E-Swasthya Kutira

(A Rural ICT Health Information Center) An Innovation May Bring Revolution in rural healthcare By.

Dr. Gyanaranjan Pradhan PT.1, PGDHM, Institute Of Health Management Research, 1, Prabhudaya Marg, Jaipur, Rajasthan, India Correspondence: drgyanaranjan@gmail.com
www.Chiers.hellophysio.in About Authors: 1) Dr. Gyanaranjan pradhan PT. (Hons.), DNHE, MOAP, PGDHM (currently pursuing at IIHMRJaipur). Chairman of HELLOPHYSIO CHARITABLE TRUST and Co-founder of HELLOPHYSIO 24x7 Indias first physio toll-free helpline & Adviser of HELLO2ABLE 24x7 helpline for person with disability and ageing. Area of Interest is developing new innovations for unmet need in healthcare sector. Also work as junior lecturer in physiotherapy, Anatomy, Physiology and social sciences for a period of one and half years. Recent activities include 1.Invited as a speaker to E-India 2012 (Indias largest ICT conference) held at Gandhinagar, Gujurat and present a paper on ICT innovations revolutionizing health care-A bottom-up approach ; 2. Shortlisted among best 51 ideas in I2i -2012 organizing by enterpreunisip cell, IIM Kolkata. Contact mob.no.09001751837

Abstract According to GOe (An initiative of WHO to find out and understand the importance of use of ICT for healthcare system and services) government should develop and roll-out ICT enabled infrastructure to address and streamline healthcare services in their country. An efficient e health infrastructure can be established with an integrated approach by incorporating services like EHR PIS HIS GPIS NER NDR Directories of Healthcare Professionals and Institutions, Tele-health, GIS etc. The importance and value of this information system was clearly recognized by OECD countries that participated the survey carried out by GOe in 2005, which included India also. Not surprisingly India is way behind from many other countries in implementing these solutions. Current health informatics in India is though disappointing but quite promising as there is some sporadic successful initiative by private and government bodies. Keeping one eye on all above facts E-SWASTHYA KUTIRA (a rural health information center) concept conceive to meet the unmet need of health information and to provide appropriate reliable health information, education ,guidance under one roof at village level. In spite of all so call obstacles like large size, population density, , inaccessibility, illiteracy, poverty, diversity in life style, rural-urban distribution and geo-environmental variation, this innovation may bring revolution in rural healthcare by promoting preventive health at right time to right individual and reach the unreached population using ICT which is well developed in India. No doubt successful implementation of this concept improves health status (indicators) of rural and tribal remote areas and facility the system towards achieving MDGs.

Introduction:
In India there are 72% of people belongs to rural area (according to census2011) &among them 68% are literate. When we analyze the awareness about diseases and good health, the most people are not adequately educated enough. So they depend on peer group, village level quacks and some time by ANM, GNM, or ASHA. It is observed that most of the time they are misguided and they are not able to get proper health care and advices at the right time by right person, which is valuable for life saving and decrease morbidity due to delayed health care or inappropriate health care. Though to serve both preventive, promotive, and curative health care need of common people. Indian public healthcare system have so many institutions like SCs, PHCs, CHCs, FRUs, mobile health units etc and also work for a long time somewhat effectively. Under NRHM this system is strengthened more and ASHA like human resource innovation implemented. All these systems primary role is promote preventive mode health care and guide them for proper health care at right time and right institutions. But there are so many factors are responsible for partially failure of this system, especially sub centers and manpower like ANM, GNM and ASHA i.e. providing proper guidance, counseling. For which people suffer a lot and there is over burden in secondary and tertiary level of health care institutions. Also disease burden and cost of treatment increases significantly. As a result a total health care system seems to be freeze. If we focus on some specific issues like maternal and child health care, the obstetrics mortality and child mortality rate is still high in rural areas and it is mainly because of above said causes like lack of proper guidance, counseling, and education in a transparent system so major draw backs, which researchers observe and analyzed from direct study and some secondary sources i.e. census, NHFS, surveys etc, it is concluded that the focus area should be as follows: 1. Absenteeism of ANM, GNM, ASHA at SCs. 2. Lack of proper orientation and training to health workers and knowledge of them about some critical health issues. 3. Lack of awareness of people about SC and PHCs i.e. what type of services are available 4. Ineffective of traditional IEC for health information education and guidance. 5. Unable to reach the actual needy person. 6. Unable to proper prioritizing the area, which should be focused. 7. Not utilizing the recent modern trends of communication and information i.e. Internet, telecommunication, audio-visual aids. 8. Lack of public involvement. 9. A strong gap in technology use I public health. Focusing on above genuine issues and to compensate the lacuna felt by the researchers, implementation of the modern technology like telecommunication, internet, and audio-visual aids for IEC (Health Education ) and maintaining electronic health record, electronic hospital information system, E-Swasthya Kutira (A complete IT enabled Center or Health Kiosk) is the effective solution when it is embedded properly with existing public healthcare system (CHC, PHC, and either government or private tertiary healthcare units). In addition to central multipurpose healthcare information control system which interconnecting and linking all ESwasthya Kutira and act as a rural village level automated unit to provide right information about disease, how to prevent, treatment advices function by using modern ICT.

