Access Health International Inc

TO IMPROVE ACCESS TO AFFORDABLE QUALITY HEALTHCARE

DIGITAL HEALTH - A ROBUST AND EFFECTIVE INFORMATION SYSTEM IS A PREREQUISITE TO A WELL-FUNCTIONING HEALTH SYSTEMAND A NECESSARY BUILDING BLOCK FOR UNIVERSAL HEALTH COVERAGE. THIS IS ESPECIALLY TRUE FOR INDIA, WHERE THE NEED TO INTEGRATE SYSTEMS IN A FEDERAL CONTEXT AND ACROSS DIFFERENT COMPONENTS OF THE HEALTH SYSTEM (PUBLIC, PRIVATE AND BETWEEN NATIONAL DISEASE CONTROL PROGRAMS) IS A PARAMOUNT CONCERN. THE GOVERNMENT OF INDIA RECOGNIZES THE NEED FOR ESTABLISHING AN INTEGRATED DIGITAL HEALTH PLATFORM FOR THE COUNTRY, PARTICULARLY IN THE CONTEXT OF THE LARGE SCALE AND AMBITIOUS AYUSHMAN BHARAT PROGRAM. WHILE IT HAS EXPRESSED INTENT TO PROCEED WITH A DIGITAL HEALTH PLATFORM, THE GOVERNMENT HAS YET TO CONCEPTUALIZE THE SCOPE, SCALE, AND SYSTEM ARCHITECTURE FOR EXECUTION. ACCESS HEALTH, WORKING CLOSELY WITH PARTNERS, WILL SUPPORT THE CREATION OF A HARMONIZED ROADMAP FOR A COMPREHENSIVE AND INTEGRATED DIGITAL HEALTH PLATFORM FOR INDIA. IN PARTNERSHIP WITH A STRATEGY CONSULTING FIRM, ACCESS HEALTH WILL STEER FORWARD THIS AGENDA BY CONVENING PARTNERS, ASSESSING NEEDS, DEFINING PRIORITY STEPS, BUILDING CAPACITY, AND LAYING THE GROUNDWORK FOR A UNIFIED DIGITAL HEALTH SYSTEM ARCHITECTURE. ACCESS HEALTH WILL WORK CLOSELY WITH STRATEGIC AND TECHNICAL PARTNERS, WITHIN CENTRAL AND STATE GOVERNMENTS, THE PRIVATE SECTOR AND ACADEMIA, TO ACHIEVE THIS GOAL. ACCESS HEALTH WILL ENGAGE A STRATEGY CONSULTING FIRM WITH PRIOR EXPERTISE IN DIGITAL HEALTH WORK AT THE OUTSET TO ASSESS READINESS FOR THE DIGITAL HEALTH INITIATIVE AND CREATE A MANAGEMENT FRAMEWORK TO DELIVER ON ITS GOALS. THIS WILL ENABLE ACCESS HEALTH TO BUILD ITS INTERNAL TEAM AND CAPACITY TO RESPOND TO THE LONGER-TERM NEEDS OF THE GRANT. ASSUMING THERE IS BUY-IN TO PROCEED WITH THE DIGITAL HEALTH AGENDA, WHICH WILL BE DETERMINED BY MARCH 2019, ACCESS HEALTH AND THE CONSULTANTS WILL CO-DESIGN A CONDUCIVE IMPLEMENTATION STRUCTURE AND PLAN AND PREPARE THE EXECUTION OF THE GRANT. SPECIFICALLY, THE STRATEGY CONSULTANTS WILL LEAD THE DIAGNOSTIC EXERCISE TO DETERMINE THE BUY-IN AND SCOPE FOR THE DIGITAL HEALTH PLATFORM IN INDIA, VALIDATE AND/OR MODIFY THE TECHNICAL PRIORITIES OR "ACTIVITIES" OUTLINED IN THIS PROPOSAL", DEFINE CRITICAL MILESTONES AND GOALS FOR EACH ACTIVITY, AND DESIGN A MANAGEMENT