eSwasthya-Health in a Card

Author : Sharique Jamal
Date added : 2003-09-24

Brief Project Background

Health is a very arbitrary term and includes psychological, sociological and physical well-being of a person, in a holistic manner to classify him/her as being healthy. The project started about two years back,in 2001, keeping in view the dismal state of affairs, in terms of health care and family welfare, in the villages of North Bihar. The government machinery is redundant and dysfunctional , with regards to hospitals, which either are few and inadequate or cater to few villages only. Lack of doctors and ambulances also add to the misery. Few other alarming state of Bihar, literally, given below, further strengthened our resolve to mitigate the problem.
We zeroed in the health care problem to be one of remoteness of villages, lack of communication, illiteracy regarding diseases, few hospitals, almost no medical equipment's for proper diagnosis and treatment and sheer poverty. With these indicator's AS benchmark in mind, we formulated the blueprint of the project, eSwasthya .
We needed money foremost to establish the infrastructure. Hence we approached Dr. Jagannath Mishra, ex Chief Minister of Bihar, who from the discretionary fund of Member of Parliament Local Area Development Scheme(MPLADS), sanctioned an amount of Rupees Twelve Million ($ 2,50,000).
Out of which spent on this project , included establishment of ten (10) Community Health Centre and eleven (11) Community Health cum Information Centre. The ten Community Health Centres have been provided with ten Ambulances with Oxygen Cylinder and state of the art Wireless Communication equipments, besides facilities for Ultra Sound, X-ray, E.C.G, Pathological Tests, Medical Store and Public Telephone.
Another factor, which we thought was vital for our project and formed the backbone, was making it ICT compatible. Health camps and polio eradication drive was also undertaken in collaboration with World Health Organization , to the benefit of villagers.
A villager can now walk in any health center , with his/her ID card and get immediate diagnosis or referral , without having to travel great distances and hence losing time and money.

