Delivering Healthcare Services through the e-Choupal Network

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Delivering Healthcare Services through the e-Choupal Network

India
Project Summary
Elevator Pitch

Concise Summary: Help us pitch this solution! Provide an explanation within 3-4 short sentences.

Lack of basic primary healthcare is the core issue we are addressing. Right now, rural citizens in the state of Madhya Pradesh, India are the primary beneficiaries. We plan to scale up and expand the model to the eight states in which we are operating. The main products and services we have introduced are: ? Preventive Primary Health Care at the e- Choupals: Lack of Health services is one of the main impediments for improving the quality of life in rural India and the same has been reiterated during our engagement with rural India as part of the e-Choupal initiative. As a central point of knowledge dissemination and communication, e-Choupals have time and again proved to be very effective. Hence, we envisaged a greater role and scope for Choupals by introducing Healthcare delivery to rural citizens at the Choupal point itself. ? Consultancy services, diagnostics and pharmacy at a tractorable distance: A complete package of services- A physician, good quality affordable basic diagnostic services and a well-stocked institution-managed pharmacy offered under one roof which is at a tractorable distance from the Choupal village. ? Secondary and Tertiary Health Care: The services of reputed doctors and specialists are made available to the populace through Tele-medicine services arranged at proximal distance.

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Your idea
Focus of activity

Healthcare Delivery

Start Year

2005

Positioning in the mosaic of solutions
Main barrier addressed

Limited reach of healthcare infrastructure

Main principle addressed

Adopt market-based models as a scaling-up strategy

However we feel that the principle which defines our initiative better is: e-Choupal is a platform and a one ? stop shop where a rural citizen gets access to all his needs under one roof. From our close association with rural India, we realized that rural citizen is forced to run from pillar to post for fulfilling every need i.e. Agri Inputs & Extension, Finance, Health, Education etc. e-Choupal envisages to solve this inconvenience by orchestrating partner companies, helping customize products that fulfill specific needs. Another principle is to bring high quality products & services within the reach of the limited resources of rural citizens.

Innovation
Description of health product/service offering:

Lack of basic primary healthcare is the core issue we are addressing. Right now, rural citizens in the state of Madhya Pradesh, India are the primary beneficiaries. We plan to scale up and expand the model to the eight states in which we are operating. The main products and services we have introduced are: ? Preventive Primary Health Care at the e- Choupals: Lack of Health services is one of the main impediments for improving the quality of life in rural India and the same has been reiterated during our engagement with rural India as part of the e-Choupal initiative. As a central point of knowledge dissemination and communication, e-Choupals have time and again proved to be very effective. Hence, we envisaged a greater role and scope for Choupals by introducing Healthcare delivery to rural citizens at the Choupal point itself. ? Consultancy services, diagnostics and pharmacy at a tractorable distance: A complete package of services- A physician, good quality affordable basic diagnostic services and a well-stocked institution-managed pharmacy offered under one roof which is at a tractorable distance from the Choupal village. ? Secondary and Tertiary Health Care: The services of reputed doctors and specialists are made available to the populace through Tele-medicine services arranged at proximal distance.

Description of innovation:

Leveraging Information Technology for both preventive and curative health disorders, leveraging the existing Sanchalak network of the company and involving key community members in the entire initiative are some of the innovative features of our model. For instance, through our Choupal Radio we broadcast content on preventive health measures and simple remedies for localized ailments to the Choupals. A doctor composes and delivers this engaging talk. This reaches even the illiterate people because all they have to do is listen carefully. A question and answer facility is available on the e-Choupal website. Queries posed are answered within 24 hours. We have found that villagers use this option to obtain not only additional information on an ailment but also to get a second opinion. A person from the community called the Choupal Health champion is co-opted by the sanchalak to facilitate these activities. He is trained by the network partner to improve his skill levels and thus deliver better. On the curative front, our Tele-medicine service allows villagers to interact directly with specialists through videoconference mode. This gives them access to specialists at a very economical cost. It also saves them trips to cities or towns thereby reducing overall costs like loss of pay, food expenses etc. Follow-ups are also made easier. Our model, being a one-of-its-kind initiative is helping create new business opportunities for other players who lack last-mile connectivity- a major roadblock hitherto. Our success could expand the basket of services and alternatives for healthcare services the rural population currently has access to. We have shown the importance of having win-win tie ups between partners in exploring rural markets. Combining strengths can achieve what single entities cannot.