FRAMEWORK THAT WILL SUPPORT ACCESS HEALTH IN TAKING OVER RESPONSIBILITY FOR THE GRANT.IN PARALLEL WITH THIS INITIAL SCOPING EXERCISE, WE WILL BEGIN IMPLEMENTATION OF THREE ACTIVITIES, WHICH WILL COMPRISE PHASE 1, AND BE THE FOCUS OF YEAR 1: CONVENING PARTNERS, ALIGNING ON AGENDA AND PRELIMINARY ROADMAP, ESTABLISHING BASELINE KNOWLEDGE AND BUILDING CAPACITY. THE SECOND FOUR ACTIVITIES, UNDER PHASE 2, ARE MORE TECHNICAL IN SCOPE AND WILL SERVE AS A FOUNDATION UPON WHICH THE SYSTEM ARCHITECTURE FOR DIGITAL HEALTH WILL BE ESTABLISHED. PREPARATION FOR PHASE 2 ACTIVITIES WILL BEGIN IN YEAR 1 AND WILL CONTINUE FOR THE DURATION OF THE GRANT. 1. GOVERNANCE SUPPORT FOR THE DIGITAL HEALTH STRATEGY, 2. LANDSCAPE ASSESSMENTS ON HEALTH INFORMATION SYSTEMS AND HEALTH DATA,3. CAPACITY BUILDING AND KNOWLEDGE EXCHANGE ON HEALTH INFORMATICS, 4. SETTING UP A NATIONAL HEALTH DATA DICTIONARY AND MASTER REGISTRIES5. SUPPORTING THE DESIGN OF A MODERN PROVIDER INFORMATION SYSTEM ("HOSPITAL INFORMATION SYSTEM"), 6. SUPPORTING THE DESIGN OF A UNIVERSAL PAYER PLATFORM ("HEALTH INSURANCE INFORMATION SYSTEM"), AND7. GATHERING CONSENSUS AND PLANNING FOR ELECTRONIC HEALTH RECORD / PERSONAL HEALTH RECORDIN TERMS OF EXECUTION, ACCESS HEALTH WILL ENSURE CROSS LEARNING BETWEEN ALL SEVEN ACTIVITIES, ENSURE PARTICIPATION AND ALIGNMENT OF DIFFERENT STAKEHOLDER GROUPS, AND DRAW ON SPECIALIZED TECHNICAL EXPERTISE FROM PARTNERS AND CONSULTANTS WITHIN AND OUTSIDE INDIA AS NEEDED. WE WILL ALSO CAREFULLY BALANCE THE PRIORITIES OF THE CENTRAL GOVERNMENT WITH THOSE OF THE STATES, ENSURING THAT WE CAPITALIZE ON EFFECTIVE SYSTEMS THAT ARE ALREADY IN USE.

THEME PAPERS - ACCESS HEALTH INTERNATIONAL WAS COMMISSIONED BY THE GATES FOUNDATION TO CONDUCT AND COORDINATE RESEARCH ACTIVITIES IN COLLABORATION WITH INTERNATIONAL RESEARCHERS AND OTHER LOCAL STAKEHOLDERS. THIS EXERCISE WAS EXECUTED OVER A PERIOD OF 18 MONTHS, WITH THEMATIC AREAS OF HEALTH FINANCING, ORGANIZATION AND DELIVERY OF CARE, STRATEGIC PURCHASING, AND DIGITAL HEALTH. WE CONDUCTED BOTH SECONDARY AND PRIMARY RESEARCH TO UNDERSTAND THE CHALLENGES AND SOLUTIONS FOR HEALTH SYSTEMS IN INDIA. THE EVIDENCE GENERATED FROM THIS BODY OF WORK GENERATED A SERIES OF RESEARCH AREAS WHICH NEED FURTHER STUDY AND EXPLORATION. ACCESS HEALTH HAS WORKED ON CONSOLIDATING THE FINDINGS OF THIS PROJECT IN THE FORM OF A BOOK.