We never thought that the Fall of 2001 would change our life inexplicably and alter our mindsets drastically. It was just after the rainy season or the "monsoon " , AS we call in India, that four of us decided to take a break from our hectic corporate schedule and go on a vacation. The nearest place from our geographical location was Nepal and it had lovely offbeat places, for complete unwinding. The timing was also right, since it was almost the end of the so called tourist packages.
Our plan was to travel by road, since the distance was not far and it was more fun motorable. From Patna, the capital of Bihar, we intended to pass through the North Bihar districts of Muzaffarpur and then Madhubani/ Darbhanga, in order to reach the border's of Nepal. The program was perfect and we embarked on the journey in high spirits. All four of us came from different areas of corporate world but the thing which bond us together, was our friendship and a sense of camaraderie towards each other. We reached Jhanjharpur, a sub-division under district of Madhubani , in North Bihar, late in the evening and intended to take a night halt. Arrangement had been made previously for stay at inspection bungalow and we were totally relaxed and looking forward to the journey ahead.
But destiny had other things in mind for us, which in our wildest dreams could not have anticipated.
AS we were having dinner, a commotion was heard from outside. Out of sheer curiosity, we decided to take a look. There was a group of people holding a small boy, around ten eleven years of age, in their hand and were gesturing towards us. We walked over to them and inquired
casually what all was going on. We all knew the local language pretty well and AS we could make out from the incoherent speech of the father, that the boy had cut himself in the field with a sharp farming tool , in the leg , a few days back. What we take for granted, that is taking tetback injection, he did not have any information nor could that vaccine be found in the remote village that he came from. What ultimately resulted was a serious case of septicemia and the infection had spread to the whole leg. The child was unconscious and in delirium. We were aghast at the level of negligence and how such an ordinary cut could assume fatal proportions. Without losing any time, though a lot of delay had already been mitigated on the part of the villager, we rushed the child in our car, to the nearest hospital. The state of affairs at the so called hospital , was pitiable, to say the least. But after much persuasion and heated words, we finally got a doctor to examine him. The time was around ten o' clock at night.
The doctor came out and told us in plain words that the infection had spread to the whole leg and the only option left was amputation, since it was now a case of gangrene. We could not take the decision without consulting the father and the child's relative. The father broke down inconsolably and kept blaming himself for bringing the child to this condition. But consent had to be given, if the life of the child was to be saved. The operation took around four hours, during which time, we inquired about the reason for such gross negligence. The relatives and other co-villagers informed us that their local "hakim" or village quack , had inspected the wound and put some lotions on it too but had not given it much concern. The main or core reason for delay was, AS we could make out, was a very low level or almost nil health care information. Add to that the remoteness of villages and lack of transport, besides only a few hospitals catering to their need, the services of which are miserable to say the least. Communication was also a major problem in the villages.
With these somber thoughts in mind, we left for Nepal in the morning, stopping on the way to ask about the situation of the child. He was still in ICU and critical. We could not do more and continued with our journey. But through out the vacation , the event kept nagging us at the back of our minds and we were bereft of the initial enthusiasm. Finally ,we made up our mind to cut short our time out period , since not much de stressing was taking place and we somehow felt guilty of the extravaganzas we were indulging in. on our way back, we stopped again at Jhanjharpuri and inquired about the child. He had been discharged but to our shock and sheer dismay, he had died due to faulty blood transfusion, during the recovery period. We were aghast and it was AS if the soul had been taken out of our body. Since we had been involved in the whole process, it was AS if we had failed miserably.
This event was a catharsis of sort and it precipitated a paradigm shift in our views on life and the luxuries we take for granted. We had gone on the journey AS young successful pushy people but returned AS mature adults, with different attitude and a whole new set of standards. We had indeed grown up after the event.
This was the turning or the cataclysmic event which triggered off a chain of brain storming session's between us, for AS is said all great revolutions or upheavals begins AS a small thought in the mind of an ordinary but committed person's, who believe in fulfilling the dream. That's what happened to us. The project eSwasthya was born , conceptualised by Nitish Mishra and the skeleton of the groundwork to be done, was chalked out. We had to keep in mind several constraints AS monetary, logistics , manpower and a detailed research of the area. First and foremost problem was monetary and this was managed fortunately by Member of Parliament, Local Area Development Fund(MPLADS) of twelve million rupees , donated generously by Dr. Jagannath Mishra. We had , after much consideration and research, narrowed down the health care problem to be one of lack of communication, few hospitals, illiteracy and poverty.
So we envisaged, keeping all the above factors in mind, a system of health care units spread across different villages, for providing immediate relief with medicine shops and also in order to cut the critical time loss in case of fatal illness, issuing of simple laminated health cards. This would have a multi pronged approach, in the sense that each villager would be issued a unique ID number on the card and that can be brought simply to any of the health centers, which would have computer linkage with other centers, and diagnosis can be done without any delay. It would save immense time and cost of travelling to hospitals AS well AS standardization of health care management could be initiated. A journey of a thousand miles begins with a small step and we believe, we had initiated the process by bringing about a paradigm change in the way health and welfare of the poor was looked upon.