A concept of tele-counseling and guidance for preventive and curative healthcare though not frequently used by government sectors (use of 108 for ambulance and mobile healthcare unit), but private sectors use internet, telemarketing for providing information and creating there brands. This trend gradually emphasis in last 7 to 10 years. Going a step forward healthcare call centers now also developed in some states in a sporadic manner, but all these are focused to serve IT as a third party interface. Till now government is not able to effectively use these to promote its various healthcare programs and guided common people for seeking services from public healthcare institutions and infrastructures to utilized available resources effectively and efficiently. Related work: There is no concerted effort to address this issue to avail the facility to rural and semi urban peoples to full fill their basic health information, guidance, counseling and instant health service delivery. We found healthcare information is vital in time of need and can be a deciding factor between life and death. Free telephonic access to accurate and precise information about a doctor, a hospital, ambulance services or a neighborhood pharmacy shop is very valuable to the public when it is on door step or on village. Sometime ASHA like health worker also need instant guidance. Based on the premise of streamlining healthcare information over phones & e-base While working in the field of implementation of tele-counseling for rural areas, the researchers felt the need of village based interface, which can fulfill the gap between common people and healthcare delivery system working for them. Researchers also got feedback from common people about the need of such platform, which provide a interface and act as medium for health education, guidance, and counseling on their nearest most area. Focusing on these issue researchers by the help of CHIERS of Orissa under Hellophysio Charitable trust tried to implement a automated health unit on five rural villages of Orissa and connect all the five units to its preexisting central call center, which previously served as a physio helpline and helpline for disabled and old age people. The villages where this pilot study going on are Barraguda of Keonjher District a known undeveloped tribal district, at Navarangpur District, at Goverdham pur of Kendrapura District and Puri district. In all the units a telephone and computer set is used to provide information and tele-counseling. The pilot process was run for a period of 15 days. During this short period, they received more than 580 number of phone call of various queries of common people about their health issues. The popularity and importance of such projects strongly felt by the researchers but not able to run it as a functioning unit to fulfill the need. So the result of the pilot study inspired a lot to the researchers, but because of some major problems they are not able to implement it as a functional unit. To serve this high need the areas of lacunas as felt by the researcher are: It is not a complete IT enabled. Lack of proper software to maintain the unit. Not able to get information about the public health infrastructure and human resources working there.