PROGRAM BUILDING HEALTH SYSTEMS RESEARCH CONSORTIUM - IN SUCCESSION TO THE THEME PAPER STUDY (DISCUSSED ABOVE) SEVERAL RESEARCH TOPICS EMERGED. THE GATES FOUNDATION FELT THAT THESE TOPICS NEED MORE SCIENTIFIC EXPLORATION. ACCESS HEALTH WORKED TO IDENTIFY AND CONTACT ACADEMICIANS AND RESEARCHERS, WHO COULD CONDUCT HIGHLY SCIENTIFIC RESEARCH TO ANSWER THESE RESEARCH QUESTIONS. WE CONDUCTED TWO ORIENTATION WORKSHOPS WITH THE ACADEMICIANS IN THE AREAS OF HEALTH FINANCING AND ORGANIZATION AND DELIVERY OF CARE, TO A DISCUSS AND FINALIZE THE IDENTIFIED AREAS OF RESEARCH. WE FINALIZED THE RESEARCH AREAS AND SHARED A REQUEST FOR PROPOSAL WITH THE IDENTIFIED ACADEMICIANS. WE RECEIVED SIX PROPOSALS FROM INSTITUTE OF ECONOMIC GROWTH, INDIAN SCHOOL OF BUSINESS, INDIAN INSTITUTE OF PUBLIC HEALTH BHUBANESHWAR, ADMINISTRATIVE STAFF COLLEGE OF INDIA, FACULTY OF MANAGEMENT STUDIES, AND INSTITUTE OF PUBLIC HEALTH. A TECHNICAL ADVISORY COMMITTEE WAS FORMULATED, AND THEY REVIEWED THE PROPOSALS. PRESENTLY, WE HAVE FINALIZED FIVE OF THESE PROPOSALS BASED ON THE SCORE PROVIDED BY THE TECHNICAL COMMITTEE AND CONTRACTS HAVE BEEN ISSUED TO THE ACADEMIC INSTITUTES. WE ARE TO START THE RESEARCH IN PARTNERSHIP WITH THESE ACADEMICIANS.AYUSHMAN BHARAT - THE GOVERNMENT OF INDIA ANNOUNCED AYUSHMAN BHARAT IN 2018. AYUSHMAN BHARAT A MAJOR HEALTH SECTOR REFORM AIMS AT MAKING INTERVENTIONS IN PRIMARY, SECONDARY, AND TERTIARY CARE SYSTEMS, COVERING BOTH PREVENTIVE AND PROMOTIVE HEALTH, TO ADDRESS HEALTHCARE HOLISTICALLY. THE PROGRAM INCLUDES TWO MAJOR HEALTH INITIATIVES NAMELY, HEALTH AND WELLNESS CENTERS AND PRADHAN MANTRI JAN AROGYA YOJNA (PM-JAY). THE PM-JAY WILL COVER OVER 10 CRORE (ONE HUNDRED MILLION) POOR AND VULNERABLE FAMILIES (APPROXIMATELY 50 CRORE (FIVE HUNDRED MILLION) BENEFICIARIES) PROVIDING COVERAGE UP TO 5 LAKH RUPEES ($7,100) PER FAMILY PER YEAR FOR SECONDARY AND TERTIARY CARE HOSPITALIZATION. ACCESS HEALTH INTERNATIONAL CONVENES A PLATFORM OF TECHNICAL RESOURCES AND EXPERTISE TO SUPPORT STATE GOVERNMENTS TO INCREASE THE LIKELIHOOD OF SUCCESSFUL IMPLEMENTATION OF PM-JAY. THE PLATFORM WORKS WITH INTERESTED STATE GOVERNMENTS WHO REQUIRE STRATEGIC SUPPORT TO CONTEXTUALIZE DESIGN AND IMPLEMENT THE STRUCTURES AND PROCESSES FOR GOVERNANCE AND MANAGEMENT.CAPACITY BUILDING - ACCESS HEALTH ENGAGES, SUPPORTS, AND