We want to provide quality primary healthcare to the underserved population by empowering the health workers with the right knowledge, technology, infrastructure, and partnerships.
Our Observations
- Most qualified doctors are residing in urban areas, and it makes almost no sense for them to shift to rural areas, not even to a small town. Most of the health care in small towns and rural areas is either by government hospitals and PHCs, and doctors who start their own practice on-side while working in the government hospitals, or by less qualified health professionals, including quakes and underqualified nurses and compounders.
- Most of the population resides in rural areas (>70%), but just the rural-urban divide is not enough to look at the scale of the underserved population. The towns with less than 50,000 population are no better. In our experience, towns with less than 50,000 population are often center for a hub-n-spoke model of rural India, where the actual population resides in the countryside, while services they seek are concentrated in that small town, which often includes only a government hospital, and the earlier observation about the rural areas equally applies to them too. Similarly, large villages especially with a greater than 5000 population are served by primary healthcare centers, and more often than not, these last-mile health infrastructures are found wanting of qualified medical professionals.
Table 1: NUMBER OF VILLAGES AND UAs / TOWNS BY SIZE CLASS AND THEIR POPULATION (Census 2001)
So, our targeted segment essentially is larger than just the rural population. In our imagination, these underserved towns, with populations less than 50,000, hold special importance for us to serve the rural underserved population. They will become the hub, in our hub-n-spoke model. Similarly, large villages with more than 10,000 population would also be the hub for the hub-n-spoke model.
Beyond that, we also want to target a well-off urban population as well. In our grandest vision, each metro-rail-station, in each metro-city of the country there should be a small ATM-like machine, you just sit in the machine, and it will tell you whether you should visit a clinic, and why? Including a quick consultation with our Specialist-on-screen for further inquiries. Pregnancy worries of sexually active metro women is one prime example of it, Corporate workforce under stress, on a tight watch for on-set of lifestyle diseases, is another.
1.1 Our Vision:
Providing accessible, affordable, and quality health care to all.
Where accessible means within physical reach in a time-bound manner, and without social or cultural taboo or stigma, in an inclusive manner, with a special focus on women’s health. Affordability is just a function of cost or expenditure, but it does entail complications of ‘out-of-pocket-expenditures’ as well as management of long-term complications, including life-long management of complications psoriasis, thyroid, asthma, sugar, hypertension, etc. Quality is largely derived from qualified medical professionals and the standardization and accuracy of the investigations and tests.
1.2 Sub-components of our vision
our philosophical target explained in the bracket
- Making the last-mile delivery of health care possible in India, through micro-clinics. (Physical Access)
- One-stop solution for the common and more frequent health care issues, including basis investigations and medicine dispensing. (Physical Access and Affordability, as reduction of traveling cost, which includes not just money spent on traveling, but also the availability of an able-male to accompany women or child to seek health care outside of their comfort zone, i.e. their own village or neighborhood)
- Utilizing ‘extra time’ of the doctors residing in metros and large urban areas, for providing the right advice, especially for the secondary and tertiary care, and diagnosis leading to specialists. (Feeds into quality, as well as affordability)
- Reducing the workload of the specialist doctors, by directing non-specialist healthcare issues to a rightly qualified, but non-specialist person. (reduces over-consumption of quality, feed into quality as well as affordability)
- Not burdening patients with carrying or producing the whole medical history for seeking health care. (Accessibility, reducing the dependency of a not-so-well-versed-with-the-system person on others)
- Privacy of patients must be protected, health-seeking behavior must be promoted, and early diagnosis of a medical condition must be prompted. (Accessibility, Affordability, and Quality, all of them combined, feeds into behavior change of the society in general)
1.3 Our solutions:
- OPD-next-Door, with Specialists-on-screen.
- Hob-n-spoke model for investigations and medicines that can not be operated at the OPD-next-door, for the scale required to operate them efficiently.
- Promoting health care-seeking behavior, by facilitating routine check-ups, ideally at OPD-next-door, at a minimal cost for operator, and seemingly free for the patient, thus promoting preventive healthcare and early diagnosis. For example, one of the most neglected healthcare is Ophthalmology, especially for women who cook on wood-burning stoves and aren’t reading on regular basis. An early diagnosis can not only save their precious vision but also reduce the cost that they need to absorb for delayed treatment.
- Tele-assisted medical services for timely consumption of medicines, which needs long-term regular treatment, such as TB, Diabetes, Hypertension, Thyroid disorders, Asthma, many skin disorders like Psoriasis, Obesity, etc.
- Assisting medical professionals with a complete history of the patient (health-resume) just a click away.
- Building machine learning models, artificial intelligence to pick early symptoms of a future illness, and health analytics.
- Enabling better decision making by the patient, to choose among alternative medicines, especially for long-term, recurring, and life-long complications.
1.4 OPD-next-Door
A small micro clinic, manned by a low-skilled medical or paramedical professional, part of the spoke in a hub-n-spoke model
We are planning to open a micro clinic among each population segment that needs to be served, with a small machine like a lounger which enables taking vitals and also initiate the patient to the specialist-on-screen, and optionally attached medical equipment. The micro-clinic would be equipped with Athena and attached medical equipment. Operating the Athena and attached medical equipment would be the responsibility of the paramedic operating the micro clinic, ideally a nurse, who can also take samples.
