How to scale mobile healthcare?

There is a fallacy in the entire social sector that impact measurement is too expensive and is simply a necessary evil to satisfy funders. This fallacy couldn't be further from the truth.  Just four years ago, presenters at the Skoll Conference shared that there are hundreds of mobile healthcare projects which remain in the pilot stage.  The main reason, lack of impact evidence based approach to grow from pilot phase to scale.

In this article, we'll share the story of one of the most innovative healthcare delivery organizations in India, SEWA Rural, which was able to go well behind that initial pilot stage to scale its solution.

This case study will show how persistence, a commitment to evidence-based learning, and iteratively integrating results of impact measurement, can help a healthcare organization grow and scale.  It didn't happen overnight, as it has been a long journey for SEWA Rural. Let's start with a bit of context about the sector and what SEWA Rural does.

History of Remote Healthcare 1980

SEWA Rural endeavors to reach out & assist the poorest of poor through its various programs.

• In all our activities and programs, we attempt to incorporate and  balance the Three  basic principles:
• Social Service
• Scientific approach
• Spiritual Outlook

SEWA Rural is one the best reference architecture for remote healthcare serving 

• 150000 Outpatient- 500 a day
• 22000 Indoor- 40 a day
• 6000  Deliveries- 20 a day
• 6500  Surgeries- 20 a day
• 1100 NICU admissions
• 300 k lab tests

SEWA Rural started in 1980 with a remote mobile bus similar to one below.

Mobile Healthcare Pilot 2010

In 2010 SEWA Rural under the leadership of Dr. Shrey Desai started a mobile healthcare program with a strong focus on "Impact Measurement" as part of a core mission.  Dr. Shrey who completed Masters in Public Health in John Hopkins University and returned for good with the support of his wife and a key team member Dr. Gayatri Desai.  While for several year project remained at a pilot level with many iterative improvements. 

Improving Results through Tight Feedback Loop - Impact Measurement 

SEWA Rural focuses on many healthcare topics. For more details read more more: SEWA Rural Community health project 

Discuss past result and results after ImTheko (mobile pilot)

SEWA Rural for several years focused on building a robust community health worker training program.  With a help of a local vendor, it started building a healthcare data application.  From the beginning the focus of the program was on improving training, gaining confidence and adoption within selected partner program. Dr. Shrey along with his data management team started to see strong preference from community health workers (  ASHA workers ). 

Scaling Mobile Healthcare Program

In 2013, with the deeper partnership with Department of Health and Family Welfare, Govt. of Gujarat,  “ImTeCHO” initiative was first rolled out to the 22 PHCs (700 villages) in high focus tribal talukas of Bharuch, Valsad and Narmada dists. Thus in total about 600 ASHAs are trained on the smart phones delivering maternal, new born, infant and child care at the doorsteps.

Maternal Mortality Ratio Improvement

The following chart accurately describes improvement in Maternal Mortality Ratio. With the help of Gujarat Government and program assistant this program now aims to scale it to 6 Crore Population.  That's an amazing success story!

*** Population Reach (These slides are not readable - so give a summary conclusion)

Thanks to Dr. Shrey Desai and SEWA Rural team. 

The difference between what we do and what we are capable of doing would suffice to solve most... problems.

  -Mahatma Gandhi

Next Steps: Connect to Global Goals.

SDG 3 targets and indicators

Going forward we recommend SEWA Rural to move forward with SDG reporting and country wide SDG Tracking for a similar healthcare delivery organizations.

Some of the key indicators associated with SEWA Rural are as follows

Building SDG 3 Tracker in Short Time

Impact Cloud is perhaps the most innovative platform that lets you build data aggregation application within less than an hour.

The process starts with selecting SDG3 Impact Theme in Impact Strategy. Once you selected, choose your nature of data aggregation.

Theory of change maternal and child health

1.  Build theory of change with indicators appropriate to program organizations goals. 

2.  Next select a data source where you will aggregate results - data coming from clinic's healthcare management system or any other external sources.  Import data from external sources, so that Impact Cloud can create a permanent data sync.

Maternal and Child Health Outcome Indicators

Indikit has developed an in depth maternal and child health outcome indicators.

Review Complete List here. 

SDG 3 Portfolio Level Data Aggregation

Portfolio Level data aggregation perhaps can be implemented by country wide government program.  Perhaps they can work with similar rural healthcare delivery organization.  Based on the program data aggregation built with one organization can perhaps be rolled out throughout India or other countries.

 SDG 3 Impact Tracker

Once program participants are designed, all portfolio aggregation requires is to collect results from each program participants.   Impact Cloud ® will automatically aggregate results from different program participants and show scorecard similar to one below.

Learn Key Facts behind Maternal Mortality

Maternal mortality is unacceptably higher in both developing country and even in certain parts of developed country such as Mississippi, USA. About 830 women die from pregnancy- or childbirth-related complications around the world every day.

Learn More: SDG Indicators