STRENGTHEN COMPETENCIES, CREDIBILITY AND CONFIDENCE OF HEALTHCARE PRACTITIONERS, POLICY MAKERS AND NATIONAL AND STATE LEVEL INSTITUTIONS TOWARDS BUILDING LONG TERM CAPACITIES IN HEALTH SYSTEMS AND CONTRIBUTING TOWARDS IMPROVED HEALTH OUTCOMES FOR THE PEOPLE OF INDIA.PHC RAJASTHAN - THE GOVERNMENT OF RAJASTHAN HAS RECENTLY UNDERTAKEN THE TASK OF ENSURING BETTER PERFORMANCE OF ITS HEALTHCARE SYSTEM, WHICH FALLS BELOW THE INDIAN AVERAGE ON MANY COUNTS. IN ADDITION TO GOVERNMENT FINANCED HEALTH INSURANCE UNDER THE BHAMASHAH SWASTHYA SCHEME, THE GOVERNMENT OF RAJASTHAN HAS BEEN ACTIVELY SUPPORTING THE USE OF TECHNOLOGY, INNOVATION AND PROCESS REENGINEERING TO PROMOTE BETTER HEALTH OUTCOMES BY STRENGTHENING PRIMARY CARE AND ENSURING GOOD GOVERNANCE BY WAY OF BETTER ACCOUNTABILITY AND TRANSPARENCY.TO THIS END, THE ACCESS HEALTH INTERNATIONAL IN 2016, ENGAGED THE BOSTON CONSULTING GROUP TO HELP THE GOVERNMENT OF RAJASTHAN IN REVITALIZING ITS PRIMARY CARE SYSTEM. THIS IS BEING DONE THROUGH STAFF AND INFRASTRUCTURAL GAP FIXING OF 295 PRIMARY HEALTH CENTERS IN THE FIRST PHASE (OF A TOTAL OF ABOUT 2100), SYSTEM STRENGTHENING(E.G., VIA HR PROCESSES, MANAGEMENT INFORMATION SYSTEMS AND PROCESS REDESIGN) AND DISEASE-SPECIFIC INTERVENTIONS (E.G., TO REDUCE NEO-NATAL MORTALITY FROM THE CURRENT 3.2%).THESE TRANSFORMED PRIMARY HEALTH CENTERS WERE RELABELED AS ADARSH PRIMARY HEALTH CENTERS, AND HAVE HELPED INCREASE UTILIZATION AND AVAILABILITY OF CARE WITHIN THE PUBLIC PRIMARY CARE SYSTEM IN RAJASTHAN. IN ADDITION, COMMUNITY STRENGTHENING IS ALSO PLAYING A CRITICAL ROLE, E.G., VIA TARGETED INFORMATION AND EDUCATION CAMPAIGNS AND FEEDBACK MECHANISMS.WHILE THE ENGAGEMENT HAS ACHIEVED SIGNIFICANT SUCCESSES, THE SELECTED FACILITIES WERE NOT AMONGST THE WORST PERFORMING FACILITIES IN THE STATE. NOW, THE OBJECTIVE IS TO SCALE UP THE EXPERIENCES FROM THE ADARSH INITIATIVE TO ALL PRIMARY HEALTH CENTERS IN THE STATE BY EARLY 2019. THIS WOULD ENTAIL ADDRESSING STRUCTURAL, PROCEDURAL, AND MONITORING FUNCTIONS WITHIN THE PUBLIC HEALTH SYSTEM, WHILE ENSURING SUSTAINABILITY OF THE CHANGES UNDERTAKEN. TO ELICIT BROADER SYSTEMS ACCOUNTABILITY AND ENSURE SUSTAINABILITY, THE BOSTON CONSULTING GROUP AND ACCESS HEALTH INTERNATIONAL WILL WORK TOGETHER TO DEVELOP A MODEL TO IMPROVE ACCOUNTABILITY THROUGH A TOP DOWN, LOW