Hyderabad: A pregnant woman in the remote Tongla village in Eastern Bhutan had retained the placenta after delivery, needing immediate medical attention, but her village is a two-hour walk uphill from the nearest road. Even if she reached the roadhead, there was no guarantee that she would be able to get transport to reach the nearest hospital.
Statistics show that 40% of the population in Bhutan is still an hour’s walk away from the nearest healthcare centre and there are only 12-13 healthcare professionals per 10,000 population in Bhutan, which is much less than the World Health Organization benchmark of 23 per 10,000 population.
Access to healthcare is one of the key challenges faced by developing nations and more so for the Himalayan nation due to its tough hilly terrain, unpredictable climatic conditions and meagre and scattered healthcare resources.
The Bhutanese government decided to tap the power of information and communication technologies (ICTs) to deliver round-the-clock and quick access to healthcare to its 7 million citizens spread across 38,000 sq. km.
Thus was born Bhutan’s ICT healthcare solution called Health Help Centre (HHC), a public-private partnership, in December 2009 under the Accelerating Bhutan’s Socio-economic Development (ABSD) programme, with the vision to provide access to professional healthcare services within one hour for 90% of the population by 2013.
HHC offers toll-free emergency and non-emergency medical services that can be availed across Bhutan by dialling 112. People can request for the service either in English or in local dialects. The call will land at the HHC call centre, which will collect basic details such as the type of emergency, location and the number of victims, and identify the ambulance closest to the location using geographic information systems or geographic positioning systems technology for dispatch. Health facilities will be intimated of the patient’s arrival so they are prepared to handle the case.
For non-emergency medical advice services, paramedics at the HHC will medically categorize the problem presented by the caller using a clinical assessment software.
For non-emergency problems, appropriate medical advice will be given to the caller based on disease algorithms. If it is a minor ailment, an e-prescription will be sent to the caller’s mobile phone or email address.
The e-prescriptions would be for over-the-counter drugs that are regulated by the Drug Regulatory Authority of Bhutan. Callers can also avail medical counselling services, healthcare facility information and register complaints if they have any problems with the HHC.
The HHC has been built into a management information system, which helps the government monitor service delivery in real time, and understand and interpret data in order to scale up the services and formulate better strategies to deal with healthcare challenges.
To choose the right technology and implementation vendor, Bhutan called for a global tender, and employed consulting firm McKinsey and Co. to evaluate the bids.
A consortium of Regal Information Technology Pvt. Ltd from Bhutan, ProCreate Techno Systems Pvt. Ltd and Equant Technologies from India emerged as the successful bidder.
The vendor’s primary task was to build technology that integrated a well-equipped call centre with a data centre, created multiple competencies, upgraded and equipped ambulances, and standardized operating procedures before handing over the project to the Bhutanese government.
“Meticulous monitoring and control of the execution processes is the fundamental difference that we brought, especially, for the particular domain and when the system is being applied for the people and the society at large we are able to create extra control and monitoring because of which the system is very efficient and optimized,” said Ranganatham Veluru, chairman and managing director of ProCreate Techno Systems.
Prior to starting his new venture, Veluru was with Satyam Computer Services Ltd, heading the team that was responsible for creating the technology behind India’s emergency response service, Emergency Management Research Institute, popularly known as the 108 service, which is operational across 11 states in India.
Veluru says the 112 service is technologically superior as it reduces the human element to a great extent by utilizing the power of mobile applications in distribution of resources.
For instance, paramedics in ambulances can give status updates of an emergency case to the HHC by simply sending a text message, without having to call. The message updates the system automatically, thereby reducing the call burden on the call attendant and improving the efficiency of the system. Also, if an ambulance driver is on leave, the system automatically assigns the job to another driver who lives closer to the location where the ambulance is stationed. The system also has the ability to eliminate duplicity of calls; generally if an accident takes place, multiple calls are reported about the same incident, leading to confusion and wastage of precious healthcare resources.
One of the major challenges of the project in the initial stages was getting skilled workforce that include paramedics, call takers, and drivers. “It was a challenge,” Veluru said. “But our experience in incubating a similar project in India helped us. We took plus-two qualified people, and sent our people to Bhutan to train them as emergency medical technicians.”
According to the data available from 5 April 2011 to 5 September 2012, HHC took care of 6,857 emergency medical transport and 4,762 inter-facility transfer situations; it offered medical advice to 2,375 callers.
The service was launched in December 2009.
On an average, 23 people use the emergency response services daily and 5 people seek the healthcare helpline service.
An extensive publicity campaign by the Bhutanese government is underway to build awareness about the 112 service. “It slowly builds, as it is serving it becomes more and more popular,” Veluru said.
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