Unable to connect and interlink the units with center call center, PHI, and human resources effectively by available sources. Learning from this pilot project, researchers inspired and facilitate to develop a conceptual framework of Wider Idea of IT enabled unit named E-Swasthya Kutira, a Central Health Call Center and a network to effectively interlinking the various components to fulfill the main objectives of the project. Objective: 1. Meet the common goals of Government and health requirement. i.e. promoting preventive health care by health education and guidance 2. Identification of patients. 3. Strengthening the Health IT sector. 4. Channelizing public toward seeking health education by latest technology. 5. Generating awareness, not only for particular disease, but also for other as well. 6. HIV education and prevention counseling 7. Mental health counseling. 8. Help people to achieve health services. 9. Tracking pregnant mother and ill childrens to decrease maternal and child mortality rate. Functional Components: Though the main functional component is E-Swasthya Kutira, but the supporting component like Central Health Information Call Center and the interlinking network will also act as a steering body. Description of each is as follows: E-Swasthya Kutira: It is a small unit, which supposed to present in each village. It is a space of 6 x 8, which is equipped with computer with visual LCD (Touch Screen) of 32 inches, webcam, leased wireless internet connectivity, telephone, and other basic requirements like electricity, power back up, and solar cells. The software will be very user friendly. Optional Condon and iron/folic acid tablet vending machines. From here one can get following services: Tele-Counseling Video-Counseling. Information about diseases and various treatment options Information about nearby PHC, CHC, and other healthcare institutions and there facilities. Information about ambulances and mobile healthcare units. Audio-visual aids for health education and information. Iron/Folic acid tablets and condom. Community disease information. Online register for seeking special healthcare for Maternal-Child Care, Tuberculosis, and Malaria. Get information about upcoming health campaigns and program details. Beside common people the health worker of that village or incharge like ASHA or ANM can seek helps like:

Specific information about any disease and required knowledge through audio-video aids. Specialist consultation. Maintaining various records electronically like Birth and Death Record, pregnancy record, and records related to special diseases. Sharing with central health information resource center and nearby healthcare institutions. Get information about upcoming health campaigns and program details. In case of emergency healthcare need like delivery, accidental cases, and emergency child care. The health worker can immediately contact and give prior information to referring provider. Central Health Information Call Center (CHICC): It is state art center served as central information, data storage unit along with a well equipped multi-purpose health call center situated at the state level. It is equipped with Backup power Supplies for uninterrupted services. For disaster recovery plans like mirror image servers and hard drives for database retrieving. Beside these some advance facility like: Computer telephony integration Call routing and automation Automated Call recorder Predictive dialer technology In voice respond IVR Multimedia contact channels such as fax, e-mails, SMS gateway. All above technology enables to get linked with E-Swasthya Kutira, all public health institutions and all health care human resources. Beside all also with registered peoples having special health care need like pregnant mother, infants, child, TB, malaria patients. This center should be managed by highly qualified and trained Medical, Para-medical, and life science professionals to deliver quality service related to objectives E-Swasthya Kutira as mentioned. Connecting Network: This will be the vital component on each step of E-Swasthya Kutira information sharing and processing. E-Swasthya Kutira will be connected with CHIC (central health information center) and CHIC will be connected with public health infrastructures and human resource team. The cloud commuting will be the governing technology through which the vision will be materialized. Functional Process: The patient or information seeking person will reach E-Swathya Kutira, with the help of attendant with privacy respect. He /She can directly consult with respective health advisor of central health information center via telephone and video as well. The required guidelines and health education provided by the advisor with the subordinated with related audio video teaching aids. According to situation and case from the CHICC information to the

nearby Public Health Institute and respective ASHA, ANM, or health worker immediately sent via telephone or/and SMS for taking necessary attention to the concern/seeking individual. It also helps the ANM, GNM, and ASHA like health workers for training processes. One individual can get information about the upcoming health program and campaigns and register special healthcare needy individual like pregnant woman can be track, monitor, and follow up regularly through CHIHC by specialized health advisors and lot concern health workers for necessary help. Conclusion: Now a days government is trying to strengthen health information system and also in the process of forming national health information back bone more effective and coherent to fulfill the future healthcare need to provide quality healthcare with analytic decision making process in the same as well. Also the department of telecommunication fixed its goal to provide high speed internet connection to each village in the near future and with no doubt mobile connectivity is also significantly increasing to the rural areas. So the innovation ESwasthya Kutira implementation is not a dream, but also become a potential interface between public and health delivery system towards achieving improved health indicators to fulfill the millennium development goal. Not only govt. but also E-Swasthya Kutira use full for NGOs and other organizations working in health field. After side modification of software component it also useful for all corporate and public hospitals to provide service information and guidance at reception time or inquiry counter to reduce time and manpower involvement. Abbreviations: 1)GOe-Global observatory for e-health ;2)ICT-information communication technology:3)OECD-Organization for economical co-operation and development. -END-