HealthRise India Program Launch · •Problem Statement ... Fear to visit Hospital alone Expensive...

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HealthRise India Program Launch Grantee & CAC Kick-Off Meetings November 19-20, 2015 New Delhi, India MAMTA Health institute for Mother and Child

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.

Outline

• Intervention Framework and Key Activities

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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

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

Outline

• Timeline for next 6 months

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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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