Results

A chain is AS AS strong AS it's weakest link. In India , the developmental chain and IT progress is gauged only by the revenues generated from the highly urban and economically viable zones. But the weakest links that can make or break any socio-economic progress, are the the basic needs of a human being, that is food, shelter, clothing and most importantly health. If health care is lacking , the other three needs are redundant and void.
We intended to make the project module self-sustaining, after initial start up funding, which had been provided. The working model, AS projected by us, would in simple terms , be offering health related services at a nominal rate to the villagers and the output, would partly go in the upkeep of the center's and personnel. This would make the project viable and feasible, monetarily AS well AS based on realistic assumptions. The ratio of distribution of income incurred from services offered and expenditure, was 75-25%.
The beginning was made and the target area was identified, being one of the most deprived and impoverished regions of Bihar in India. The perennial scourge over here ,in Madhubani , was floods and the aftermath of diseases that follow, leave aside the regular illnesses that was omnipresent throughout the year. This cemented our goals more and the other vision we had was to incorporate a holistic approach to health care solution, so that the other rural evils AS illiteracy and poverty, could also be tackled under this eSwasthya project.
The power of utilizing Information and Communication Technology, could also act AS a catalyst in precipitating various important, nonetheless fringe benefits AS derivatives.
During the last two years, amount of twelve million rupees (US $ 0.25 million) have already been utilized , from which ten Community Health Centers and eleven Community Health cum Information Centers have been established and are partly functional, with the infrastructure given below.
Bhagwatipur in the Andhratharhi block was to function as model center with all available facilities while the rest of the centers will act as coordinating as well as awareness building nodes.
Available infrastructure: Building (1067 sq ft), ambulance with oxygen cylinder, wireless
Ultra sound, ECG, X- ray machines, generator, medical shop and PCO. These facilities are for all health centers. Internet connection is proposed for linking up for medical information with regards to health cards.
The modus operandi of the project has been to gradually address and change the mindset of the villagers, regarding the age old notions that they have per se health care. This is of vital importance in rural sectors, only then will acceptability and change can be made in their lives.
The first step we did was to form an operationally viable and sustainable cluster of villages as a unit. Past estimates and experience show that a group of 10-12 villages with a population of approximately 25,000 each is optimum. This cluster will have a nodal center with a building and other physical assets , which will be strategically placed and will act as the central operational point for the cluster. It will hire a staff to create awareness among the rural people. It can proceed through the following steps:
1. Holding village meetings in each village twice a month, and try to gain the trust of the community;
2. Use charts with easy to understand visuals and graphics and other visual aids;
3. Promote Family Planning;
4. Take active aid of the already established village midwives and quacks and bring them on board to help out in some way;
5. Educate the residents on the importance of personal hygiene and preventative cures through the use of visual aids; and
6. Create a team of people who are at least semi-literate and who can be trained to further spread it through the community. Once we are able to show some tangible benefits, it is hoped that it will become a movement and spread through word-of-mouth.



There will ultimately be 600,000 people that can benefit from the proposed venture. The figure of beneficiary was ample justification for our commitment to the project, eSwasthya.
If successful in the Jhanjharpur sub-division of the Madhubani district of Bihar, the concept will be applied to other impoverished regions of India.
We have also undertaken few important logistic, monetary and and other facilitation from World Health Organization. The funding from WHO was in regard to the five ambulances which were utilised for Pulse Polio Drive, in collaboration with Bihar Institute of Economic Studies, during the month of April 2003.
Besides collaboration with various voluntary agencies AS Rotary International, Lions Club for organising regular health camps, we have also put in place some fixed days for checkup and monitoring of health. Doctors come on a weekly basis and on a nominal charge, the villagers are diagnosed and medicines prescribed. We have also approached voluntary doctors for free counseling on the Net, the portals AS Doctors Anywhere showing positive interest. UNDP is also in the process of incorporating us in their disaster management programs, which they undertake during floods.
A National Health Insurance scheme, launched by Govt. Of India, has shown immense interest in utilizing and tying up with our project, for rural insurance. The costing of this is very nominal and any hospital cost incurred can be fully reimbursed at the nearest referral hospital.
Outlook, a weekly journal , reported about our eSwasthya project in the June edition of Science special, for innovative use of IT , in leveraging technology in an innovative way, to the level of grassroot benefits.
Govt. of India , Ministry of IT, have all shown great interest in the project and have pledged whatever support that they can facilitate.
The project has been greatly acclaimed by agencies and organizations globally and was recently felicitated and recognised AS the ten most enterprising social entrepreneur venture from projects submitted from all over the world, for taking technology to the rural masses, in a cost effective and innovative manner. This was done on behalf of an organisation known AS Digital Partners, a Seattle (US) based group , at an International conference in Baramati, Pune in the month of May 30th to June 2nd , 2003.
In order to put riders and checks to the whole project, so that whole business process went smoothly as we had envisaged, we formed a monitoring committee, consisting of representations from all the organizations directly involved with us, the details of which is given below.
The steering committee consist's of officials of BIES, DM Madhubani, SDO Jhanjharpur, Civil surgeon Madhubani, BDO's of Jhanjharpur and Andhratharhi ( the target areas officials) and representatives of Program Implementing Agency(PIA), Adithi. They will be the guiding beacon towards fructification and justification of the project.
Targets or results will be measured by the regular database monitoring and also on the spot surveys, carried out randomly, at the target villages. These figures, once again will be totally transparent and will be put on the Net for global viewing, so that monitoring can be done by others, besides ourselves.
AS of date, all the above factors are fully operational and functional in the target area of Madhubani district, for the past two years.