1.5 Athena
the health kiosk, and core of our idea
In our imagination, Athena is a small ATM and lounger-type machine, which would be able to take basic vitals such as weight, height, BP, pulse, pulse oximetry, temperature, respiratory rate, chest size, waist size, hip size, etc. Athena would enable us to make a basic diagnostic of the patient, especially in light of frequent and recurring data of vital signs and patient history. These basic measurements would be free of cost, and any patient would be able to just walk in and take these measures, and talk to our AI bot through Athena. Currently, we see NLP as a barrier for a talking-seeing AI, which is why the paramedic is required to explain everything to the patient who had come to the micro clinic. The para-medic or nurse (now onwards, just nurse) essentially becomes the first point of contact for the patient walking into our clinic, she will also guide the patient to take the vitals, and get registered with Athena. Athena would be a cloud-connected, non-portable machine with video conferencing capabilities, along with taking vitals. If the patient has come for simple fever or small things, and AI does not suggest any consultation with a specialist is required, the nurse herself can prescribe the basic medicines, which then can be taken from the pharmacy there itself. In case the medicine is simple but requires at least an MBBS doctor to look into the case, an online consultation would be booked on Athena. While there will be a patient app, for the patient to see all of her details, each Athena shall essentially also function as the patient information kiosk, as well as clinical-management-dashboard, operable by the patient, and the nurse, respectively.
1.6 Doctor-on-demand
the remote consultation with matching qualification, avoiding over-consumption of specialist qualifications
In case the nurse feels that the patient should take consultation with a specialist or a general physician, for any problem that she is not qualified to advise for, she would put a request in the cloud, either through her own system (phone/mobile) or through Athena. In both cases, the online consultation (video conferencing with the doctor) would be through Athena’s screen, speaker, and microphones only. Ideally, the nurse should be a third participant in the online consultation, with a separate mechanism, including calling up more doctors in the consultation, but we are planning to keep it simple and just one-to-one, between doctor and the micro-clinic (patient assisted by the nurse, to tackle language barrier). The doctor may suggest further tests, for which either the Athena would have attached equipment such as hemoglobin analyzer, or biochemistry analyzer, etc., or nurse would be prompted to take the samples, which then can be sent to the hub of the hub-n-spoke model for more investigations, along with the prescription. In both cases, the reports will be uploaded online to the patient’s health vault through Athena, and doctor shall be able to see them and suggest further courses of treatment and management. The doctor should also be able to prescribe medicine and further courses.
1.7 The Pharmacy
Medicine dispensing, including on-demand
The micro-clinic would also be equipped with medicines that are of common use. Analytics and long-term collected data would help us to keep only those medicines that are commonly used, and we foresee their consumption (with a much higher probability) before their expiry date. This will help using reducing wastage, thus making a better economic case to keep them there, rather than fetching from the hub each time. Given that, there has to be a sample collection and transportation service, the medicine delivery from the hub to spoke can be just tagged along with the person carrying samples, this makes the more frequent supply of the medicines to the micro-clinics, and better management of the less used medicines, including seasonal illness combatant. The medicines will be initially dispensed by the nurse/micro-clinic operator, but later on, Athena should be able to do that all by herself.
1.8 The Hub
a small-scale smart clinic, in a rather populous town, with better investigations capabilities, Athena of course would sit everywhere, and an inventory of medicines, and investigation ingredients for all the Athena under it
We would set up a small investigation lab with smart connectivity serving several micro-clinics, possibly also nearby clinics of other doctors, who can come on-board with us, for online consultations, as well as to send their samples to us. All the medicine dispensations for the micro-clinics, as well as tests and investigations that can not be done in the micro clinics, would be diverted here. Initially, we would be tying up with already established labs and hospitals in the vicinity, and with increasing patient load, we would be setting up these labs ourselves for a seamless experience of all the lab-tests internally for our medical professionals as well as for the patient. This would allow us to have better control over standardization of lab services as well as quality assurance. The hub, thus, essentially be hosting a micro-clinic, and an investigation lab with more capability than micro-clinic, everything connected to Athena.
1.9 The Moving Camps
Athena hosting its bigger sisters
For those services, such as ophthalmology, which requires a specialized doctor and machinery for an eye check-up, and can be utilized effectively and efficiently only with a larger population base and check-ups need not be frequent, a bi-annual or annual check suffices, would be provided in a moving camp. The example of eye-care, an ophthalmologist would be carrying her machines and equipment to several micro-clinics to host a regular check-up of the population at a regular interval, ideally once a year. The host would always be Athena-equipped micro-clinics, where a nurse would be announcing the camp dates to the served population in well-in advance. This modus-operandi can also be utilized for blood banks and NGOs which run blood collection drives. A camp should bring a lot more machines for routine, and detailed profiling of each individual in the population, whether healthy or not, for a full-body routine check-up, thus promoting health-seeking behavior and early diagnosis of the whole population for the onset of any predictable complication. Commonly conducted routine check-ups or camps are Eye-check-up, Blood banks, Thyroid, etc.
1.10 The Referrals and IPDs
For all the conditions, that we are not able to cater to we’ll be tying up with nearby hospitals, including ambulance services. Any patient in want of emergency service should be able to order or seek IPD or Ambulance services from the nearest health care center for further treatment and investigations, ideally using our app, which would also allow the medical professional in the partner organization to see the patient’s medical records. Each hub would be responsible for a tie-up with the nearby hospitals, on behalf of all of its spokes (micro-clinics).
1.11 Insurance and Government Support
For all the OPD services, for which we can enable the patients to take advantage of insurance and government schemes, we would be looking forward to making these benefits available to the patients. However, most of the insurance work with IPD, and we in our model do not envisage, as of now, IPD services.
