Why not? Being classified as prefabricated structures, containers avoid the regulatory hassles associated with floor area rules or land-use agreements that arise in setting up physical infrastructure. Minimalist in design, it can be transported through rail and used in the remotest corner of the country.
When I heard the announcement yesterday that CSIR and Hewlett-Packard India had launched an e-healthcare center (eHC) by using shipping containers, frankly speaking, I said to myself, ‘Here comes another solution-in-a-box that’ll go from one pilot to second, or even third pilot and then consign itself to government documents. After all, what business does CSIR have to get into healthcare delivery? As for HP, as part of social innovation agenda, they’d demonstrate something and move on. That’s what many companies, whether MNCs or local, do.
But it appears there’s some method in this madness. CSIR, which is an umbrella organization of 38 research labs and has contributed to the generics drug industry, is taking its mandate further. After taking on open source drug discovery, it now wants to use ICT for affordable healthcare delivery. Together with HP, it has funded the design and development of eHC which is basically a container converted into a primary healthcare center complete with medical equipment and IT infrastructure for diagnosing, testing, and medicine disbursement. HP has enabled health cloud that allows for electronic medical record keeping, remote monitoring, consultation and a health policy dashboard. The eHC has run for 100 days examining 4000 patients in Chausala village in Haryana. The next eHC will be set up in Lakhimpur Kheri in Uttar Pradesh.
Healthcare delivery has not been the mandate of CSIR at all, admits Anurag Agrawal, coordinator at the Centre of Excellence for Translational Research in Asthma & Lung disease at IGIB in Delhi, a CSIR center. “But healthcare research is our mandate which requires healthcare data. By this initiative we are integrating the two in a secure manner,” he says. An AIIMS alumnus, who was at Baylor College of Medicine in Houston,US, before taking up this assignment at CSIR, is one of those returnee professionals in India who are fired by the zeal to change the system.
CSIR has secured funding in the 12th Plan to set up at least 30 such centres across India, hoping that in five years that they exhaust their funds, they’d have proven the business model and inspired more caregivers to adopt this ‘product’. (Yes, that’s what HP likes to call it.). Two other companies have supported this initiative. Medical aseptic training, specialized medical consumable kits, electronic stethoscopes, corrosion protection and solar reflective coatings for eHC were provided by 3M India and Orion eServices provided integration of the medical equipment and other devices with the health cloud and training to the eHC personnel.
Agrawal has thought of a few business models to begin with. Since a village of 5000 people will require Rs 50,000 per month to run this centre, he thinks if the National Rural Health Mission, which seems interested in this, comes forward in any village or district, then it could sustain eHC. If not, in the second model, eHC would charge each person Rs 10 /month. In some places, either some foundation or trust, like the OP Jindal Foundation has done in Chausala, can fund for the utilities like electricity and water.
In the third scenario, there are villages where people want to pay for healthcare services but either they don’t have expertise or space to put up a healthcare centre. eHC could fill the gap there.
In the fourth case, which is applicable to regions like the North East, Agrawal says a company, say, for instance the Tata group, may have many employees in the region and is keen to provide healthcare services to its people but there are no avenues for care delivery. It could then set up eHC and run it with support from CSIR, and its partners which will even crowd source doctors.
CSIR director general Samir Brahmachari says the OSDD has given him the confidence that open innovation for healthcare will play an important role in the data intensive world.
Today, it costs about Rs 75 lakh for setting up a 3-container eHC. HP says with volume, the cost would come down to Rs 25 (and lower) for 1-container eHC. That compares favourably with a brick and mortar Primary Health Centre that today costs Rs 1 crore in Haryana.
In a country where 18 percent of all episodes in rural areas and 10 percent in urban areas receive no health care at all, technology is the only medium which can make healthcare accessible. But how cost-effective will it be for the users and how profitable for the healthcare providers? Is V-Sat and the dependence on satellites, the best mode of connectivity when the world is moving towards fibre?
Two years ago I wrote about Cisco’s healthpresence, a low-end version of its bandwidth guzzling telepresence, for developing countries like India. Cisco had then said it had sorted out the thorny issues of delivery and was working with partners like Airtel, Apollo Hospitals and others. As far as I know the large scale roll out that Cisco had anticipated didn’t work out as well as they had planned.
Aravind Sitaraman, President – Inclusive Growth, Cisco Systems, says the company has piloted the medical solution in 2 states and 7 districts. The Cisco health care solution has currently been implemented in Raichur, Shimoga, Chitradurga, Gwalior, Sehore, Datia and Chindwara in partnership with the governments of Karnataka and Madhya Pradesh.
“As of December 10 2012, we have conducted 21,500 specialty and super-specialty consultations. We have contributed to the reduction in maternal mortality and infant mortality rates,” says Sitaraman. The company has used the same infrastructure to educate pregnant women on what to expect when expecting and has conducted special workshops to identify children requiring special attention and educating their parents on how to handle such children.
As for the cost, Cisco says it has brought it down to $1 per consultation and believes it is reasonable. Agrawal thinks Rs 10/person in a village is the optimum price a village person could be willing to pay for his general well-being. But as with earlier pilots — at least 60 in the last decade — it’s as much to do with the well being of the ecosystem as with the economics of the care itself.
How far eHC will go, we’ll know in a few years. But the pathetic public health indicators that India has, any number of such healthcare experiments will only add to the lessons learnt.