Integrated women and child healthprogramme: A community outreach modelOverview of Proposal for POC andPilot at Gajwel constituencyHyderabad, September 2014For discussion purposes only

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Agenda

2.0 The context and objectives: POC and pilot for Gajwel constituency

3.0 The concept

2.1 Healthcare performance in Gajwel constituency

2.2 Critical gaps and potential services

4.0 Operationalization of the model

5.0 Project implementation and monitoring

6.0 Key outcomes of the POC and Pilot project

2.3 Potential services, components and beneficiary segments

3.1 Field activity plan

3.2 Service areas and execution map

3.3 Resource requirement

4.1 Timelines, action plan

4.2 Project Monitoring committee

7.0 Support from the Government of Telangana

1.0 IntroductionContents of Detailedpresentation submittedas a concept note forapproval by the StateHealth Ministry - TS

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Opinion ofcommunity

experts

Discussionwith key

stakeholders

Piramal HMRIResearch

Field VisitsOpinion of

internalmedical experts

Aug 112014

3 Shortlistedthemes

We AreHere

6 Potentialthemes

Potential healthcare pilot at Gajwel

Assessment ofpotential

interventions

Today

The context: We have had iterative discussions with variedstakeholders to arrive at potential healthcare concept for Gajwel

1. Women health2. Infant and child health3. Maternal care4. Chronic condition screening5. School health programme –JBAR CHIP6. Drinking water

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In 66.67% of villages, Garbage is thrown in the vicinity of households: Sanitation issues

More than 95% of the people have to travel 5 KMs+ to reach a PublicHealth Facility

Out of the above 95%, only 50% of the people have access to Public Transport

Qualified doctors are available in only 11.11% villages

Absence of JSSK 102 service and helpline prompts for dependence on 108 for transport ofpregnant women and sick new born

The context: Field survey & key observations

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The concept:Integrated women and child healthprogramme through community outreachmodel

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Healthcare reach Limitations of care reach (Secondary research)

~ 97% of pregnant women received3 ANC check ups during pregnancy1

Institutional delivery is ~ 77%2

Functional 104, School Health CHIPprogrammes

Functional 9 PHCs, one CHC

Only ~ 25% of the population hasaccess to specialist care4

75% of the population need tocommute an average of 25 KMs toaccess specialty care5

Limited Specialist level screening toidentify high risk maternal cases

Source(s)

1,2 – NRHM MIS Standard reports – Maternal and child health Updated till 15 Sep 20144,5 – Field survey of Piramal HMRI

The healthcare performance on key indicators at Gajwel constituencymeets certain Indian health standards…..

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CurrentHealthcarePenetration

Populationreach

Conditionreach

• Socially excluded sections• Economic vulnerable sections• Demographic vulnerable• Physical vulnerability

S

I

R

E

F

Screening

Identification

Referral

Enable

Follow up

• Gender based• Age related• Community based• Endemic• Acute & Chronic

… but saturation of healthcare at the last mile is only possible througha three dimensional approach

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D

• SC,ST populations constitute ~19% of total population1 (18.58% SC; 1.36% ST)

• ~ 120 habitations of SC, ST communities2

• 95 is the number of households per habitation vis-a- vis the average of 472 for other communities3

• 535 population per habitat vis-à-vis 2112 population per habitat of other communities4

• High prevalence of school drop out (5-15 years range); as high as 50.43%5 among SC and79.41%6 among ST

Demographics: SC, ST sections in Gajwel constituency

Key implications for healthcare models

Dimension -1: Segmentation of population highlights gaps of currenthealthcare reach

• The SC, ST community population is highly fragmented and scattered

• Reach of traditional channels for healthcare delivery likely to have limitations

• The current design of Public health programmes (104, School CHIP under JBAR) experiencelimitations to address the needs of diverse segments

Source(s)1. Census 20112,3,4 http://indiawater.gov.in/IMISReports/Reports/BasicInformation/rpt_RWS_AbstractData_S.aspx?Rep=0&RP=Y&APP=IMIS5,6. Source: DiSE data 2012-13(As on Sept-2012)

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Screening Identification Referral Enable Follow Up Closure

Gender basedcare initiatives(15+ years age)

Child health(5-15 years)

Maternal care

Newborn care

Care Services Continuum

Pote

ntia

l Ar

ea o

f int

erve

ntio

nDimensions 2,3: Redefine the areas of intervention and care servicesto asses the gaps of healthcare execution

Areas of improvementAreas doing well Proposed areas of intervention from Piramal HMRI

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Beneficiary segment Segment scope Overview of theservices Potential number of beneficiaries

15 years+75

(Especially SC, STadolescent girls &women)

1. Healthawareness

2. Screening &identification

3. Referral4. Follow up

~ 26,000 women (SC,ST communities 15+years)1

Programme @ Gajwel constituency

5-15 years

(Essentially schooldrop pouts)

1. Screening &identification

2. Referral

• ~ 9,000 school drop outs (SC, STcommunities)4

Programme @ Gajwel constituency

Pregnant womenfor deliveries

Newborn check up(Sick infants 0-30days)

JSSK 102Programme

• 6,024 women expectedpregnancies3

• 5,422 expected neonates4

Programme @ Gajwel, Siddipet,Zaheerabad AH/CHNC jurisdiction(Estimates in a year under the areas covered byCHC/AHC @ Gajwel, Siddipet & Zaheerabad)

WomenCare

Children

The 3 dimensional analysis suggests the following beneficiarysegments and service areas of priority

1. Census 2011; 2. DISE data 2012-13(as on 30th Sept-2012); 3,4. CHFW, Govt of AP, 2013-14.

Pregnantwomen &newborn

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WomenCare

(15 years+)