Operational model:

We have a three-tier model in place: Tier1: Choupal Level Choupal Health Champion (Paramedic) Tier 2: Hub/Mall Level Choupal Saagar Health Center Pathology & Pharmacy Telemedicine setup Tier 3: Network Partners Local Hospitals Specialist Doctors Diagnostic Centers Super Speciality Centres The activities at Tier 1 include dissemination of health advice and information at the Choupal premises, arranging the necessary infrastructure for the free health camps organized in the villages and facilitating access to Q&A service through e-Choupal. Activities at Tier 2 include providing the necessary infrastructure to the physician and provision of requisite space for the lab and pharmacy, facilitating organized and quick service to patients who visit the health center and organizing health camps in remote villages after adequate communication of the same. Activities at Tier 3 include Telemedicine services which help the rural citizens gain access to reputed specialists from top hospitals in the country. The model is a combination of technology facilitated through the e-Choupal infrastructure and a community interface in the form of Sanchalak (Opinion Leader chosen from the village and under public oath to work for the entire community), hence he is obligated to reach all sections of the community. Secondly the sanchalaks revenue model is based on his interaction with the community and hence there is a double bind for including all members of the rural populace.

Human resources:

The commitment of the organization to this project can be gauged from the fact that it is being spearheaded by the Vice-President (Human Resources). He provides strategic guidance and unhindered support to the team at place on the ground. The team benefits from his rich experience gained from 25 years of working in the Services industry. On a tactical level, the Manager (Rural health and Education), a postgraduate in Agri-business management from a premier B-School in the country drives and monitors the project. The state team, comprising the Branch manager, Channel Manager and Hub in charges carry out the operational tasks. Their understanding of the rural realities results in valuable feedback that shapes and influences the reach and efficiency of the project.

Key operational partnerships:

We have a partnership with a reputed organisation in the health care segment. The partner brings its core expertise in medical care at both ends of the spectrum- rural initiatives and super specialty hospitals. We also partner with state government agencies in local regions in organizing initiatives like Pulse Polio drives. The partnership is very strategic since the core aspects of health care are managed and provided by the partner while we take care of the last mile connectivity and delivery factors.

Impact
Financial Sustainability:

<ul><li class="entry-label">Fees charged to clients?: <span class="entry-text">Yes</span></li><li class="entry-label">How do you assure affordability?: <span class="entry-text">Fees are charged to patients availing the services. We charge Rs.25 as consultation charge which is valid for a period of 1 week irrespective of the number of times a patient comes in foe consultation during that period. This figure has been arrived at after extensive research on the ground level about income levels, average annual health care expenditure per family and factoring in the family?s ability to pay in rural India.</span></li><li class="entry-label">Earned incomes as a percentage of operating costs: <span class="entry-text">NA</span></li><li class="entry-label">Other funding sources: <span class="entry-text">Currently the project has been operational for one year with the company providing the necessary infrastructure. A cost benefit analysis of the business model indicates that the project is financially viable and profitable. In addition as this vertical is an additional arm in the e- Choupal initiative this results in only marginal additional fixed costs which can be recovered easily. This is one of the major competitive advantages we enjoy when compared to the other players in this space and provides as an effective entry barrier. As a part of the scale up operations to cover 8 states the company plans to earmark additional dedicated resources. </span></li><li class="entry-label">Strategy for long-term sustainability: <span class="entry-text">We are now following a three-pronged strategy: a. Leverage Technology to reduce cost of delivery Telemedicine, echoupal website, Choupal Radio b. Build volumes to increase profitability i. Spread word of mouth publicity ii. Organize awareness camps through the sanchalak in villages far flung from towns where proper medical facilities are lacking iii. Conduct health camps in the catchment villages c. Enter unexplored terrain: Obtaining regular feedback and carrying out research to unearth the innate medical needs and then customize the offering to serve these needs better </span></li></ul>

