In my last [post](http://healthmarketinnovations.org/blog/2011/jan/10/transforming-healthc...), I wrote about Health Management and Research Institute (HMRI), an exciting public-private partnership started in Andhra Pradesh that uses Information and Communication Technology (ICT) to improve health care access and quality. In this post, I will look at similar initiatives.
<strong>The Bihar Incarnation of this Model</strong>
[Chikitsa Paramarsh evam Rogi Shikayat Samadan Seva](http://healthmarketinnovations.org/program/chikitsa-paramarsh-evam-rogi-...) (Health advice and complaints cell for health services) is operational in Bihar with the phone number 1911. Calls are received at centralized location at sub divisions of each district, then transferred to the doctors in government hospitals. Doctors guide the callers and provide necessary medical advice.
<strong>Award-Winning Enterprise in Orissa</strong>
In Orissa, a similar initiative called [Hello Doctor 24 x 7](http://healthmarketinnovations.org/program/hello-doctor-24-x-7) was designed by students of MKCG Medical College Berhampur and KIIT Institute of Technology. People in Berhampur can dial toll-free number to seek information on doctors in their areas and nearest referral center. The services are provided to people living in rural parts of Orissa in public private partnership with district health authorities. This initiative was [recognized](http://www.eindia.net.in/2010/awards/award-winners.asp) as one of the best private sector eHealth project initiatives of the year at the [eIndia 2010 conference for eHealth](http://www.eindia.net.in/2010/).
<strong>Call Centers To Open in Bhutan</strong>
In neighboring country Bhutan, a [health help center](http://healthmarketinnovations.org/program/health-help-center-bhutan) is being set up by government of Bhutan in partnership with Procreate Systems. It is expected to be operational in January 2011. Bhutan’s population is located distantly in a scattered geography where there is significant shortage of healthcare professionals and facilities, as well as long lead times in reaching for professional care. People also have difficulty affording professional care. Considering traditional solutions ineffective in solving issues around access to healthcare in Bhutan, government opted to set up this toll free number. People can call to receive health information and counseling. In emergencies, people will also use this number to call an ambulance.
Similar initiatives have been planned by governments in Gujarat and Delhi. An Expression of Interest was invited from private providers in both states.
<strong>Using Call Centers in Corporate Social Responsibility Programs</strong>
Similarly Piramal Health Care, a large pharmaceutical manufacturing company in India, set up [E-Swasthya Initiative](http://healthmarketinnovations.org/program/piramal-e-swasthya) as a corporate social responsibility in 40 ‘no-doctor’ villages in [Jhunjhunu](http://en.wikipedia.org/wiki/Jhunjhunu) district of Rajasthan. Using protocols, a call center in Mumbai generates automated responses to calls with recommended prescription and treatment. Doctors in call center validate the diagnosis and recommended treatment. Medicines are delivered through local women called Piramal Swasthya Sahayika. These women, who must be literate to participate, are trained in preventive health and first aid as well as customer service. Piramal e-Swasthya tele-clinics are set up in villages.
Villagers who feel ill come to this center, and Swasthya Sahayika conduct diagnostic tests, communicate the symptoms and test reports to the call center. Doctors provide remote advice. Depending on a person’s medical condition, the system charges them INR 30-50 (about .50- 1 USD). If doctors believe an ailment is serious, they advise the clients to visit a secondary healthcare facility. Swasthya Sahayika workers also conduct preventive health sessions to create awareness about issues such as sanitation, nutrition and first aid.
This program started operating in March 2008, and by April 2010 they treated 25,000 patients in 40 villages with an annual budget of $ 500,000 USD. They subsequently added 60 new villages, but also lost 25 villages out of initial 40. They felt they were not seeing enough patients per village to make the service sustainable, profitable and scalable.
*Editor's note: Be sure to come back next Monday for part 3 of Vijay's series on using ICT in government contracting programs. Vijay will discuss infectious disease surveillance programs government has launched. He will also share lessons learned and challenges of this model.*