Transforming Healthcare delivery using Information Communication Technology through Public Private Partnerships

While about 70% of India’s 1155 million people live in rural areas, most qualified medical professionals are located in urban and semi urban area. Many people in India lack access to quality healthcare, forcing them to depend on informal healthcare providers or “quacks”. Yet increasingly, technology is providing a solution for this longstanding lack of access.

In a three-part blog series, I will give some examples of information and communication technology (ICT) initiatives in India, offering examples of success as well as challenges initiatives faced in implementation.

<strong>Opportunities for ICT</strong>

Limited resources have the potential to be effectively and efficiently utilized using ICT-based health information systems and decision support systems. There are multiple opportunities to improve health care delivery. ICT systems can improve the dissemination of health information, facilitate remote medical consultation, counseling, diagnosis & treatment, and improve collaboration & cooperation among health workers—particularly through mobile technologies such as SMS. It can facilitate research on health systems performance. ICT can also enhance government’s ability to monitor the incidence of public health threats, and improve the efficiency of administrative systems in healthcare facilities.

Several state governments in India have partnered with the private sector in initiatives involving the integration of technology, communication and managerial capabilities. These initiatives create synergies between the strengths of private providers and government and improve their capability of fulfilling the social obligation of government to protect the health of the community at large. In this first blog post of a three part series, I will focus on an initiative that started in my home state, [Andhra Pradesh](http://en.wikipedia.org/wiki/Andhra_Pradesh).

<strong>Dial 104 for Health: Information, Advice, and Services</strong>

One of the largest examples of using ICT in public-private partnerships is the [Health Management and Research Institute (HMRI)](http://healthmarketinnovations.org/program/health-management-and-researc...), an innovative concept started in year 2006. With the support of the Government of Andhra Pradesh, a not-for-profit organization set up a health helpline promoted as “104 Advice" with a call center operating 24/7. 80 million – population of Andhra Pradesh – can access the helpline with the toll-free three digit number “104” and request help. Services are delivered through specially trained counselors and proven state of art telecommunication equipment and technology, services provided include triage (classifying a caller’s condition into critical, serious or stable) and medical information, counseling services and complaint registry.

The database is based on 140 directories, 400 algorithms and 165 disease summaries. Apart from providing medical advice the trends of complaints, diseases and epidemic breakouts are noted and communicated to concerned government officials for immediate action and designing preventive plans. This program was initiated as a public-private partnership with capital expenditure being provided by government of Andhra Pradesh and operational expenditure being shared, wherein government bears 95% of the operational costs and HMRI bears 5% of operational expenditure (including management costs).

Now that the system has matured and a documented model is in place, various state governments are looking at competitive bidding and a structured approach with adequate terms and conditions safeguarding government’s interest while contracting.
Rural masses have taken advantage of HMRI’s free advice and counseling. The 104 Advice line receives about [50,000 calls every day](http://www.hmri.in/). These calls generate enormous data which can be analyzed by governments and used for planning evidence-based interventions in healthcare—even interventions specific to individual villages.

<strong>Challenges and uncertainty of this model</strong>

Yet questions remain. Who owns the data generated? Does HMRI have an obligation to share the data with government? While there is no clarity on this issue, few programs like HMRI are willing to share data.

Roughly INR 4800 million [about 105m USD] has been spent by government till date, and there are no independent indicators generated from the field to measure the outcomes of the program. No baseline survey was conducted at the time of initiating the HMRI project. Another remaining area for improvement is the role of [ASHA workers](http://india.gov.in/spotlight/spotlight_archive.php?id=14) in integrating advice from the 104 help line with village level interventions. No ASHA role has been specified in the scheme, but I feel these health and social activists ordained by government can play an important role in implementing health advice given by phone.

*Editor's note: Stay tuned for part 2 and 3 of Vijay's series on government-sponsored health advice lines! He will reveal new programs established in Bhutan, Orissa and other regions.*