More than a decade after people around the world started using e-mail and text messaging to communicate with family, friends and work, healthcare services have finally transformed by digital and mobile technology. One reason is that the healthcare industry is magnificently larger than many other industrial sectors. In the past two decades countries like United States, Europe and Japan have invested hundreds of billions of dollars in healthcare information technology. However, now a lot of the innovation is taking place in emerging markets like China, Singapore, Indonesia and India. These countries are responding to developments and investing in digital services and mobile apps at a rapid pace. World Bank estimates the Indian government’s spending on healthcare at Rs 37,061.55 crores which is 30 percent as compared to China, where the government spending is 56 percent of the total health expenditure. The Out of Pocket Expenses (OPE) in India on healthcare by its citizens is amongst the highest in the world.
Healthcare industry is also a different type of industry. People need its services to stay alive. Most people do not have a choice about whether to “consume” healthcare services. They need to go see a doctor at a hospital when it comes to their health. Also, competition is severely limited because most individuals seek healthcare near where they live and there often are not that many choices. However, now the cost of digital technology has dropped significantly and much can now be achieved without spending millions on expensive information systems. Both the speed and reliability of telecommunications and mobile phone networks have continued to improve. Today, expert healthcare can be at your fingertips, as demonstrated by ground-breaking companies such as World Health Partners (WHP).
The company believes that a sustainable healthcare system must ensure two foundational elements: prevent onset of illnesses and ensure simple illnesses don’t get serious. A system that efficiently delivers preventive and primary healthcare close to the clients is the tools that will make this possible. By adopting triaging principles, secondary and tertiary care becomes logical extension of this approach. They are a non-profit organization dedicated to bringing healthcare within a walk able distance to underserved communities ‘here and now’. WHP harness already existing resources in every sector without ideological constraints. They use management systems and technologies to fashion them into an effective service delivery channel. This means a range of interconnected processes: medical professionals in urban areas digitally connected with rural patients; local entrepreneurs or quasi-medical personnel invest to join the network as facilitators; metrics in real time to supervisors; management tools to doctors to ensure mass provisioning of care; supply chain that works on flow casting principles to ensure efficient inventory control.
Adapting to Global Customers Needs
WHP is a non-profit organization that provides health and reproductive health services at scale to rural and underserved communities by enhancing the efficiency and efficacy of currently available resources. They harness the latest advances in communication, diagnostic and medical technology to establish sustainable service delivery networks. The company’s vision is to bring the benefits of modern health and reproductive health care to those most in need.
Medical resources are extremely limited in the villages and urban slums of the developing world. This shortage deprives the majority of people of even basic healthcare. With doctors unwilling to locate to these areas, there is no immediate relief in sight. WHP is mandated to deliver primary health to such distressed communities here and now. According to, Miss Prachi Shukla, Country Director, WHP, “Such an urgency of response is a WHP hallmark since it believes that most health care needs are time sensitive and cannot wait for ideal conditions to develop. This means all currently available resources, however meagre, need to be harnessed in villages and slums, and supplemented with resources present in developed areas. This necessitates a plan that collectivizes resources scattered across sectors and locations—public and private, rural and urban. Accordingly, WHP’s solutions can work in areas with weak infrastructure, high levels of poverty, low resources and widespread illiteracy.”
Talking about the challenges that the company faced, Prachi says, “Clients tend to complain about time and resources. We provide services close to the community especially marginal and vulnerable living in hard to reach rural areas and urban slums, which reduce time and also the cost of healthcare, including transportation.”
Intelligence on Tap
Massive amounts of sensitive data and rapidly changing technological environment, healthcare is among the economic sectors facing the most significant challenges in implementing effective IT solutions. From small doctor’s offices to major hospitals, the healthcare IT environment is increasingly complex and, if not managed appropriately, can negatively impact patient care. The main USP of WHP is the company’s complete ecosystem for delivering primary healthcare that includes electronic medical records, differential diagnosis for doctors for ease of diagnosis, low bandwidth audio/video consultation (which works on 40Kbs) and complete ICD 10 diagnosis list. Prachi asserts, “Simplicity has been made the cornerstone of WHP’s use of technology. This is because of the organization’s focus on delivery of healthcare to rural and other underserved communities which inhabit areas of low resources and weak infrastructure. WHP designs its technologies so the simple frontend largely limits itself to collecting the diagnostic signals and data, which are transmitted for processing to the highly sophisticated systems in the backend.” Since the human resource available in villages is sub-par, the technologies need to be kept simple and intuitive. Most of the village interface requires only numeric literacy since rural communities have difficulties in adopting systems that expect them to use text. WHP uses specially developed applications to compress data so they can be transmitted even when the connectivity is weak.
On the Cloud
WHP’s Althea system has an innovative design. A specially developed application is loaded on a laptop or tablet, and is used as a platform to integrate commonly available, medically certified diagnostic devices. The system can be used by the village provider on her own for tasks, such as screening of patients or to communicate with city doctors. The system currently uses devices to measure blood pressure, pulse, temperature, blood sugar, blood count and cardiac signals, with provision for adding dermascope for skin. The system can work in any digital environment ranging from 2G which is universally available to 3G, 4G and internet. Better connectivity enables higher quality of services. The village facilitator uses pre-coded checkboxes in English or in the local language so writing text—the biggest bugbear for semi-literate populations–is completely eliminated. An algorithm combines the symptoms registered by the village user with the basic vital parameters and patient history to generate a list of differential diagnosis for the doctor. The system also provides task lists for predictable services, such as estimation of gestational age, growth monitoring, and immunization. Each interaction is captured and stored in the internet cloud as an electronic medical record (EMR) under a unique patient identity which makes referrals easier. The EMRs also provide an opportunity for remote monitoring and pattern recognition through analytics.
