AN APPROACH PAPER
Rural Health Enablers
Future of jobs in india are services led, and not manufacturing led. Agriculture as a source of livelihood is continuously depleting due to various reasons. AIRA envisions that healthcare can be a service that can be generated locally and kick start reinforcement of rural economy. However apart from skilling it is required to enable them as mini entrepreneurs who as coworkers with public health system, shall deliver real results on preventive, promotive, proactive healthcare thus keeping citizens away from hospitals and CHE by delaying / denying acute / serious health conditions.
AIRA Skills Program: Rural youth prior to placement…happy and look forward for exciting career, and upcoming opportunities in life
About AIRA Sociocare :
Objects of the company
To promote Educare1, Healthcare and Agricare as a social Enterprise on a sustainable basis for realising social impact, mainly to impart skilling of Individuals leading to better employability, Carry out preventive healthcare projects to address nutritional aspects, proactive Containment of non-Communicable diseases, promote metropolitan smart agriculture leading to social empowerment and Capacity building among needy rural and urban population
Field of operation:
Under AIRA’s Educare Vertical, the focus is on Livelihood led Skilling. The sector skills covered are Healthcare & Food & Beverage. The youth served are X and XII dropouts / under employed, in the age bracket of 18 – 26 hailing from rural and tier-3, 4 cities
Presently AIRA has MoU with IL&FS Skills, #1 Skilling Company in India under CSR of McKinsey Social Initiative (MSI). MSI is sponsor and also responsible for placements, IL&FS is Training Partner responsible for all training and contents. AIRA is a infrastructure partner with responsibility of providing training infrastructure, mobilisation, Boarding and lodging. AIRA has already executed four cohorts in the area of Nursing Assistants (HNA) and successfully (99.6%) placed the candidates post skilling.
AIRA’s Goals:
⦁ To arrest mindless migration of rural youth – from villages to cities by skilling them in sectors that last 30 yrs.
⦁ Make villages as “happiness centres” where health forms basis of excellence in communities
⦁ Build value centric youth who are sensitive, foresighted, pragmatic and action driven visionaries to uplift villages in the future.
⦁ Employ technology in abundance that support, improve and sustain rural environs to improve rural revenue and improve quality of life
1 the term educare derived from latin word “to bring out what is already within”. AIRAs sustainability in 3 areas are built on this fundamental
EXECUTIVE SUMMARY
NATION BUILDING: PROBLEM AND OPPORTUNITY
Human Development Index (HDI) is a simple yet profound indicator used by United Nations Development Agency. HDI sets benchmark for nations in terms Societal wellbeing. It takes into consideration education, healthcare, economic factors. India ranks at 130, floating just above countries whose names can hardly be recalled. Healthcare, ensures wellness at family level that is fundamental to Education, and Economic wellbeing.
Healthcare is complex, elusive, community level problem. It calls for a mission-mode participatory implementation wherein Govt, NGO, CSR, Private all work in hand with shared vision of nation building.
Delivering on Healthcare has a multiplier effect in elevating HDI
Asymmetry in existing (Governmental) public health Delivery:
The Healthcare in India had been primarily served by public health system till 90s. The Healthcare at Govt. institutions were free, and somewhat met the needs wherein mainly communicable diseases (such as Polio, Malaria, TB) along with maternal care. However due to stagnant investment, the Public Health Infrastructure has crumbled and quality of care is not acceptable by today’s standard even by the poor. Due to rapid urbanisation, > 60% use Private health providers and seek intervention at late stages. Also the community health burden has shifted from communicable diseases to non-communicable diseases such as Diabetes, Hypertension, Cancer, Cardiovascular and the likes. The private health costs have been spiralling that has resulted in sizeable population incurring catastrophic health expenses [CHE]. The Public health insurance coverage is also meagre and only for BPL. facilities for APL is being looked into as of now. The solution is to systemically increase Availability, Access and Affordability with Acceptability.
