Health Call Center

1. Presented to: Sri B.K. Chaturvedi,I.A.S., Cabinet Secretary, Govt. Of India Emergency help line for the rural life line Health Call Center Presented By: Rajendra Narendra Nimje, IAS Director, Technical Education, Govt. of AP, India rajendranimje@gmail.com 29thSeptember 2006 , Vigyan Bhavan,New Delhi

2. Backdrop.. Dec,2004 • Observations on Emergency Services at Khammam District in AP • Many Casualties in Road Accident and Snake Bite Cases. Difficulties faced for Obstructed Delivery cases. • Most of the time delay attributed to late response from Medical machinery • Emergency services are not within the reach of rural poor. • Govt. has islands of health infrastructure. • There is a shortage of specialist doctors, blood & emergency medicines at PHCs and Area Hospitals.

3. Backdrop.. Dec,2004 • Mostly the emergencies are simply escalated to the District Hospital consuming valuable time leading to more fatalities • Patients are taken to the private hospitals by their relatives or passerby – May save their life but will cost a lot on treatment cost which they can’t afford. • Communication to reach any hospital for emergency is not simple. There is no easy way to remember all landlines for all Hospitals and PHCS. There is no guarantee that the phone communication reach the duty doctor.

4. KHAMMAM (DIST) CHHATTISGARH ORISSA WARANGAL EAST GODHAVARI WEST GODHAVARI NALGONDA KRISHNA

5. KHAMMAM Profile

6. Medical & Health Profile Khammam District , AP

7. Project Objectives • To provide Emergency services on demand to rural poor with the available Government Health infrastructure. • To provide an opportunity to them to tap the emergency services with a simple toll free easy to remember number • To tap the specialist services at village / block level from private sector with no permanent infrastructure overheads. • Tracking of emergency till the services are delivered. • To build an accountability in the Government Sector on utilization of resources like ambulance, blood and doctor services.

8. Concept

9. Features • Emergency Services are available to one and all accessible to remote and tribal areas • Easy to remember no. 102, toll free • HCC services are available round the clock. • Pooled resources : Government duty doctors, PHC doctors and Private specialists in various areas. Also the ambulance services and blood banks can be tapped from HCC. His ExcellencySri Sushil Kumar Shinde, Governor of A.P., inaugurating HCC on 9th March, 2005 …

10. Features • Private sector specialist services available. • Single window transactions for the users. • Better decision making for duty doctors as they have chance to interact directly with patients/relatives in emergency situation • Total monitoring of situation at the initiation of each call • Three tier system to make effective use of the infrastructure and time saving • Indigenous user friendly software to pop up resources on receipt of the call.

11. Software • Operator gets a popup on taking a call showing the area from which call is made. • It also shows the nearest ambulance, hospital and blood bank

12. Software • Operator then talks to the duty doctor by holding the caller and put them in conference if required. • He then books a ticket in the name of Hospital and all details are entered for further monitoring

13. Beginning • Brainstorming sessions with PHC doctors, IMA doctors, other officials in the district and BSNL officials for 3 digit toll free number • Health Call Center was launched in the District Hospital on 9th March 2005 • 1 server & Two PCs with UPS • 4 lines exchange with hunting facility, call parks, call diverts etc. for connecting the needy to the doctors in real time. • Indigenous Software developed to monitor emergency • Three trained operators round the clock • DMHO is the monitoring officer. Dist. Panchayat Officer is the consultant to provide administrative support. • Operating manual prepared and operators trained beforethe launch.

14. Partners • HCC is funded by the European Commission through its Sector Improvement Program- II • Initially operators were engaged through the EC funds • Rotary Club of Khammam has come forward to take up the maintenance i.e. operators remuneration and Phone,elect bills etc.

15. Cost… Infrastructure P-IV server , 2 No. P-IV PCs. With UPS Rs. 1.80 Lakhs Electronic Exchange for 4 incoming lines Rs. 60,000 HCC Software Rs. 1.1 Lakhs Internal Wiring Rs. 10000 Partition/Furniture Rs. 1.2 Lakhs Total : Rs. 4.8 Lakhs Recurring Expenditure : Operator remuneration Rs. 3000* 4 No. Rs. 12000 per month or Rs. 1.44 Lakhs per annum Phone Bill Rs. 3000 to Rs. 4000 per month i.e. Rs. 40,000 per annum Electrical Bill Rs. 2000 per month Rs. 24000 annum Total Recurring cost : Rs. 2.25 Laks per annum

16. Benefits • Emergency help line for the rural life line-Life Saving intervention • Emergency Services within the reach of the poorest and  available in the remotest areas. • Makes specialist emergency services available at Mandal and    Block levels where Government can’t attract specialist doctors even with higher pay package. • HCC keeps the track till emergency services are delivered. • Effective utilization of resources like ambulances , blood and other resources in rural areas. Govt. can think of cost saving on purchase of ambulances and operational costs. • Project triggers more institutional deliveries as obstructed labor cases are handled in time through HCC

17. Progress

18. 2006…

19. Impact • HCC was useful in saving lives of the rural people. • Wide publicity through Gram Panchayats and Cinema Slides and Medical Machinery has increased the reach of HCC • Ambulances were effectively used • Private doctors responded to the calls and participated in HCC activities

20. Difficulties • Concept understanding problem with Medical & Health Department • Remedy : Brainstorming sessions held with medical staff at all levels • Private doctors association was a must and meetings held with IMA doctors. They agreed with a condition that their services will be available for the limited period and they should not be hold up unnecessarily • Initial Funding was a bit difficult though the amount requirement was small • Govt. of AP was briefed on the concept in Dec. 2004. It took some time to tap funds from EC-SIP II as the funds were tied up to other activities. Commissioner FW, Govt. of AP and SIP director at Delhi visited Khammam and funds were allotted.