Lessons

Though initially the project eSwasthya target area was health care, the overwhelming response to the technology aspect from the villagers and their zeal to learn, has made us confident about the application aspect of various related ICT modules. Once we have instilled confidence in the rural mindset by recognizing the benefit of implementing modern means for improving their quality of life, our work is half done. Even the learning curve is no less than the urban sector, they just need the proper impetus and guidance. The enrollment and identification for creation of Self-Help Group is a benchmark of our acceptance and our success. Connecting to the the Net has opened up a vista of information world for them and the convincing them now about adopting ICT AS a means to remove their problem, is no more a hurdle.
There are no negative outcomes of the project but unintended consequences could be the private medical practitioners, quacks, witchdoctors, hakims etc which are rampant in villages, may view this AS a threat to their dominion, for they have been fleecing and misguiding the villagers from time immemorial. Threats can be posed by the village quacks and profiteers who are well-entrenched in the community and have a vested interest to see that there business continues. The quacks pass themselves off as credible medical consultants and prescribe medicine that people believe, will cure their ills, but in actuality is ineffective. It is important to make these people a part of the process so they do not undermine the project. The more awareness that can be generated about personal hygiene and medicine the better the chance for success of the health centers. It has to be made clear that the quack will be better off working with the people on the project than against them.
Our system will legitimize the whole process besides making it very economical for the poor rural people and providing them with a whole lot of other related fringe advantages.
IT utilization for social welfare can never be used in isolation. Only when it is used as a means to address a larger end can progress and viability be justified.
The utilization of technology is different for different person’s, hence according to one’s needs , IT can be a mode of sharing various relevant information.
Bridging the so called digital divide is possible only when the benefits are absolutely clear to the beneficiaries. A realistic projection of business model has to be in place, so that no “magic expectation” is there in rural mindset.
Health center’s could double up as places for generating information , regarding social evils and prejudices rampant in rural societies, by other collaborating agencies.
Where opportunities was nil, in terms of job and employment, we made great strides in creating employment scenario, in training the villagers(self help groups) for health center’s computers manning, Internet Kiosks, medicine shops personnel, PCO booths monitoring, ambulance drivers and various other openings that may come up subsequently.
Raising the rural health care standard of the target villages may prove to be a cascading effect for the adjoining villages and they may also demand the same from their constituencies. This could be another unintended consequence but which has a positive larger picture.