The top action items for next 3 years should be
⦁ Capacity building in rural areas [Traveling Nursing assistant, Nutritionist, lab-technicians, counsellors]
⦁ Integrating Preventive care [ Screening, Follow-up, behavioural change, Referral]
⦁ Implementation [Participatory mode: Public, Private, Community, CSR, NGO]
Public Health System: Pictogram
Data:
CAPACITY BUILDING: CONVERTING THE RAW TALENT
Capacity building for RHE requires PUSH type of intervention. General model is 2-step migration for employment in urban area of work and 1.1 step in case of entrepreneur (RHE) model. Initially suspect candidates need to be mobilised and counselled to create career aspiration. Once they are shortlisted, they shall migrate from their native place to the identified skill-campus. They are immediately exposed to hospital as shadow resource to understand the career/ work demands. This ensures healthy attrition of disinterested candidates while reinforces commitment of aspiring candidates. The instruction is biased @ 70% towards hand-on practicals, 30% requisite theory. The pedagogy shall have flipped class room, video lessons, quiz based reinforcements to impart knowledge in 1/4th the time required for traditional chalk-talk classrooms.
Students shall build models to retain learnings. For specialisation exposure such as CPR they shall shadow work in ER rooms, NCD clinics. Application phase includes paid internship and field deployment under PHC as
RHE Diagnostic kit (typical) List equipments
RHEs ready to be deployed in the field llustrations are from nerosynaptic and Heart Rescue India
(MSR)
SKILLING (TIMELINE)
Mobilisation & migration [Step-1] 7d
Exposure [Wk-0] & enrolment [Wk-1] 3d
Block / Instruction 42d
Integration 7d
Application, Internship, Field work 120d
Deployment [Step-2] 2d
INTEGRATING PREVENTIVE CARE
The prime problem in healthcare delivery is recruitment and retaining the care givers at rural settings. The interventions done by NGOs and Govt through targeted camps / mobile clinic does not enable continuum of care and lacks coverage of population. RHE approach is all about taking care to doorstep thus unleashing promotive, preventive, proactive care. The RHEs are from the same cluster of villages thus developing trust, affinity and sustainability of intervention, RHE model creates livelihood in local area, thus limiting mindless urban migration. Initially the RHEs are trained, deployed in collaboration with public health system with cost borne by CSR and after 6 months they should be able to generate the livelihood by offering products and services for the consumer as a entrepreneurs.
RHE – Process flow (NCD)
Awareness: dissemination of information,
Mobilization: Mass screening, Baselining
Care Pathway: Treatment, follow up, baseline and titration
Adoption: Lifestyle changes internalised
Self Care: empowerment, self manage chronic condition
RHE – ACTIVITY MAP
Diabetes, Hypertension Awareness, Video, Models, Risk BMI, RBC, Lifestyle,RBC / Hba1C, BP Diabetic: Neuropathy, retinopathy, Referral, Telemedicine Compliance to medication, Nutrition.
Breast / Cervical Cancer Audio Video, Self examination, leaflet, manequin Ambulatory Mammography
/ Thermal imaging help in choosing the right treatment, counceling Nutritional, emotional support to fight and survive emotional and psychological support Compliance to medication, Nutrition.
Cardio Vascular & emergency responder Awareness, Video, Models, Risk Risk assessment, ECG, Biomarkers if possible First responder. Pre hospital: Defibrillation with AED, ASPRIN, 12
Lead ECG, fibrioanalyst repercussion checklist Referral, Telemedicine Compliance to medication, Nutrition.
Anemia & Malnutrition Video, Mensural cycle, Hygiene, Right diet Assessing nutritional status in community. Create nutritional profile for individuals Diet Charts and Neutreceutical, food preparation demo Referral, Telemedicine Compliance to medication, Nutrition.
Mobility & Rehabilitation Rehab scope Palliative care Tie-up with hospitals Rails tube feeding, Walker support,Wound care: Pressure sores,Coloplast Rehab techniques, Physiotherapy basic, compliance to advice, monitoring, counselling Nutrition adoption per recommendation
MEASUREMENT AND EVALUATION FRAMEWORK
Indicator Healthcare professionals Intervention, Access, Quantified Risk Factors, Improved Health
Ambulatory Health
screening devices Services, Quality,
Follow-up for Lifestyle map, Coverage
of target population, outcomes, Ecosystem for
prevention, Social &
Domains
Medical Supply Chain
SoPs, Protocols compliance Advice, Care under
supervision. Financial risk protection,
Improved Q.A.L.Y.
Livelihood Generation Reduced Migration of
Rural youth
Data Analysis Financial Reporting, Facility improvements Population based Targeted health
& Synthesis Assessment of Progress and Performance surveys, Coverage, Health status, Equity, outcomes based on data. Sustainability