Dr Dipanjan Sujit Roy, CEO, WISH Foundation in an interaction with Prathiba Raju speaks about how the non-profit organisation is building a value-added primary healthcare centre and transforming healthcare through innovations and to bring in innovative, in processes, products and devices
Why do you think primary healthcare centres are important for India?
Currently, the country’s population is approximately around 1.37 billion. For such a vast country, the first point of contact should be primary healthcare centre (PHC), which is the basic structural and functional unit of the public health services and 99 per cent of our health problems and issues can be solved at this level. For this, we need a robust PHC as it will be of major help in the current system and government hospitals like AIIMS, Safdarjung Hospital will not be over-burdened. A majority of these patients from northern states go even for OPD consultation to such big hospitals, which showcases that PHCs are not functioning optimally as they should have been. In order to have a better health outcome, importance should be given to PHCs.
Can you elaborate on WISH’s 300 primary healthcare clinics?
Wadhwani Initiative for Sustainable Healthcare (WISH) is a non-profit organisation, which delivers improved PHCs by building a value-added model that can be showcased and adopted by the government. Our tagline is transforming healthcare through innovations and to bring it to processes, products and devices. Ours is a PPP model, which strengthens the PHC delivery system of a particular locality with early, door step diagnosis and preventive care, helps in reduction of maternal and infant deaths and reduces the burden of communicable and non-communicable diseases (NCDs) using innovative approaches. We just don’t run the PHC but we are into preventive and promotive service also. As of now, WISH is running 300 such hubs ,spoke-models of primary health, wellness centres and associated sub centres in five different states — Rajasthan, Delhi, Madhya Pradesh, Uttar Pradesh and Assam.
Any particular reason for only being in these five states?
Apart from Delhi, the other four states of Rajasthan, Madhya Pradesh, Uttar Pradesh and Assam are EAG states (Empowered Action Group) or referred as ‘bimaru’ (unhealthy) states. These states lack good public health infrastructure. So, we wanted to focus on such states instead of the performing ones, for example — Tamil Nadu, Karnataka or Kerala. We are in MoU with all the four states where we have put up an innovative PHC model with the best practices and standards. It demonstrates to the state governments on how it can be replicated and scaled up in other places. We started our work in Rajasthan; some of the best practices were implemented in other states also. For example, we give technical and management assistance to Mohalla Clinics in Delhi and play an advisory role with the Government of Madhya Pradesh where we try to help them by putting up health and wellness centres. Similarly, we worked with governments of Assam and Uttar Pradesh.
Health being a state subject, each state government has its own preferences, issues and problems. So, how does WISH help them to overcome these challenges?
Each state is unique and has its own challenges and capacities. So, we do our in-depth analysis and closely engage with the state governments. There are plenty of challenges our team has faced. We have the expertise to overcome them and provide better primary healthcare to the population. For example, in Assam, the situation is completely different than that of Rajasthan, so the standard operating procedures (SOP) or the way we look at health and wellness centres is different. We do a case-to-case and state-to-state basis study and understand the issues. Further, state government officials are advised on what will be the best for a particular state and for the population in that particular locality. Few examples are an urban model of dengue prevention and healthcare service in Gorakhpur, Uttar Pradesh and an urban technical support programme of strengthening primary healthcare delivery in Madhya Pradesh. WISH provides innovative technology and connects the last mile population for a better healthcare delivery.
What are the issues you have addressed in the states. Any changes your model has achieved?
Wadhwani Initiative for sustainable health is supported by philanthropist Sunil Wadhwani. Along with government funding, WISH also lends some portion of funds, which helps the centres and gives better outcome-based approach. For example, we have added a lot of ‘point of care’ devices in these centres. Only in Rajasthan, WISH has direct service delivery as per Indian Public Health Standards (IPHS). In order to address the manpower issues in PHCs of Rajasthan, we approached retired government doctors to continue their services. As for frontline health and administrative workers, we have associated with local people who were willing to join as per government salary. WISH’s Aadarsh PHC model was adopted in 2015. In 2016, Government of Rajasthan asked Boston Consulting Group to do a quick survey on the model, which indicated that there has been a substantial improvement in process indicators in maternal and child health, communicable diseases, non communicable diseases and in geriatric, specialised ophthalmology.
How do you see the health and wellness centre initiative by the central government? Are you associating with it?
The national health policy, looks at transforming 150,000 PHCs into health and wellness centres (HWC). In this HWC platform, WISH is currently running nearly 50 centres in the five before-mentioned states, where we provide tele-medicine through which specialists can be consulted by patients. During tele-consultation, we make sure that the patient is accompanied by a nurse, midwife or a frontline health worker. Usually gynaecology and cardiovascular diseases are dealt more frequently in these centres. In each healthcare centre, we provide 12 services. The government has a mandate to transform 150,000 PHC to HWC which is a challenging task, in which WISH is playing a small but unique role of showcasing 50 centres which can be demonstration models. We are also working into a deeper implementation plan and the presentation will be shared with the government and the states, who wants to implement or scale it up much faster.
Can you brief us about WISH Foundation Artificial Intelligence (AI) and how it is going to help the healthcare domain?
The Wadhwani Institute for Artificial Intelligence (WIAI) is also working on a few simple apps, which is going to help the healthcare domain to give better health outcomes. For example, one AI-based solution will be on quick identification referral system for high-risk pregnancies.
How are you using the collected health data?
We do generate a lot of data but the data is maintained and owned by Government of India. It’s not owned by us, whenever the government wants us to analyse it, we support them and create a dashboard for the decision makers to take certain decisions.
WISH Foundation has been working with Mohalla Clinics, how do you see this model? What kind of help is given by WISH?
In Delhi, mohalla clinics has been one of the models for urban healthcare, where WISH is the knowledge management partner. We do not run clinics. We give the digital information system and make the processes easier. We have tried to make this model efficient, effective and in mohalla clinics, we have introduced Swastha ATM, a medicine dispensing machine. The prescription is also digitised, so the chance of error is much less.
Can you tell us about the funding pattern?
Our founder donor gives us a decent grant of money, which gets completely transformed into healthcare initiatives in the five states. And, we also have donors like USAID and government donors like BIRAC. Besides, the Government of Rajasthan and the Aditya Birla Group also funds us.
Why creating robust PHC is important?
Primary healthcare is not a good return for investment, so you will not see many private players who are willing to work here. But unless we improve our PHCs, the intended general health improvement of the country can not be achieved. If PHCs become robust then it will make a huge difference in the healthcare delivery in India.