Current and Future Impact:

<ul><li class="entry-label">Total number of clients: <span class="entry-text">2500</span></li><li class="entry-label">Clients in the past year: <span class="entry-text">2500</span></li><li class="entry-label">Percentage of low-income clients: <span class="entry-text">50%</span></li><li class="entry-label">Impact: <span class="entry-text">A total of 2,500 patients have benefited during the last year. More than 50% of the clients qualify as ?low-income or marginalized?. The rural health services model of the e- Choupal ensures that the low-come and marginalized citizens have access to good quality and affordable health care. In addition we ensure awareness of basic health care practices both preventive and curative through modules broadcast through the e-Choupal network free of cost. Beyond direct service delivery there is a behavior change in terms of the rural population leveraging technology to seek information. This can be proven by the fact that several health related queries are posted on our website by the rural citizens and are answered directly by the experts. </span></li><li class="entry-label">Overall "market": <span class="entry-text">The average population which is covered by a Choupal is approx 6000. These constitute 1200 households. The average spend per household on health care is Rs.4, 400. Thus the total average spend on health care per Choupal is Rs.53 lakes. The number of Choupals in MP is 1700. The market potential in one state is approx Rs.910 crores. Therefore the total market potential across 8 states where the e Choupals are present is approx Rs.7, 200 crores. Any region with similar constraints as rural India can adopt the model for delivery of health services.</span></li></ul>

Scaling up strategy:
Stage of the initiative:

<i>Start Up</i> stage.

Expansion plan:

Our project is one year old and hence in the start up phase. In the next three years, we would like to roll out the project in the whole of Madhya Pradesh and then extend it to other states like Uttar Pradesh, Maharastra, Rajasthan, Andhra Pradesh and Karnataka. In the delivery structure, we would like to increase the reach at the village level by co-opting the local paramedic through the sanchalaks and improving the delivery through them by focused training and accreditation. We also would like to leverage our current rural distribution network to provide essential health products at the doorstep of the rural citizens. In the scaled up model, we would also like to partner with government projects and ensure increased delivery in rural India through the echoupal channel.

Origin of the initiative:

By our association with Rural India through the e-Choupal, designed to tackle the challenges faced by Indian agriculture, we have realized the similar challenges exist for most perils faced by the rural citizen. So in line with our vision to Improve the quality of life in Rural India, the rural health services model was designed riding on the e-Choupal Network. The e-Choupal project has been driven by our Chief Executive Mr.S.Sivakumar. S. Sivakumar is the Chief Executive of ITC's Rs. 2000 Crore Agri Businesses Division. Mr. Sivakumar is the recipient of HMA Young Manager Award in 1999, MTA Ugadi Puraskar in 2002 and Chemtech Foundation Award for Outstanding Rural Services in 2005. He has also been named a fellow of the prestigious World Technology Network He is a regular speaker at a number of international conferences.

Sustainability
Policy change:

1. Courses for capacity building of the existing paramedics in the village: There should be a program for training them and also certifying them. By virtue of the program, the quality of delivery of the health care in Rural India can be improved. Given the fact that most of the major problems effecting rural citizens can be managed by small interventions done by people at the grass roots. 2. Allow change in the pharmacy regulation, where in, by means of a basic course, rural citizens can get certified and hence be able to sell basic drugs in the village itself. 3. Standards for data exchange and also proper regulation and protocol for leveraging modern technology like telemedicine . 4. Incentives on tax for capital equipment and also concessions for players in the rural health care segment so that corporate segment get enthused and their project life cycles are reduced drastically.

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