Healthcare Summit Rajasthan '15 — technology for e-initiatives in healthcare

Remarks at the Rajasthan Healthcare Summit, 2015, where the state government invited private operators into its planning. Dr Bakshi sets out four ways mobile and electronic technology could extend care at scale. The recording is poor in places; what follows is an edited transcript of the passages that are clearly audible.

First, let me congratulate the minister and the mission director for organising such an open and professional meeting, where the government tells us openly what it is thinking and what it intends to do, and invites the private sector to take part in delivering good healthcare to all its people. We are also citizens of this country, so we are equally responsible, as professionals, for doing something good for our own people.

I thought I would point out three or four ways in which large-scale intervention can be done using mobile and electronic technology.

The first is how you deliver care to the patient. There is a small experiment running in Kerala, where the state government decided to create women entrepreneurs and tasked them with running small clinics. They do not have the clinical expertise themselves, so the arrangement is supported at the back end by Manipal Hospital in Mangalore, where our doctors give the consultation. The patient pays a fee, the entrepreneur earns from it, and a small share goes to the platform and to the doctor. It works for everybody, and it is a simple model that could be scaled across the country quickly.

The second is how you strengthen the front-line worker. There are around six lakh ASHA workers, and the total training we give them is about twenty days. After that they are out in the field, isolated, with no way to extend their knowledge or to call somebody when they are in trouble. Suppose a child is dying in front of one of them. What is she supposed to do? There is a great deal of room to raise the capability of ASHA workers with the right devices. The more we do for the individuals at the front line, the more effective that person becomes, and the better the whole system becomes.

The third has not been discussed at all today, and it is groups. How do you put five ASHA workers together with one nurse so that they can talk to each other? We have WhatsApp, we have Facebook, we have SMS groups. Not everything has to be handed down from above. These are intelligent people. They can help each other, train each other, support each other. What they cannot easily do is form those groups for themselves. So there is a third dimension here: support group formation, and let them learn from one another.

The last one is the most interesting, and it is the personal health record. Imagine seven crore people in this state each holding their own record, tracking vaccinations, primary care visits, medication and complications, available to the providers who need it. Aadhaar already exists. Why can we not build a personal health record on top of it, so that the doctor, the administrator, the private provider and the patient can all see it and use it to improve care?

I believe that would have the same order of impact as vaccination, or sanitation, or an improved water supply, because it lets hundreds of other professionals build better care on top of it.

What can Manipal do in all of this? Manipal is best known around the world for its work in medical education. We turned a small town in coastal Karnataka into a global centre for it. Wherever the government needs help with building capability, whether at the level of the individual worker or at the level of a group, we are there to support it, and much of that can be automated.

We do have a hospital in this state, and a large university here, and we work closely with the government. Yes, we are a for-profit organisation. But we believe, very sincerely, that unless the whole community benefits, there is no successful business for us to do here.