Mobile Health Services-a breakthrough model for serving rural population

As we celebrate International Women’s Day and the empowerment of women in some of the remotest part of our own country, I cannot ignore some hard facts that continue to confront us.

Globally, an estimated 287,000 maternal deaths occurred in 2010 of which India accounted for 56,000 – a staggering 19%! The new-born health challenge faced by India is bigger than that experienced by any other country. India accounts for 25% of the world's child mortality - every year, 7,60,000 babies die within the first month in India.

The chance of a baby surviving varies between Indian states too. A baby born to a family in the state of Goa has a risk of new-born death similar to a baby born in Argentina (9 per 1,000 births) whereas a baby born in Chhattisgarh has a risk similar to an Afghani baby (51 per 1,000 births) - this is a six-fold difference within one country! And we are not even capturing the deleterious effects of these on families and their financial circumstances.

The commitment of the Government to the Millennium Development Goals – specifically MDG 4 and 5 (to reduce maternal and infant mortality) notwithstanding – we are still quite a distance away from ensuring a safe and healthy future for our mothers and children.

Care around child birth and the care of small and ill new born babies have the greatest gaps in coverage, equity and quality of care. Among the many health system bottlenecks and other special issues that we face, key ones include:

• Early marriage and adolescent pregnancy
• Inadequacy of health facilities
• Low number and competency of health workers
• Challenges in delivery of health services
• Lack of awareness around healthy behaviour and poor sanitation

Most of us would normally take these services for granted, especially in urban locations. But in rural India? Amongst vulnerable communities? Can we leave this only for the Government to address? Is there anything that we can do to make our own contribution to a large problem?

At the Piramal Foundation, ensuring Maternal and Child Health Survival amongst vulnerable populations has been a key focus since we started.

Piramal Swasthya, the healthcare initiative under Piramal Foundation, leverages state-of-the-art technology to bring healthcare to the doorsteps of the vulnerable people, bridging the gap in healthcare services and performance, between rural and urban areas. In doing so, the team works extensively with state governments across India to supplement and complement primary healthcare services through the use of innovative technology and process innovations – including Health Helplines, Telemedicine and Medical Mobile Units.

I can still recollect the initial efforts that we made in the healthcare space – effectively to democratise healthcare. E-swasthya – the pre-cursor to the current model worked by empowering women in rural Rajasthan. E-swasthya has worked with women in ‘no doctor’ villages to create a cadre of Piramal Swasthya Sahayikas – women who are in a position to provide basic education on health practices and advice backed by a team of trained doctors at a call centre. The challenges during implementation led to a Harvard Business School case study on the subject which highlighted the challenges of making an impact on rural healthcare.

Case | HBS Case Collection | June 2010 (Revised May 2011)

Piramal e-Swasthya: Attempting Big Changes for Small Places - in India and Beyond.

By Rosabeth Moss Canter and Mathew Bird

https://hbr.org/product/piramal-e-swasthya-attempting-big-changes-for-small-places-in-india-and-beyond/310134-PDF-ENG

Some of the efforts in this area – not just our own - are now galvanising larger forces for the greater good of women and their young children. The Sustainable Development Goals (which would outline the global agenda for the post - 2015 world) are aimed at bringing governments, national and international organisations, academic and research partners together to offer innovative, scalable solutions to this complex issue. The SDGs and the National Health Policy which our own Government is working on, should provide some concrete roadmap to a core issue that defines our success – a protective and nurturing future for our young mothers and their off-springs. Successful models need to be implemented quickly across the country and indeed adopted in other developing economies.

Let’s work towards ensuring that any Women’s Day celebration is more about empowerment, independence and harnessing of energies..... far beyond issues of survival and sustenance.

Piramal Swasthya (aka HMRI) wins the TOI Social Impact Awards 2015.

It has received this recognition in the Health – Corporate category for improving maternal health through telephonic medical advice, mobile health services and specialist consultation through video conferencing.

In another closely contested category, Education, Piramal Foundation of Education Leadership was tipped as the favourite amongst the jury, but lost out since multiple awards to the same corporate house were discouraged. Another near winner was Piramal Sarvajal, which also made to the final round of the Environment category.

With respect to Piramal Swasthya, one of the judges, Justice Shah observed “It is good that for a change an NGO has decided to work in the Northeast, an area often not seen as a part of India.” He added that it was commendable that they worked on maternal and child mortality amongst disadvantaged communities in remote areas of Assam. Rights activist Aruna Roy, familiar with Piramal Swasthya's work, said they were doing a very good job in the Northeast where it was difficult to find people willing to go, live and work.

To read more on the results of TOI Social Impact Awards, click here https://timesofindia.indiatimes.com/india/TOI-Social-Impact-Awards-2015-After-a-healthy-debate-their-vote-goes-to-mobile-healthcare/articleshow/46497723.cms

Times of India Social Impact Awards are organized by the Times Group, which traces its roots back to 1838 and is India's largest media house with a dominant presence across all media platforms and a footprint spanning the whole of Indian sub-continent. About the awards: https://timessocialawards.timesofindia.indiatimes.com/

Epilogue

Iconic Harvard Business School Professor’s Rosabeth Moss Cantor’s case at Harvard Business School read “

Anand Piramal and his team sought to "democratize healthcare" in India through the development of a new service delivery model. If Henry Ford could build and deliver cars to everyone in the United States, Piramal thought, then why can't India deliver healthcare to the 70% of its citizens who lack access to it? They began pilots in 2008 but soon ran into unexpected difficulties. After a second round of pilots in early 2010, they had to decide whether to proceed and if so how.”

Today the total beneficiaries of Piramal Swasthya have crossed 43 million people and the numbers are growing. The model shows the successful implementation of a model that

1. Unlocks the benefits of India’s vast rural penetration of telecom and the growing use of mobile phones
2. providing mobile services in remote areas at a fixed day and fixed time and using mobile vans
3. using technology such as Doc in a box or telemedicine to give access to populations that have no doctors due to terrorist infestation. The model’s success is the achievement of healthcare on a massive scale a far cry since the idea and its challenges were explored in the Harvard case. The model should now be implemented across India in local languages and tweaked to suit the healthcare needs of that population. Since healthcare in India is a state subject – every state should quickly adopt successful experiments in other states so that Universal healthcare becomes a reality.

Note from Harvard Business School

Rosabeth Moss Cantor wrote to us on hearing the news about the TOI award “ I'm delighted to know about this much-deserved recognition. Congratulations to Anand and your whole family. I will be sure to mention this when teaching the HBS case this Thursday to Advanced Leadership Fellows and again April 15 to MBA students.” I hope all is well and send you best wishes.

Rosabeth Moss Kanter,

Arbuckle Professor, Harvard Business School; Chair & Director, Harvard University Advanced Leadership Initiative

Thank you for sharing this terrific news. Kudos to everyone involved at Piramal. I am so pleased that these social ventures that I saw taking birth have grown to have such impact.

Nitin Nohria Dean Harvard Business School.