TOUCH APPROACH, TO STRENGTHEN THE PRIMARY HEALTH SYSTEM. WITH BOSTON CONSULTING GROUP'S FIELD KNOWLEDGE IN RAJASTHAN, AND ACCESS HEALTH'S INVOLVEMENT IN DRIVING ACCOUNTABILITY IN OTHER STATES IN INDIA, THE TWO ORGANIZATIONS WOULD WORK IN TANDEM AND SYNERGIZE THEIR EFFORTS TO DEFINE THE PREREQUISITES FOR ENSURING ACCOUNTABLE PRIMARY CARE. THE OUTCOME WOULD INCLUDE A FRAMEWORK OR GUIDE FOR MONITORING PRIMARY HEALTHCARE PERFORMANCE AND ACCOUNTABILITY, WHICH WILL BE REPLICATED FROM RAJASTHAN, IN A STATE WHERE ADEQUATE POLITICAL BUY IN FOR CHANGE EXISTS.FINALLY, TO ADDRESS THE HIGH BURDEN OF NEONATAL DEATH IN RAJASTHAN, ACCESS HEALTH INTERNATIONAL WILL PROVIDE KNOWLEDGE SUPPORT TO THE BOSTON CONSULTING GROUP ON DEVELOPING CHANGE PACKAGES FOR REDUCING NEONATAL DEATHS IN THE STATE. THESE CHANGE PACKAGES HAVE BEEN DEVISED BASED ON ACCESS HEATH'S EXPERIENCES IN OTHER STATES ON CAPACITY BUILDING OF HEALTH WORKERS ON QUALITY IMPROVEMENT PROCESSES THROUGH EVIDENCE-BASED PRACTICE. THE QUALITY IMPROVEMENT PROCESSES WILL FOCUS ON THE THREE MAIN CAUSES OF NEONATAL MORTALITY VIZ. SEPSIS, BIRTH ASPHYXIA AND COMPLICATIONS OF PREMATURITY. THIS CHANGE PACKAGE HAS BEEN TAKEN UP BY THE GOVERNMENT OF TELANGANA, UNDER THE AMBIT OF THE AAROGYASRI SCHEME, AND WILL SERVE AS AN ADDITIONAL TOOL TO FURTHER THE EFFORTS OF THE BOSTON CONSULTING GROUP IN DRIVING DOWN NEONATAL DEATHS IN THE STATE. ACCESS HEALTH INTERNATIONAL WILL ALSO PROVIDE TECHNICAL ASSISTANCE IN DEVELOPING SOLUTIONS FOR IMPROVING HOME BASED NEWBORN CARE, REFERRAL OF SMALL AND SICK NEWBORNS AND FOLLOW UP OF 'SPECIAL CARE NEWBORN UNITS' GRADUATES IN THE COMMUNITY THROUGH TESTED ACCOUNTABILITY MECHANISMS. SUSTAINABILITY OF THIS INITIATIVE WILL BE ENSURED THROUGH IDENTIFYING AND CAPACITATING LOCAL INSTITUTIONS, WHO WILL ENGAGE WITH LOCAL STAKEHOLDERS IN AN ONGOING MANNER TO ENSURE THE SUCCESS OF THIS INTERVENTION.FINALLY, ACCESS HEALTH AND BCG WILL EXPLORE OPTIONS OF TESTING THIS ACCOUNTABILITY MECHANISM OUTSIDE RAJASTHAN, ESPECIALLY AROUND PHC TRANSFORMATION. ONE OPTION WILL BE TESTING THIS HYPOTHESIS OF TRANSFORMING PHCS VIA TOP-DOWN ACCOUNTABILITY IN A DIFFERENT STATE, WHERE THERE IS SIGNIFICANT POLITICAL BUY IN - THIS WILL BE DONE BY DIVERTING SOME RESOURCES FROM RAJASTHAN TO THE OTHER STATE, AT THE END OF THE FIRST YEAR OF THE GRANT PERIOD.