Can ICTs Improve the Indian Rural Health System?

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Despite real progress since 1990, India has not achieved universal health coverage yet.

For instance, the country still has the highest infant death rate in the world. In 2013, 1.3 million children under the age of five died. For many, this was due to preventable causes like birth complications, pneumonia or diarrhea. Tragically, the majority of fatalities occurred in poor rural households.

A shortage of skilled medical staff in rural India

In India, most of the medical facilities are in the cities, where only 27 percent of the population lives. Approximately 716 million people are currently living in rural areas and they only have access to deplorable health centers. Most of the time, they have to travel a long way to get there. When they arrive, nothing assures them that they will find a practitioner to treat them. Rural India is indeed facing a 64 percent shortage of health professionals.

Aware of the situation, successive Indian governments have been working on this issue. In particular, they have hired women as health workers in remote villages. Today, they are the backbone of the public health system in the countryside. However, most of them are semi-literate and have an insufficient basic training.

A lofty young couple to tackle the Indian rural healthcare issue

They took the leap in 2013 and their dream seemed impossible to achieve. After all, Abhinav and Shrutika Girdhar had no healthcare experience. All they had were years of frustration with the rural medical system.

Shrukita grew up in Mumbai, but her grandparents live in a village of 2,000 people. Whenever they get sick, they have no choice but consult the local health workers. They are only two and they have poor medical skills. Often they cannot cure treatable problems, and often times, this leads to the patient’s death.

Such a situation worried Shrukita, so she opened up to her husband. As the son of two doctors and an entrepreneur at heart, Abhinav was willing to take action. Together they agreed they would focus on improving the training of health workers.

That’s how they left their well-paid jobs and started Bodhi Health Education.

An accessible, personalized training program for health workers

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In India, road conditions are usually poor, so it was unrealistic to organize the training sessions in the villages. On the other hand, mobile coverage is good and there are over 900 million cell phone users. Plus, Shrukita being an IT engineer, they opted for an e-learning solution that could easily be delivered through Android-based devices.

That way, they would tackle the challenge of training uneducated people. Most health workers have limited formal education and it is hard for them to learn medical topics. That’s why the Girdhars and their team of medical specialists developed an adapted curriculum. They made sure to explain every concept and procedures using pictures and videos. Additionally, they deliver the lessons in Hindi and India’s regional languages. That way, the learning is simple, interactive, and engaging.

Furthermore, the Bodhi curriculum relies on a personalized educational approach. After a lesson, the learner has to answer practical questions; after a module, she must then take a quiz exam. The results are sent to the trainers who can assess the learning process. It allows them to tailor the program to the health worker’s pace and progress.

Reluctant medical authorities

At first, Shrutika and Abhinav had to overcome resistance to e-learning. The medical authorities were doubtful about using technology to train community health workers. Despite this rebuff, the young entrepreneurs persisted. In less than two years, they developed 100 training modules. The Bodhi curriculum now covers topics like maternal and child care, immunization as well as tuberculosis.

Besides, the Girdhars introduced their program to health workers, who all showed great interest. They found it easy to use and were happy for the opportunity to increase their skills and knowledge. They knew it could help them better treat people, but also earn more money.

In view of these results, the Indian medical authorities agreed to give it a try. Bodhi Health Education could develop partnerships with the government, private hospitals and healthcare companies. These organizations provided tablets, computers and smartphones to upload the Bodhi curriculum. Over 1,000 community health workers could at last access the training.

Towards a better healthcare for the ‘bottom of the pyramid’?

For Shrutika and Abhinav, this is only the beginning. In the next five years, they aim to train more than 60,000 rural health workers. They also want to go international and promote their solution in Asia and Africa.

And of course, they will focus on the regions with the worst health indicators to achieve a major impact!

Why Leadership Is Important for ICT Initiatives

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Information and Communication Technology (ICT) based projects are being implemented on a large scale in developing countries. It is believed that ICT opens doors to various opportunities, which can be used by people for their development. In this article, I focus on the implementation and monitoring aspect of ICT enabled initiative and the role of leadership in the project’s successful roll-out.

The content of this article is based on my research study on eSeva, an ICT initiative, implemented in the ‘Eluru’ district of Andhra Pradesh state of India. The objective of eSeva project is to provide vital information to citizens in rural areas at a click of a button. The project considers ‘information’ a crucial entity towards bringing a change in people’s life. The project was initiated by Mr Sanjay Jaju, an Indian Administrative Service (IAS) official.

It was during his tenure as District Collector, the number of services provided through the telecentres was greatest i.e. around twenty services. ‘Grievance redressal’ was the most sought service by the rural citizens. Citizens used this service for accountability of government officials.

There was resistance towards adoption of eSeva services by the government employees, especially towards grievance redressal service. However, all the services of the initiative were personally monitored by Mr. Jaju, and he used to make sure that all the registered grievances were addressed on time. There were mechanisms in place for government officials who were insensitive towards complaints registered by people. Due to a greater number of services, the project was financially sustainable during the early days.

Heydays of the project came to halt when Mr. Jaju was transferred to some other district. The District Collectors, who joined later, did not take much interest in the project due to their varied priorities. ‘Grievance redressal’ was the first service which got hammered. Grievances were registered at the centres, but no action was taken on them by the government authorities.

Consequently, citizens stopped using the service. Mr Jaju introduced services like issuance of ration card, voter ID, etc., but a change in the administration lead to removal of most services. At present there are only 3-4 active services in the centres, which include utility bill payments, issuance of caste certificates and information services. Therefore, changes in leadership created havoc for the initiative.

Not only most services stopped due to changes in leadership, but also some decisions of the authorities indirectly affected the financial sustainability of the project. For example, Joint Collector (JC) of the ‘Eluru’ district passed an order which made it mandatory for the Village Revenue Officer and Revenue Inspector to distribute caste and income certificates in villagers personally. Through this order, the role of telecentres in the issuance of certificates was eliminated.

‘Caste/Income Certificate’ service is one of the main revenue generation services for the centres. eSeva centres act as the front end to receive applications for caste or income certificates, and also deliver the certificates to people once ready. The entrepreneurs are wary of the consequences of such orders, as it would directly affect their business. However, district administration maintains that the order was passed in the good will of the district administration.

Hence, from the above discussion, it is apparent that interest of district authorities and government officials proved to be the one of the major reasons for a reduction in the number of services in eSeva centres. Gradually, sustainability of the telecentres is at stake and entrepreneurs are struggling to keep their centres running profitably. Leadership can bring a positive change, however, it is also necessary that the change is sustained. A new idea or an innovation from a leader is highly welcome. However, future considerations on the sustainability of that idea or innovation should be made, should there be a leadership change.

Gaurav Mishra is an Assistant Professor at Development Management Institute (DMI) – Patna