Boats, Buses & Technology: The Many Routes of Innovative Healthcare Delivery
For innovators, India’s massive population is the strongest motivation to keep innovating. However, success doesn’t come without challenges as “India lives in its villages.” More than 70% of India’s population is scattered across 6 lakh villages nestled among the mountains, forests, and river beds that shape the surface of the world’s 7th largest country, a 3,287,240 sq. km subcontinent.
With a potential market of 1.2 billion people, social entrepreneurs can bank on volume to turn profit without sacrificing affordability, but they must first find a way to efficiently REACH that market. In addition to geographic obstacles, the dearth of trained medical professionals, most of which are concentrated in urban areas, makes for another healthcare delivery challenge.
The great charge of India’s frugal healthcare innovator, therefore, is to get high quality products and services to far-flung regions of India while remaining financially viable as an enterprise and affordable for rural patients.
In my last post I touched on some of the product innovations that are creating impact in healthcare through a holistic delivery approach. In this post I delve more deeply into basic healthcare delivery innovations, exploring the biggest challenges and most successful initiatives getting healthcare to remote regions of India
Thanks to the ingenuity of innovators, healthcare now reaches remote communities in India on boats and buses, beamed down from satellites in telemedicine consultations, and in the colorful tents of mobile health camps. Where patients can’t reach clinics and hospitals, mobile healthcare brings high quality services to their doorsteps. Many of the most successful mobile healthcare innovations focus on primary and preventative care, as it is low cost, easy to deliver and has tangible and lasting results beyond the physical intervention.
Bundling education and IEC (Information Education Communication) efforts with medical care has emerged as another important aspect of effective mobile health programs. Awareness building initiatives ensure that proper health and hygiene measures stick, so that care provided isn’t subverted by lack of basic preventative measures. Effective innovations in mobile healthcare must identify the right “bundle” of offerings to make certain that the transience of mobile health programs do not result in mere palliative care without addressing the root causes of health problems.
Bringing Health and Hope to Assam’s Isolated Island Inhabitants
For the 30 lakh people living in one of the 2 lakh villages situated among the 3000 isolated, erosion prone islands of the Brahmaputra River in Assam, doctors and hospitals are a luxury of the mainland. And, although it can be as little as a few kilometers away, the distance, as well as the required ferry travel, are enough to prevent these marginalized communities from receiving the healthcare they need. Seeing an opportunity within this delivery challenge, the Center for Norteastern Studies (C-NES) in conjunction with the National Rural Health Mission (NRMH), Government of Assam initiated the Akha Boat Clinic Initiative (Akha means “Hope” in Assamese). Healthcare reaches these ecologically and economically fragile communities on fully equipped boat clinics carrying a complete medical staff—doctors, nurses, and technicians—and furnished with examination rooms, operating suites, pharmacies, laboratories, kitchens, toilets, general stores, and sleeping quarters.
The boats make 5-6 trips per month to selected islands where health camps last anywhere from 10 to 20 days. Aside from any required emergency services, doctors prioritize child immunizations, pre and post-natal check ups, and preventative care. Education and IEC initiatives also form a core component of the offering and include workshops on various issues such as reproductive health, hygiene, nutrition and healthy lifestyle recommendations. These supplementary activities ensure that the care provided by the Akha Boat Clinic staff creates long-term improvement in the health status, and as a result the income level, of these island communities.
Rapidly growing since its inception, the Akha Boat Clinics now serve 200,000 beneficiaries in more than 10 districts in Assam. From 200 camps in 2008, the number of camps broke 2,000 in 2013. Markers of success in the communities served by the Akha Boat Clinics include a dramatic increase in routine immunizations administered, from approximately 9,000 in 2008 to more than 20,000 in 2013, as well as a decrease in the number of children out of school due to repeated illness.
Mobile Camps Treat and Educate India’s “Unreachable” Communities
The Smile Foundation offers another interesting example of an effective mobile health initiative. Through their Smile
Health Camps and Smile on Wheels initiative, the Foundation delivers health and education to marginalized communities in remote rural areas and urban slums. Smile on Wheels currently runs 19 vehicles to 265 remote villages and slums across India, using their attractive colorful bus as a platform to promote awareness on health and hygiene. To supplement the bus program, the Foundation organizes customized camps offering more comprehensive services including highly specialized gynecological, pediatric, ophthalmologic, and surgical services. Camps can range anywhere from one to fifteen days.
The Akha Boat Clinics and the Smile Foundation’s mobile initiatives demonstrate some of the best of innovative healthcare delivery in India. Their emphasis on education and awareness building initiatives and their focus on primary and preventative care enables the short-term, mobile interventions to have enduring impact.
Telemedicine Uses Technology to Extend Doctors’ Reach
Telemedicine, like mobile healthcare, is extending the capacity of India’s strapped medical infrastructure. While 70% of India lives in villages, the majority of trained medical professionals are stationed in urban and semi-urban hubs, leaving remote clinics and small rural hospitals without essential skills. While mobile clinics and health camps have a lot of scope for impact, they require physical infrastructure and extensive travel. Where this type of intervention is not feasible, telemedicine provides diagnostic expertise and primary care in medically starved areas.
A pioneer in telemedicine, Navanti Hospital’s Telemedicine Centre, based out of Mumbai, serves more than 30 peripheral health centers across India through daily telemedicine consultations with Navanti’s doctors. iKure, is one such health provider that utilizes Navanti’s telemedicine consultations in their rural health centers across West Bengal. By providing access to skilled medical professionals, with a focus on primary and preventative care, telemedicine creates impact in otherwise “unreachable” regions of India. Although telemedicine initiatives are limited in their scope, like mobile health successful telemedicine initiatives focus energy where they can create impact, on primary and preventative care.
By focusing on primary and preventative care, and supplementing health services with useful information and education through strategic partnerships and comprehensive IEC materials, mobile health initiatives can transform their punctuated interventions into sustained impact, circumventing the vicious cycles of illness and poverty.
About the Author: Research & Project Manager at Innovation Alchemy, Hannah Rosenfeld explores the intersection of design & social impact and supports entrepreneurs in thoughtfully crafting products and services to transform underserved communities.