The project has the following components:
- Piramal Swasthya Sahayika (PSS) - PSS are local literate women who acts as the communication link between the patient and the doctor. The women undergo a rigorous training programme in which they learn to collect simple diagnostic information and provide preventive medicine, first-aid and customer service. These women are given a medical kit, marketing material and a mobile phone. They are then assisted in setting up a tele-clinic (Piramal e-Swasthya Centre) at their own homes. During a consultation, a PSS records patient history through a simple one-page form, measures vitals such as blood pressure, temperature, weight and then calls a remote paramedic based out of a call centre in a city (currently Jaipur, India). This process takes close to 5-7 minutes per patient.
- Call Centre Paramedics - After talking to and examining the patient, the health care worker communicates this diagnostic data through a cell-phone to a centralized call centre paramedics. The paramedics are mainly graduates who have been trained to use a Clinical Decision Support System (CDSS) to diagnose the problem. As prompted by the software, the paramedic asks a series of questions to the health worker, who in turn asks the same to the patient. The responses are communicated back to the paramedics.
- CDSS - Based on the data made by paramedics, CDSS gives a provisional diagnosis and prescription. CDSS can process over 70 ailments. This takes a total of 5 minutes.
- Doctor - One doctor per every six to seven paramedics reads through the diagnosis given by CDSS and edits as necessary. At this point, the patient call is live and the doctor can talk to him/her, the PSS or the paramedic if needed. This is currently observed only in 10-15 percent of the cases. The doctor then approves or modifies the diagnosis and prescription provided by the CDSS. This is vocally transmitted to the patient through the health worker, and the doctor spends about 45-60 seconds in this process. A SMS is also sent to the health worker and the patient. This makes the entire process at the Call Centre to 7 minutes.
The total cost of treatment is between Rs.30 - Rs.50, depending on the medical condition. The Piramal e-Swasthya Centre is also a village-level pharmacy stocked with medicines necessary to fill the basic prescriptions recommended by the call centre. If the ailment appears serious, the call centre recommends that the patient visit a secondary or tertiary health care facility immediately. The health care worker also conducts preventive health workshops, which generate awareness about issues such as sanitation, nutrition and first aid.
This model provides reliable, high quality health care at a villager’s doorstep through cutting-edge technology developed from sophisticated diagnostic protocols, not only allowing the patient to receive immediate relief, but also saving on valuable time and money that is usually lost in travelling to see a doctor in a nearby town. Furthermore, for the first time, patients have access to world-class medicines at an affordable price.
Between Mar 2008 and April 2010 E-swasthya has treated 25000 patients in 40 villages, and now operates with an annual budget of $ 500,000. The program has recently added 60 new villages, but has ceased operations in 25 out of initial 40 villages. Centres in these villages were not seeing enough patients to make the service sustainable, profitable and scalable.
Purpose: Extending Geographic Access
Purpose: Improving Diagnosis and Treatment