health kiosks a nano-model for primary care and health information at remote and unserved locations
TRANSCRIPT
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Health KiosksA nano-model for
Primary care and health information at remote and
unserved locations
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Primary care and Info services
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The Context• Health care gaps remain in rural parts of many
northern states in India and many rural clusters in southern states, despite expansion of public health care network.
• Even in cities, we find shortage of primary care because of market forces in favour of high tech and specialist care.
• Govt is introducing The National Health Mission to include urban areas
• Health kiosks can provide a nano-solution on primary health care-on every front
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Basic Tasks in Health Kiosks
Primary care for <40 minor and common ailments
• Common ailments
• First Aid
Screening for major ailments
• Cancer, anemia, TB etc• Diabetes, hypertension• malnutrition
• Local language
• On tabs and mobile platform
National Health Programs
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Locating Tele Health Kiosks
Community locations without private or public care in 3-4 km radius
• Need based, on request of Gram-panchayats or organizations, industrial floors
During events like yatras, pilgrim centers
• We can convert existing health sub-centers, anganwadis (afternoon), samajmandirs. Also, ashramschool premises, petrol pumps etc
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Infrastructure
• Small rooms, makeshift (fiber models available) or rented
• Cupboards cum tables (kappatables)• 2-3 plastic chairs• Hand wash• Basic equipment• Tab or computer, cell phone
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Kappatable
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MedicinesAllopathic Ayurvedic Homeopathic
1albendazole arogyavardhini arnica 2antacid chandrakala belladona3amoxicillin Sitophaladi Ipicach
4aspirin kutajghanavati arsenic alba
5chroquin Guduchighanavati Merc Cor6Cetrizine sootshekhar Hepar sulf7Doxycyclin Tribhivan kirti China 30
8Eye-ear drops Triphala Hinguastak calendula9Fersolate neemtail
10Gential violet 11Miconazole
12paracetamol 13OP 14Condoms
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Some 40 illnesses
bodyache nuasea cough wounds burning urinebackache vomiting throat sore allergy vaginitisheadache hiccoughs cough& phlegm ringwormcommon cold abd pain ashthmadysmenorrhea constipation child pneumonia boil/pus FIRST AIDtoothache acidity dogbite snake bitefevers jaundce scabies dog bite
indigestion anemia sore eyes scorpion stingdiarrhea ear infectiondysentryworms
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Fever Aspirin/Pamol Tribhuavnkirti, Guduchighanvati Belladona Tulsi kadha, w arm w ater, tepid sponging
old injury pain/muka mar Aspirin/Pamol Arnica 30
Toothpain Aspirin
RS Common cold paracetomol* tribhuvankirti allium sepa ST3/ST3/LI19/LI4 Lemon grass tea
URTI Aspirin/Pamol Sitophaladi, tribhuvan***, Ginger+honey or jaggery
URTI-productive Cozal+pamol Sitophaladi, Milk+haldi, Jeshthimadh, adulsa
childhood LRTI Cozal+pamol Milk+garlic
LRTI adults Cozal+pamol Steam inhalalation
Tonsillitis Cozal+aspirin/pamol Mirc IR
Asthma attack# Salbutomol-inhale/tab Sitophaladi Rein17/LU7 Breathing exercises,
GIS Acidity Gellucil** Sootshekhar***
Hiccoughs Jaggery
child dirrhea ORS Jaiphal (balghuti)
Diarrhea-adult Furazolid+ORS Kutajghanvati Arsenic alba Cofee,
Constipation triphala churna, Arogyavardhini LI4/ST36/ST6 Aamla, Rajgira bhaji,
Constipation-child Gheee/oil by mouth at night
w orms albendazole
dysentery-amebic metronidazole Kutajghanvati Merc Cor Cofee,
dysentery-w ith blood Cozal+dicylomine Kutajghanvati Ghee
Nausea/motion sickness Ipicac Moravala
vomiting/ motion sickness domperidone sootshekhar Arsenic alba
Pain-abdomen-adult Dicyclomine#& para Mag phos
Indigestion, gases Hinguastak churna ST36/P6 for appetite
Pain-abd-baby (criyng)# Hing appl/murudsheng
skin Boil Arogyavardhini Hepar sulf
Inf w ounds Cozal+dressing triphala w ash+neem oil calendula papaya, aloe
Itch/alleregy/insect bite CPM
Fungal infection w hitf ield /miconazole
Scabies-dry Gammsacb
Urinary Burning urine sodamint dhaniya paani, kulatha kadha
Hemopoietic Anemia Fersolate
Other infect disMalaria chloroquin China 30 chirait-kadha
Jaundice & fever Pamol Arogyavardhini Bhi-amalki kalk
conjunctivitis Tetra eye drops
ear infection Cozal+Para+CPM
Wax in ear Hydrogen peroxide
Fem Repr sys Vaginitis GV+Metro pessary# Triphala w ash Crushed garlic petal
dysmenorrhea Paracetomol
Lactation(to boost lactation) Shatavari kalp
Emergencies dog-bite soap w ash
snake bite Elastic bandage
Chest pain (acute)# IsobarbideT+aspirin
Ushnatavikar Burning, piles, nosebleed Chandrakala Barf for nosebleed
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Human Resource options
• Select from existing ASHAs• ANMs or male health workers• Ashramschool/Resident school teachers• New Anganwadi workers• Volunteers
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Training• A basic training program in technical and
management of kisoks-attuned to the level of trainees
• Training on duty-thru video clips, skype conference etc
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Basic services
Primary care
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Hub Back Up
Medico support Hub
kiosks
kiosks
kiosks
kiosks
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Initial fixed costsestimate source
Shelter/room 30000-50000 Owner-panchayat
Furniture/equipment 10000 Donor/CSR
Consumables-initial 5000 Panchayat/CSR
Training -initial 10000 CSR
Computer/Tab/mobile 15000-25000 CSR
Total 80000-100000
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EconomicsItem costs Comments
Info services Free..(from district costs)
Primary care/screening About 10-15/daily at Rs 10 per unit makes about 100-150 Rs per day
Goes to paramedics for part time work
Medicines About 10-20 Rs per day From the client, part may be from Govt system
Referral Free
Maintenance Connectivity, power, clean up etc: Rs 500 pm
Owner agency/panchayat
Different business models can be constructed like pre-paid contributions etc
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Monthly MIS
Single page report
Care Preventive services Accounts
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Legal issues• Trained paramedic-at present no such cadre• Standard protocols to be used• The use of medicines based on doctor-support at
remote end..on mobile/conf etc• Grampanchayat using 73nd amendment for
endorsing a health kiosk with paramedic support.• