HealthRise India Program Launch · •Problem Statement ... Fear to visit Hospital alone Expensive...
Transcript of HealthRise India Program Launch · •Problem Statement ... Fear to visit Hospital alone Expensive...
HealthRise India
Program Launch
Grantee & CAC Kick-Off Meetings
November 19-20, 2015
New Delhi, India
MAMTA Health institute for Mother and Child
Outline
• About MAMTA
• HealthRise Objectives & Target Beneficiaries
• Problem Statement
• Intervention Framework and Key Activities
• Key Partners
• Key Project Staff
• Timeline for next 6 months
12/8/2015 A Medtronic Philanthropy Healthcare Access Program 2
About MAMTA Brief introduction
VISION Working together in building a world that is just, equitable and inclusive
KEY THEMES SRHR MNCH&N HIV/AIDS & TB NCDs
STRATEGIES
Community action
Capacity building
Research & Evidence Building
Systems strengthening
Networking & Collaboration
Key Collaborations and Partnerships over 10 years:
AUSAID Ministry of Health and Family Welfare, GOI DFID Ministry of Women and Child, GOI European Union Ministry of Youth Affairs and Sports, GOI Finland Development Aid National Institute for Urban Affairs Foundations : National AIDS Control Organisation (NACO) (EJAF, Packard Foundation, Ford Foundation, BMGF, McArthur) State AIDS Control Society (SACS) IPPF Ministry of Panchayati Raj, GOI International HIV/AIDS Alliance National Commission for Women, GOI SAARC/SAIVAC National Health Mission, Flagship Programme, GOI USAID National Institute of Health and Family Welfare (NIHFW) UN agencies (UNDP, UNAIDS, UNICEF, UNFPA, WHO) NIPCCD Corporate Partnerships ` BIRAC-BMGF-DBT
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Health Rise India – Overall Objectives
1- Increasing screening and diagnosis (detection) of people
who have not been diagnosed and are not aware that they
are suffering from diabetes or hypertension but are at risk
for either disease by July 2018.
2- Increasing management and control of Diabetes or
Cardio Vascular Diseases (particularly hypertension) by
July 2018.
Target Beneficiaries
A. Individuals of 15-70 years age group from rural and urban areas who
belong to following categories:
a. At risk individuals of diabetes and CVD
b. Individuals living with diabetes/hypertension and not meeting their clinical targets
(FBS, HbA1c, total cholesterol)
c. Individuals living with diabetes/hypertension with co-existing morbidity or
complication (nephropathy/neuropathy/retinopathy)
B. Health workforce:
a. Healthcare providers - Doctor and Nurse
b. Frontline functionaries.
C. Family and caregivers
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Outline
• Problem Statement
- Burden
- Access to care
12/8/2015 A Medtronic Philanthropy Healthcare Access Program 6
Problems – Burden of Disease, Shimla
NCD STATUS* Diseases
Hypertension
(29.2%)
Ever Diagnosed
(30%)
On treatment
(26%)
Controlled
(9%)
Uncontrolled
(17%)
Not on Treatment
(4%)
Undiagnosed
(70%)
Diabetes
(3.3%)
Ever Diagnosed
(81%)
On treatment
(76%)
Controlled
(37%)
Uncontrolled
(39%)
Not on Treatment
(5%)
Undiagnosed
(19%)
*Source : Health Rise Needs Assessment Overview India: Shimla and Udaipur. Institute for health metrics and evaluation. Mar 2015
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Problems – Access to NCD care Perceived by the community
Reluctance towards self-care
Financial problem
Lack of knowledge about diseases
Lack of knowledge about services
Fear to visit Hospital alone
Expensive health care
Overcrowded health facilities
Unavailability of doctor
Long waiting time
Lack of laboratory facilities
Improper attention of the health care staff
Lack of space
Hectic process of collecting lab-reports
Medicines are not free
Timings of health facility are not
convenient
Improper infrastructure
Lack of specialist doctor
Lack of positive attitude
Long distance from home to
health facility
Poor transportation facility
Lack of family/community
support
Inability to take decision
independently due to family/
culture
Reluctance towards self-care
Financial problem
Lack of knowledge about diseases
Lack of knowledge about services
Fear to visit Hospital alone
Expensive health care
Overcrowded health facilities
Unavailability of doctor
Long waiting time
Lack of laboratory facilities
Improper attention of the health care staff
Lack of space
Hectic process of collecting lab-reports
Medicines are not free
Timings of health facility are not
convenient
Improper infrastructure
Lack of specialist doctor
Lack of positive attitude
Long distance from home to
health facility
Poor transportation facility
Lack of family/community
support
Inability to take decision
independently due to family/
culture
Problems – Access to NCD care Perceived by the community
Lens 1
Individual Factors Health System Factors Community /
Environment Factors
Reluctance towards self-care
Financial problem
Lack of knowledge about diseases
Lack of knowledge about services
Fear to visit Hospital alone
Expensive health care
Overcrowded health facilities
Unavailability of doctor
Long waiting time
Lack of laboratory facilities
Improper attention of the health care staff
Lack of space
Hectic process of collecting lab-reports
Medicines are not free
Timings of health facility are not
convenient
Improper infrastructure
Lack of specialist doctor
Lack of positive attitude
Long distance from home to
health facility
Poor transportation facility
Lack of family/community
support
Inability to take decision
independently due to family/
culture
Geographic
Accessibility Acceptability (Awareness)
Long distance
Poor
transportation
facility
Reluctant towards selfcare
Lack of knowledge about diseases
Overcrowded health facilities
Lack of knowledge about services
Long waiting time
Improper attention of the health care
staff
Inability to take decision independently
Hectic process of collecting lab-reports
Improper infrastructure
Improper treatment
Timings of health facility are not
convenient
Fear to visit Hospital
Lack of positive attitude
Affordability
Financial problem
Expensive health care
Medicines are not free
Availability
Unavailability of doctor
Lack of laboratory facilities
Lack of space
Lack of specialist doctor
Lens 2
2.9 5.7
17.1
74.3
0
10
20
30
40
50
60
70
80
GeographicAccessibility
Availability Affordability Acceptability
pe
rce
nt
82.9
11.4 5.7
0
10
20
30
40
50
60
70
80
90
Individual Health System Community/Environment
Pe
rce
t
Overall barriers reported to access healthcare services by the respondents
Source: Shimla Results, Phase I Medtronic-MAMTA
Prioritization - ACTION
Community level:
• Community (including patient) empowerment
Health System level:
• At Primary Health care level -- Strengthen structure
(HR & Infrastructure) of the healthcare services.
• At Secondary/tertiary care level -- Simplification of
the healthcare delivery process.
Intervention Framework for Change
Intervention
Target Beneficiary
Intermediate outcome
Final outcome
Impact
Reduction in
Premature
morbidity &
mortality
Enhanced
capacity of
frontline
functionaries
in delivering
NCD care
Intervention
Frontline
functionaries - Improved timely access to
health facilities
-Improved treatment
compliance
-Reduction in out-of-
pocket expenditure People in the
community
nctionaries
Intervention
Empowered
individuals and
their
family/care
givers
Population (Age 15-70)
Risk Assessment
Healthy
At Risk
Diseased Obj 1- Increasing diagnosis Obj 2- Increasing management and
control of Diabetes or CVD
BCC for lifestyle
modification
CM for early diagnosis
Sensitization and motivation for early diagnosis
Customised counselling using mhealth and paper based education material
E-clinic for expert advise
Regular follow-up
Treatment & Behaviour
Compliance
Capacity Building of health workforce
Patient group meeting and peer group counselling
Patient tracking for clinical parameters
Group meetings with families and caregivers
Self management skills thru mhealth
Training and refresher training
Mentoring support
Advocacy for regular supply of drugs and materials
E-clinic for expert advise
Stay healthy
Sub Center
CHC
District Hospital
Medical College
PHC
Individuals seeking care
No proper channel of referral up the chain
Sub Center
CHC
District Hospital
Medical College
PHC
Individuals seeking care
No proper channel of referral up the chain
Sub Center
CHC
District Hospital
PHC
Individuals seeking care
No proper channel of referral up the chain
Mobile App
Medical College
Sub Center
CHC
District Hospital
PHC
Individuals seeking care
No proper channel of referral up the chain
IVRS
Mobile App
Medical College
Sub Center
CHC
District Hospital
PHC
Individuals seeking care
No proper channel of referral up the chain
IVRS E-clinic
Mobile App
Medical College
Sub Center
CHC
District Hospital
PHC
Individuals seeking care
No proper channel of referral up the chain
IVRS E-clinic
Mobile App
Medical College
Sub Center
CHC
District Hospital
PHC
Individuals seeking care
No proper channel of referral up the chain
IVRS E-clinic
Mobile App
Medical College
Technology solution – responses
Solution How will the project benefit? Who are the beneficiaries?
Mobile app
- About disease - Am I at risk - Goal tracker
(a) Increase disease literacy (b) Self Mgmt skills
(a) At risk (b) Patient
IVRS
-Facilitate appointments with specialists
(a) Early decision to seek care (a) At risk (b) Patient
E-clinic
-Consultation with Specialist -Follow up services
(a) Early decision to seek care (b) Treatment adherence and behavior compliance
(a) At risk (b) Patient
• Aligned with National Government Plan
• Intervention design evidence and need based
• Participatory approach
Unique value
Sustainable technology based low-cost solution
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• Apprise State Government about the project and ensure their concurrence and
participation
• Development of Intervention Protocol:
– Conduct Rapid situational analysis for identifying opportunities to integrate e-
clinic, m-health technology into existing system (health, education and local
governance).
– Design of Intervention Protocol based on situational analysis.
• Recruitment of project staff at state and district level and their training about
intervention protocol including M&E framework
• Content development:
– Risk Assessment Tool
– Training manual
– IEC material for frontline functionaries
• Development of mobile app, IVRS and prescription software for e-clinics
• Operational testing and finalization of mobile app and IVRS application in the
field.
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• Sensitization meetings with key opinion leaders
• Mapping of communities and health facilities(public, private and others)
• Risk Assessment and screening of the target population for diabetes and
hypertension using RA tool
• Radio campaign-defining audience, key message development, finalisation
of communication channels
• Establishment of e-clinic , Development of prescription software, pilot
testing
• Advocacy meeting to enable patient support mechanisms with different
government departments
• Monitoring and supervision
Key Project Staff
• Project Director
• Project Manager
• M&E Manager
• Medical Specialist
• State Programme Manager
• Manager (eclinic)
• District Coordinator
• Outreach Worker
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Key Partner
Purposive selection
- Government medical college with associated hospital
- Have collaborated and worked in the past
- Willingness to collaborate with MAMTA
Role of Indira Gandhi Medical College, Shimla, Himachal Pradesh
(a) Technical (medical) support
- laboratory services for diagnosis
- care and treatment
- management of complications
(b) Operational support
- execution of services through health centres run by department of community medicine,
IGMC
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