, stha = established - across homeostatic, psychological, financial and spiritual dimensions). It defines for us the concepts of positive health, self sufficiency and local empowerment that could become the underpinning philosophy and possibly contribute towards greater global understanding. Healthcare delivery, health financing and even public health measures could benefit by keeping common values in the centre and attempt to bridge gaps between modern medical interventions and traditional wisdom.
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