21. Difficulties • Operational cost for HCC – Funding was an issue • Initial Funding for one year was tapped through EC-SIP II • Requests were sent to many NGOs to take up the project. Initially NANDI foundation of AP shown some interest but later they did not agree for taking up this project • Finally, Rotary Club of Khammam has came forward to take up the project and MOU was signed with them for operation of HCC • Teething troubles • Training and refresher courses conducted for Medical Officers • Regular monitoring meetings conducted at Collector level • Getting 3 digit number took some time from BSNL

22. Difficulties • Operators faced lot of difficulties • Good trained call center operators are not available at Khammam. We could not get them from Hyderabad though the distance is on 200KM • Call center operators were getting many calls of trivial ailments and the real emergency calls were much less. • Operator- Doctors lack of coordination • Other difficulties • Three tier structure was not well received. The operators and duty doctors found an easy route to send the ambulance from district hospital defeating the purpose of HCC • DMHO did not used the logs and reports to fix responsibility on the defaulting MOs and staff. • 102 is not accessible from mobile – This technical hitch is being sorted out.

23. Replication • Health Call Center Project is easily replicable for any District in India • It needs very little investment for setting up and little investment for operation and maintenance • HCC is a Most cost effective health emergency intervention in India • It takes very little time to set up HCC and make it operational. Max. 3 months. • It may not take much time to get the toll free number from BSNL for this purpose • Software customization may not be difficult. • HCC is scalable and it will work for Taluk, District or State as a unit equally well.

24. Recognitions Health Call Center won the Bronze medal in9th national e-Governance conference held at Kochi in March 2006 Hon’ble Minister for PWD, Govt. of Kerala presenting a Trophy, medal and a Certificate to Sri Rajendra Nimje for HCC project at Kochi on March 2nd 2006

25. Future • SP, Khammam is interested to use HCC for police emergency calls. • Fire service can be added to HCC • Plans are on to monitor epidemics, GE, JE cases • GPS to be installed on ambulances to monitor the physical location • Achievements of HCC are apprised to the Chief Secretary, Govt. of AP for examination and replication

26. http://www.immunizeall.org Conceived by: Rajendra Nimje, IAS e-Initiatives • ‘E-Immunization’Incubated in my Fellowship atStanford Universityand Piloted in Khammam district at Thirumalayapalem PHC. • Increases immunization percentage upto 90% by tracking each dose of immunization for each baby and also reducing burden on ANMs. • It baggedSilver Icon Award in 9th National e-Governance Conferenceat Kochi in March 2006 • It won the ‘Social-e-Challenge’ Award in 2004 at Stanford University

27. http://www.parishkruthi.org Conceived by: Rajendra Nimje, IAS e-Initiatives • ‘Parishkruthi’ means grievance redressal – It provides A ray of hope to the voiceless petitioners. • Parishkruthi has made the administration more responsive, effective and transparent. • It was nominated as‘Finalist’ in the Stockholm Challenge Awards 2006in PublicAdministration category. • More than 1,00,000 grievances handled through parishkruthi in last one and half years.

28. http://www.giripragna.org e-Initiatives GIRI PRAGNA • ‘Giri-Pragna’ means Enriching Tribal Knowledge • Giri Pragna provides computer education and Computer Aided Education to 10,000 tribal students in remote areas of Khammam district. • The project is launched in September 2005 • It was selected as‘Finalist’ and the only entry from India in Education category for the Stockholm Challenge Awards 2006 Conceived by: Rajendra Nimje, IAS

29. Thanks The initiatives are available at • www.khammam.com • www.immunizeall.org • www.healthcallcentre.org • www.giripragna.org • www.parishkruthi.org Submitted By: Rajendra Narendra Nimje, IAS Director, Technical Education, Govt. of AP Ex-District Collector & District Magistrate, Khammam Government of Andhra Pradesh, India nimje@ap.gov.inrajendranimje@gmail.com Office: +940-23221511 Mobile 99491-02244

31. New Developments in AP • EMRI- a non-profit organization of Satyam Group has started a similar initiative in AP in August 2005. It is called 108 Emergency service. • Any one can call on the toll free no. 108 and the call center will ensure ambulance immediately. • It operates within 20 Km radius of the town. • They invested Rs. 34 Crores for facility and Rs. 70 Crores for land • It is operational at 50 locations in AP • EMRI- has plans to operate in the rural areas but do not want to invest on Ambulances.

32. 102 Vs. 108

33. European Commission- SIP-II Budget for KhammamAll figures in Rs. Lakhs.

34. Title Name • Rudrakshapalli Incident- 7 Butchered, 15 Injured near Satupalli • Chattisgarh Blast by Naxals- Patients in BCM hospital • Satupally Tractor Accident • Kothagudem Bus Lorry Accident near Thallada

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