SughaVazhvu Healthcare delivers primary healthcare to the population through a combination of community level monitoring and the provision of continuous care at the local level. In our approach, which has a focus on rural India, a community-based, physician staffed healthcare centre, assisted by a village based Health Extension Worker (HEW), sits at the core of a sustainable model of ‘pro-active’ healthcare delivery. This centre provides the broadest possible range of healthcare services (including dental fillings and scaling, cervical cancer screening, vision screening and dispensation of glasses, and management of chronic diseases) at the primary level.

Sughavazhvu Healthcare in collaboration with ICTPH has rolled out its healthcare delivery model to establish its effectiveness in rural Indian context. Over a period of time it hopes to work with multiple such field partners across the country. Sughavazhvu Healthcare is also collaborating with ICTPH to develop a complete ’Managed Care‘ offering for its rural populations by building on its existing unique primary care delivery model and aims to offer a full-service model of healthcare and financial protection at doorsteps of rural India.

Problem

At over 3 million square kilometres, stretching 3,000 kilometres from one tip to another, in both directions, with a population crossing 1.2 billion individuals living in over 600,000 habitations, India is one of the largest countries in the world. With 70% of Indian population residing in rural habitations but with 70% of India’s medical infrastructure being available only in urban locations, there is significant disparity in access to basic healthcare. While India perhaps has a reasonable supply of secondary, and tertiary care services in the cities, the limited supply of qualified healthcare practitioners (the doctor:patient ratio for rural India stands at 1:30,000) in modern medicine, willing to work in rural geographies, leaves the health of rural populations largely in hands of unqualified and unlicensed practitioners, who today define the large unorganized primary healthcare market in India. State governments across the country have sought to fill this gap by offering healthcare services through a combination of sub-centres and primary health centres. However, the actual record of the delivery of these services remains very mixed even at these centres, in large part because of the challenges of inadequacy of human resources as well as a paucity of funds.

Solution

Mapping and risk profiling catchment populations coupled with a village-based physician led care delivery outline the ‘pro-active’ care methodology at SughaVazhvu Healthcare. Epidemiological mapping through GPS markers for households, basic house-hold (HH) level information and non-invasive risk screening is accomplished at each house hold (HH) using android based mobile phones synchronised real-time with the HMIS. Bar coded individual identity cards provide a systematic data base for provisioning continual care to the population. Identified very high risk individuals, for example for cardiovascular diseases (CVD) (based on height, weight, blood pressure, tobacco consumption, and waist and hip circumference as risk markers), and reproductive tract infections (amongst women) are exhorted to seek treatment at the RMHC immediately. SughaVazhvu Healthcare provides for a wide range of village based healthcare services ranging from acute care, chronic disease condition management, ophthalmic care, dental care, and population level screening and aggressive management of the health of those individuals that are deemed to be at high risk, through multi-skill training of our physicians. The Health Management Information Systems (HMIS) as developed by SughaVazhvu Healthcare in collaboration with ICTPH is the first-of-its kind primary healthcare management tool in India.

Exemple

The Rural Micro Health Centre (RMHC) expansion has followed the ‘proximate catchment’ methodology in order to benefit from word-of-mouth awareness building, optimal supply chain management across the network, and most importantly, measurable health outcomes throughout the SughaVazhvu value network. As of today, SughaVazhvu Healthcare is a network of 7 RMHCs, serving an enrolled population of 65,534 rural Indian residents, across 35 Indian villages. The house-hold level risk assessment protocol has been implemented at one site, (Karambayam RMHC) screening 3,781 adults at their homes, wherein amongst other risk parameters, 524 adults were diagnosed as being at high risk for hypertension and referred for confirmatory diagnosis and treatment to the Karambayam RMHC. The rigorous training on evidence based protocols equips the physician to multi-task as they manage infectious diseases, non-communicable diseases, dental treatments such as scaling and fillings, comprehensive eye examination and prescription and dispensation of spectacles, mental health counselling and treatment (under development), and cervical screening including cervical cancer screening sing the VIA/VILI methodology. Through a network of seven RMHCs, a total of 11,716 patient visits have been managed by SughaVazhvu. Various methodologies are implemented throughout the network to ensure maximum participation of populations served. RMHC based specialist camps, such as for cervical cancer (launched in October 2011) are anchored by the RMHC physician and the Health Extension Worker (HEW). Through, walk-in cervical cancer screening available in all our seven RMHCs, we have screened a total of 295 eligible women, with 21 women as VIA/VILLI positive. Through the cervical screening camps, a total of 169 women were screened with 15 testing positive on VIA/VILLI.