WHP boasts of impressive work/programs in India as well as Kenya. Few of them are:
Pediatric and TB Care in Bihar
Currently, the aggregate strength of the Sky network is 842 technology-enabled centres based in larger villages. The Sky network has treated 3,364,865 cases of childhood pneumonia, and 5,256,277 childhood diarrhea cases. Persistent liaising with District TB Officer and other government officials resulted in sharp improvement of cases being notified through a government portal as legally mandated. In the earlier phases, the TB component under the public private partnership model faced many challenges but a focused attempt to build good rapport and understanding with government officials in most of the project districts was responsible for the turn- around. Efforts are underway to get the remaining (difficult) districts to follow the same pattern. Grassroots level NGOs, self-help groups, both voluntary and government organized have been contacted for undertaking dissemination and facilitating timely consultation either at public or private facilities. They will also act as voices for TB prevention and care enabling and facilitating early initiation of TB treatment.
Public Private Interface Agency (PPIA), Patna, Bihar
Over half the estimated 4.6 million annual TB infections in India are treated by a scattered range of private providers. They can be ignored only at a national peril. WHP’s intervention in Patna is part of an initiative of the Ministry of Health and Family Welfare’s Central Tuberculosis Division to find innovative ways of engaging with the private sector. WHP’s project initially covered the city of Patna (2 million populations). It later expanded to the entire district (4 million population). The project networks doctors, laboratories, pharmacies, and informal providers into a cohesive system with a strong electronic backbone connecting them to enable better coordination of activities. The clients receive tests and medicines free. WHP, with support from the Bill and Melinda Gates Foundation, reimburses the private providers at market rates.
Maternal and Reproductive Health Services in Uttar Pradesh
The UP model presents a new paradigm of hybrid programming in low resource settings–resources scattered across various sectors are laterally combined on the basis of core competencies to optimise efficacy. This approach is very effective in addressing the challenge that has persisted with service delivery to rural and remote communities. Under the WHP model, public sector quasi-medical personnel called Auxiliary Nurse Midwives (ANMs), posted at the first available skills-based facility for rural communities, visit the entrepreneurs’ centres to provide family planning, antenatal and gynecological services either on their own or in electronic consultation with city doctors. This is done under a formal arrangement with the public sector so this additional component is integrated into the ANMs’ work schedule without disturbing their other functions.
Tuberculosis Health Action Learning Initiative
WHP’s Tuberculosis Health Action Learning Initiative (THALI) is a path breaking project in eastern India which creates a pathway for the government to engage gainfully with the private sector. The project started in the city of Kolkata in 2016 to cover all 263 wards. The project is implemented by a consortium of expert organizations in which WHP plays the role of the prime supported by JSI focused on research, evaluation and knowledge dissemination, Global Health Strategies on strategic advocacy and media relations and Child in Need Institute (CINI) on community outreach and mobilization.
Output Based Aid (Oba) From Government
WHP’s project in Rajasthan successfully demonstrates an Output Based Aid model, an approach advocated and finally abandoned over a decade ago by international donors. The main challenge was inability to monitor service delivery. In Rajasthan, WHP is co-locating entrepreneurs in 10 of the government-run primary health centres (PHCs) to play a force multiplier role. Almost all the PHCs are in remote areas where hiring (and retaining) doctors pose a serious challenge. Local entrepreneurs bear the entire frontend investment to join the network and facilitate consultations with city doctors for patients referred by the PHC staff.
In Kenya, WHP is currently administering a pilot project of three clinics that addresses the health and reproductive health needs of rural communities within walkable distance. Called Maisha Clinics, these facilities are located in Homa Bay County, one of the poorest in western Kenya. The clinics, focused on women and children, are selected to ensure that each can serve a cluster of villages that together offer an adequate catchment population necessary to achieve economic viability. The chief innovation of this project is in deploying nurses drawn from the pool of an estimated 20,000 un- and under-employed nurses in Kenya. The nurses are willing to work in areas where the doctors don’t want to locate and are able to serve communities that are vastly underserved even of basic health services. While most clients are treated by the trained nurses on their own, cases that require higher levels of medical competence are remotely treated by city doctors or clinical officers using a specially developed electronic system called Althea. Currently, over 80% of the clients receive treatment from nurses. Clients at Maisha Clinics pay for services which are significantly lower than the total costs they incur for obtaining them from urban-based clinics, the most common alternative. WHP projects that each Maisha Clinic will reach complete sustainability within three years.
An important feature of WHP’s operations is the call center that is particularly useful for cases that require aggressive follow-up over long periods as in tuberculosis treatment or antenatal care. The call center based in Patna currently handles case registrations, product placement, and reimbursement of claims, client satisfaction and alerts. The call center also oversees the functioning of the interactive voice response (IVR) system that WHP uses to deal directly with clients both for demand generation and treatment adherence. The financial settlement feature of the call center has led to other projects in different parts of the country availing the service.
En route to Future
WHP`s revenue is depended on the project phasing. Some of the company’s projects are in the last phase hence their revenue has reduced to $ 5.5 million in 15-16 against 10.5 million in 14-15. WHP’s last year 16-17 revenue is $ 5 million. Their roadmap for next 2 years is around 5million / year.