Improving the dire state of healthcare in rural India

Challenge

My challenge is to solve the dire state of healthcare in India and make it like Delhi Metro – efficient, inexpensive and accessible for all. Particularly, rural and remote areas have to face the wrath of inadequate healthcare in India. The reasons for these are multi-fold. Lower government expenditure (a mere 1.3% of GDP as compared to world average of 6%). There is shortage of doctors and nurses – there's only one doctor for about 10000 people which is 10 times more than the WHO recommendation. To add to the misery, even in the available pool, there is lack of well-trained personnel due to not up to the mark teaching infrastructure and faculty. Also, many doctors prefer to go into private sector which absolutely makes sense because the government's low investments have not been able to make the public sector a lucrative career choice. I agree the end goal should be serving the humanity but that should flow top-down and not just the doctor can be held responsible for this who has to make a huge financial investment (her)himself to become a doctor. The private healthcare is the reliable solution left, but that is un-affordable for a majority of population and also it is concentrated majorly in urban areas. Thus, the rural and remote areas are eventually underserved. 

There are several structural problems which have crippled the healthcare in India and many of the problems can be solved if the government acts more responsibly and provides more financing for the development of this sector as well as fair auditing of the current infrastructure. However, some of the initiatives are possible from our end as well. 

Solution 

The unregistered medical practitioners or ‘quacks’ in the rural areas can be trained formally in healthcare and can be provided a basic certification. Such people live in the villages, thus are available locally. They already have some knowledge of medicine, either self-acquired or through tacit knowledge. What can really upgrade them is a set of formal training which can enable them to do the right diagnosis based on theories of medicine, or atleast be able to make the decision of getting the diagnosis done from the nearest facility available before it is too late.  

A network can be conceptualized which connects the quacks to certified doctors in the city and diagnostic centers. Once a formal connection is established, the quacks can be connected to the group of doctors through WhatsApp with whom they can be in touch regularly for guidance and consultation. The quacks can also be given the basic training of collecting samples which they can then send to nearest available diagnostic centers in one go and help in interpreting results and give recommendations to the patient accordingly. Thus, there is no need of lab establishment in the rural and remote areas. 

The quacks can be made aware of preventive healthcare and the quacks can be pushed to promote the same within their areas as well. Awareness can be spread about – proper sanitation, vaccination at proper time. Regular health checkups because of easy and cheap accessibility can be an effective step in monitoring the health of the local residents which will prevent the potential diseases to grow further.  

Another important implementation that can happen through the medical practitioners with basic certification is monitoring and reporting the performance of 108 Emergency vans. Currently there are several inefficiencies in the 108 service due to which there is sub-optimal response time and unattended calls. According to a report, in Odisha, ambulances were dispatched only for 5.43% of the calls. Further no details regarding the incident were recorded. In Madhya Pradesh, the average reporting time of the ambulance was reported to be 41 to 47 minutes whereas they promise 18 minutes. If tracking can be done at the source of incident with proper details, such cases can be reported to the administration and improvement can be brought about in the 108 services which will eventually lead to provision of more healthcare facilities in remote and rural areas. 

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Before and after storyboard 

Before - 

After-

Looks like prototype 

Low cost experiment to test feasibility 

Hypothesis:

The quacks will be able to learn the basic skills and be capable enough to administer the same for the benefit of the local people.

Details of experiment:

I will contact my friend who is a doctor in a well-established private hospital and design a workshop with his guidance which can provide a quick training on basic healthcare to the quacks. After that, I will contact the head of a village which is nearby Bangalore to take permission to organize this workshop. I will also take one of my friends along with me who would be able to interact in the local language. We will conduct the one-day workshop in the village in which we will address the village quacks and the local villagers.

Success criteria:

a) A short exam based on the workshop to test the basic medical knowledge of the quacks and to test the health awareness of the general public  

b) Take feedback after 2 weeks from -  

        i) Quacks – if they have been able to provide better services after the workshop and if more people are visiting them due to increased awareness and confidence
       ii) Local villagers – If they have seen any improvement in the quality of diagnosis done by the quack as compared to before. 

Cost of the experiment:

The following investments are expected to occur - 
1. Time to conduct all these activities
2. Setup cost for the workshop like projector and screen on rent
3. Driving cost to the village
4. Meals for the team
5. Opportunity cost of around 2 days of work for my doctor friend as he would be spending time in designing the workshop as well and 1 day of opportunity cost of assistant to the doctor if needed.  

Thus, the cost would be very less. As I would be taking a favor from my friends for the social betterment, I would not need to pay them. Thus, this experiment can help to test the feasibility of the proposed solution in less time and low cost. Reliability of results can be improved by replicating the same experiment in a few other villages for which the cost would be even lesser as the same workshop design would be used. 

And if this experiment proves to be successful, we can work formally with the government and administration to establish a proper infrastructure for designing and conducting workshops to train quacks and provide them certificate as well as implement other features which have already been discussed in the prototype.