Development Impacts

Since health care is of prime importance to each human being, availing such services at a very nominal costing, will not hurt anyone and this is the most important factor that makes our project feasible. Plus the value additions with regards to subsidized ambulance facility, medicines, specialized diagnosis through Internet, nominal cost of regular RMP's , will all add up to a self sustainable and a highly feasible module.
The future projection of the project is application to other areas that the connectivity to the Net envisages and building up on the knowledge base provided by it. Once the linkup is successfully completed, the potential for growth with regard to betterment of rural sector under the ambit of ICT, is immense and various facets could be suitably explored.
The technical nitty gritty, we tried to keep it simple and easily replicable, with regards to issue of health cards. We had it in mind to keep the overheads minimum initially, so we started with the idea of a plain laminated card (like any driving license), which had unique ID number. This was simpler and cost effective to issue and also easier to implement. In case of us going in for smart cards, the cost would have gone up also and smart card reader would have been required at each terminal, which was just not feasible.
The software for the laminated heath card was developed with front end VB and backend MS Access, which is there on all machines. Terminal was all that was required to retrieve or access patient data and subsequently print the health card. Implementation of this basic technology was not a hassle at all and all the villages could easily be linked up. We were also looking at Wi Fi network for connectivity to the Net, which was cheap and removed the phone line aspect.
In compatibility with our aim to provide a holistic approach to the other related problems in rural sector, which can be suitably dealt with, the infrastructure remaining same, were the vital benefits that arose from ICT implementation.
We have used ICT AS a backbone to address a larger issue of health care and also an important tool , by utilising the various positive features that are linked to it. The connectivity of the health center, to the Net, will literally open up Windows for the rural sector, by exploring the below given areas, which are extremely feasible and scalable. These additional benefits are based on the same implementation model and hence will be nominal costing on implementation, but with immense ramification and utility.
· E- Literacy
· E- Health
· E-Tourism
· E-Sthree
· E-Post
· E-Wisdom
· E- Rural Bazaar
· E-Indian Languages
· E-Doctors
· E-Disability Empowerment
Case in study, among many that we have successfully cured and rehabilitated, in terms of holistic well being, was one of Asha Devi. She gave birth to a triplet, all three girls. At night her husband informed the local health center, which in turn rushed with the ambulance to her village, which was remotely situated. The driver on his wireless, in the meantime informed the doctor, so that he could be available at the time of his return and the delivery be done without any delay.
That is what happened and Asha is indebted to our eSwasthya project for not only saving her and her daughter’s life, which otherwise would have taken critical proportions, but also for creating awareness among her and her family regarding the prejudices and fallacies that they had for the girl child. Awareness camps for women by Adithi, our program implementing agency , has done yeoman’s job in removing many a mind blocks and sheer illiteracy , with regards to reproductive health and women empowerment.
With regards to employment, Raj Sau, was an addict of hooch till a few years back. After attending some of the awareness camps at the center, he was suitably committed to improve his state of affairs. Now he operates the computer, after taking learning classes, at the center and earns around $ 60 a month. Same way, from the revenue generated from the services offered, we have hired ambulance drivers, booth owners and many more.
During floods also various diseases came to our knowledge, and whatever we could muster up with our means and external agencies, we did in full faith.
To summarize, we have begun a journey in full earnest, in the heart of darkness, and have lit a lamp, where there was no light. But our strongest conviction is not just identification and curing of illness, but going deeper and creating awareness about the illness and the reasons for it’s manifestation. This leads to a holistic understanding and in the future makes the person stem the disease, without waiting for it to blossom into a full blown case.
Health center now brings a smile and hope for the remote villages of Jhanjharpur and they know now, the beginning has been made and the torch has been lit.

Project Information

Organisation : Bihar Institute of Economic Studies
URL : http://www.biesindia.org
Total budget in US$ : 1,50,000
Country of activity: India [IN]

What is partners role?: ð Main program implementing agency is Adithi, which has immense expertise and competence in successfully completing various rural health and sanitation projects.
Other agencies involved in collaboration as well as association, with our project:
ð Digital Partners: a US based group, which works on leveraging ICT technology for the poor section, has pledged logistic support, in the form of computers and allied hardware and was instrumental in providing mentorship.
ð Shamdasani Foundation: a Hong Kong based voluntary organization, regularly sends monetary help, which is duly utilized for purchase of health care equipment's.
ð Ministry Of IT, Govt. of India: under their standard blueprint of nation wide implementation of health card scheme, they have promised technical support and/or monetary funds, if feasible. Attached is a letter from Mr. Arun Shourie in this regard.
ð Ministry of IT, Bihar Govt.: talk is going on for any facilitation or help that can be deemed feasible.

Contact Information

Sharique Jamal
sjamal@biesindia.org,sharique_jamal@rediffmail.com
49/1 New Patliputra Colony, 800013, Patna, +91-612-2520721

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