Dr. Dinesh Kumar Tyagi

CEO & MD - e Governance Practice

Insights of the Public Health Care System in India

• Government hospitals (Inclusive of CHC) in Rural – 3964 / Urban-2256

• A Community Health Centre covers about 3,60,000 population inthe country and conducts about 1 delivery a day

• A Government hospital services approx a population size of1,56,556

• On an average a hospital bed is available for about 2336 citizens

• There are about 70 doctors for 1 Lakh of population

• Random checks in Govt Medical institutions show that 29.67% ofdoctors are absent, (6% of posts vacant)

Health Status in India

• 3.5 million people in the country are expected to be HIV+, India isbecoming the 2nd largest- WHO website ( Recent survey shows declining trend, due to the efforts of NACO)

• Infant mortality rate per 1000 births is 60- 11th Plan, GoI

(SL-13,China-30, Vietnam-19)

• Under Five mortality per 1000 live births 87- 11th Plan, GoI

(SL-15,China-37, Vietnam-23)

• 40.9 million people are expected to having diabetes & this is the 4th

largest cause of death by disease in the country-WHO

• One year old fully immunized for measles 58%

• There are an estimated 12 million Visually challenged people in thecountry

• Over 90% of the Visually challenged live in Rural Areas

• The above number is expected to raise by 18 million by the year 2020

• Rural folks, by their economic status as well as by nature don’thave the habit of preventive health care seeking attitude

• In most cases of diminished vision, the patient feel that they stillcan manage coping with their life

• Cannot afford associated expenses of the treatment likeaccommodation, food and transportation

• Patient cannot leave family since he/she is the only earningmember

• Fear of surgery

• No one to accompany

• Family opposition in case of old age, etc..

Other Dimensions- Health Issues

Rural Telemedicine

Healthcare through ICT

6

The Tripura Vision Centre Project

• The Tripura Vision Centre project has been

conceptualized to deliver Primary and

Preventive Eye Care Service to the rural

citizens in the state of Tripura

Number of Locations 41

Hub Location Agartala

Population covered 35 Lakhs

Highlights of the Project:

• 19 Ophthalmologist for almost 35 lakhs patients

• The entire State population accessing the

State HQ for eye care, as been provisioned access points.

• A TVC present in less than 8-10kms radius for the rural patients

• Screened more than 30000 patients.

• Accountability for the patients through the online

VCMS module

• System Internalized with Dept H&WF, GoT

Remote Consultation with a Doctor • All cases at the Tele-Health Centre reviewed over Video Conferencingby the expert doctor from the Secondary care unit.

• Every patient record electronically captured and where evernecessary escalated to respective secondary and tertiary care units.

•IL&FS built capacity to all the stake holders and provided platform forexpert case reviews online for resolving patient issues.

• Only in cases which required tertiary care support were asked tovisit the tertiary care support.

Key Enablers

ReMeDi™ - Remote Medical Diagnostics

Healthcare can now reach every village with Tele-medicine using Remote Diagnostic Kit

Remote Diagnostic Kit

The Solution

•Medical Equipment

•Telemedicine Software

•Electronic Medical Records

•Client Server Architecture

System Features

•Real-time Video + audio + data transmission atscalable bandwidth

•Equipment taking rural conditions into account

•Breaking the cost barrier while maintaining thequality

•Connectivity over various kinds of networks with aminimum bandwidth of 256kbps and upwards.

Ailments identified in the Tele-Health centers

Cases Identified in the Thirupathur centre

Gastrointestinal Track diseasesLocomotive dieseases PaediatricsRespiratory SystemDentalTerminal IllnessEndocrine SystemCentral Nervous SystemCardiovascular Diseases (Haematology)GynacologyPsychiatryAccidental cuts/wounds/burns/injuryUrinary TrackENTDermatologyVenerology

Eye Disorders and Ailment Identified from VC

Corneal Ulcer

Visible Cataract (Matured)

Diabetic Retinopathy Suspect

Cases Identified in the Melaghar Vision Centre

CataractCorneal OpacityFungal KeratitisLid DiseasePterygiumCorneal UlcerChronic DacryocystitisHerpes Zoster OphthalmicusCentral ChroditisGalucomaViral KeratitisMarginal KeratitisBlack FlotersDiabetic RetinopathyStartgardts DiseasesMyopiaOptic AtrophPtosis

Tripura Patient Analysis

Sept 2009

Tripura Patient Analysis

Tripura Patient Analysis

Tripura Patient Analysis

Tripura Patient Analysis

Tripura Patient Analysis

Tripura Patient Analysis

Salient Features of the THC

• A structured approach of integrating Primary, Secondary &Tertiary Eye care using ICT

• Reduces unnecessary load on the Government Health Missionaryand escalates only secondary and tertiary care requirements tomain hospitals.

• Pro-Citizen approach in providing Primary & Preventive healthcare services at almost the Citizens door step.

• Preventive health seeking attitude in citizens.

• Avoid and bring down the cases of “Avoidable cases of healthcare escalation to serious diseases”

• Improve the quality of Life in Villages and their productivity.

• Build capacity in to the system in delivering health care servicestill the grass root level and improve on productivity of availablemedical resources to meet the challenges envisaged in MDGgoals.

Outcome in 3 Years

• 100% accountability of patient’s in terms of Health care needsidentified and service provisioned

• Positioning of the State as the first in enabling avoidable visualimpairment in the country

• FOCUS ON 80% SCREENING OF WOMEN AND 100% SCREENING OFSCHOOL CHILDREN IN THE AREA OF OPERATIONS

• The Locations extending scope beyond allopathic stream andventuring into Ayurveda, Homeopathic stream of medicines

• A ICT Enabled Tele-health Centre in less than 10-15Kms radius ofrural Citizens. Providing services at almost the door step of theCitizens.

The Model

Fully supported by GOVT

1. Provide Doctors & ANM

2. Fund the project

3. Supply required stocks of medicine at the center

4. Manage the operations end to end on a on going basis.

5. Government to decide the Fee structure

Role of IL&FS:

1.Provide the technology

2. Integrate all relevant stake holders

3. Train resources on the technology and the processes

4. Implement and support for 12 months & hand over the project as turn key project after clear deliverables and demonstration of the model

5. Fixed Fee

Learning's

ICT intervention can empower and provide newopportunities of rural Health care serviceprovisioning and has tremendous potential to yieldand bridge the gender in equality prevalent inaccessing Health care and services in remote and inphysically inaccessible locations.

http://www.youtube.com/watch?v=dqVCnd8PPCU