• Pyoderma• Scabies• Ringworm• Leprosy• Eczema• Pediculosis

• Xerophthalmia• Bitot spots• Conjunctivitis• Refractive errors• Squint• Night blindness• Cataract

• Reproductive tractinfections - screening

• Sexually TransmittedInfections – screening

• Contraception• ANC & PNC• Pre Menopausal syndrome• Unwanted pregnancies• Senile vaginitis• Uterine prolapse

Eye

Reproductive& sexual health

Skin

Overview of service areas for women care segment at Gajwelconstituency

• Malnutrition, Anemia• Hypertension• Diabetes• Breast cancer,

malignancy screening• COPD• Osteoporosis &

rheumatoid arthritis• Hyper/hypo thyrodism

Primaryconditions

• Tonsillitis• Ear infections• Defective Hearing• Otitis media• Deafness

ENT

• Dental Caries• Oral Ulcers• Glossitis• Cheilitis• Angular Stomatitis• Pyorrhoea

Oral

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Children(5-15 years)

• Pyoderma• Scabies• Ringworm• Leprosy• Eczema• Pediculosis

• Xerophthalmia• Bitot spots• Conjunctivitis• Refractive errors• Squint• Congenital anomalies• Night blindness

• Dental Caries• Oral Ulcers• Glossitis• Chelitis• Angular Stomatitis• Cleft Lip & Palate• Pyorrhoea/Periodontitis

• Tonsillitis• Defective Hearing• Ear infections• Speech defects• Otitis media• Congenital Deafness

Oral ENT

EyeSkin

Overview of service areas for child care segment at Gajwelconstituency

• Anemia• Malnutrition

Other medicalconditions

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• Free referral pick up and drop for pregnant women• Safe transport for sick newborn (up to 30 days)• Referral transport to higher care institutions per case is basis

• Timely reach to hospital/home• Mitigate risk due to delayed transportation• Encouragement of institutional delivery• Referral transportation in hygienic environment

• Improved care access during pregnancy for deliveries• Increase in institutional deliveries• Assurance of neo natal care access (30 days from day of birth)

The concept

The benefit

Potential impact

Project area

• Siddipet Mandal (Area Hospital area only)• Zaheerabad Mandal (Area Hospital area only)• Gajwel Mandal (Under CHNC area only)

JSSK 102 concept to aid referral transport for the pregnant womendelivery and check ups for sick new born: An overview

Pregnantwomen

SickNew born(0-30 days)

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The plan proposes to implement the pilot programmes at 5 locationsacross Medak district

Medak district: Proposed areas of pilot implementation

Siddipet

Gajwel

Jagdevpur

• JSSK 102

Zaheerabad

• SC, ST Women care• Children care (5-15 years)• JSSK 102

• JSSK 102

• SC, ST Women care• Children care (5-15 years)Toopran

• SC, ST Women care• Children care (5-15 years)

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Community

Door todoor

Women

Children

Pregnantwomen

Monitoring andcoordination platforms

ICT Platforms Service tracking cell

Tertiary careFacility/TMC

CHC

Diagnosisfacility

The project to employ an outreach model with a centralizedmonitoring leveraging ICT platforms

JSSK 102

GNM

PHC

MedicalPractitioner

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Kondapak

Jagdevpur

Gajwel

Wargal

Mulugu

Toopran

Field operations & monitoring

• Gajwel block accounts for 23% of SC,STwomen

• ‘Complete and move to next’ model;programme to commence at Gajwel block

• Gajwel is divided in to 4 sub regions

• 7 teams to be deployed in total

• 4 GNM per each team and a doctor oncase is basis

• Gajwel to act as a local monitoring office

• Ahmedipur PHC to be connected toHyderabad for Telemedicine

SC,ST population concentration Community to PHC

PHC at Ahmedipur

Operationalization of Women and child care programme

Block map of Gajwel constituency

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A case in point: Project Shruthi to address preventable hearingdisabilityPOC in partnership with Medtronic at Hyderabad

Decreased cognition & learning

Decreased life & social skills

Social exclusion

Exclusion from livelihood

Economic dis-advantage

Social exclusion

Decreased family interaction

Increased dependency –low self-dignity

Social exclusion

Hearing Disability… An Unseen Burden

Create and manage a self-sustaining ecosystem forawareness, diagnosis,treatment and rehabilitationof ear diseases inunderserved patients indeveloping countries

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Awareness, Screening, Diagnosis, Counseling, Facilitation, Treatment , Follow-upIntervention:

Medtronic Shruti – HMRI Hyderabad Proof of conceptIntervention across care continuum leveraging pioneerMICT platforms*

*Medical Internet Communication Technologies

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Medtronic Shruti – HMRI Hyderabad Proof of conceptProject areas and impact

• Vulnerable population in Hyderabad(population at slums, below poverty line etc.)

• 70,000 population – Target coverage

• Universal door-to-door screening

• Beneficiaries - All age group and gender

Project area: 6 communities in GHMCProject reach

Project outcomes (As on date)

• 30,000 population screened

• 6,000 with ear problems identified

• 2,000 with critical ear issues identified

• 500 patients registered for treatment at ENT

• Developed extended care @ 3 Charityhospitals

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Piramal Swasthya is a registered non-profit organization based in Hyderabad, Telangana State. Piramal Swasthya is supported by PiramalFoundation and works towards making healthcare accessible, affordable and available to all segments of the population, especially those mostvulnerable. In order to achieve this goal, Swasthya leverages cutting edge information and communication technologies to cut costs withoutcompromising quality as well as public-private partnerships to scale its solutions throughout India and beyond.

Swasthya envisions a future in which all vulnerable groups have the necessary information to make informed decisions regarding their healthand affordable, available and accessible high quality health infrastructure to support the realization of those decisions.

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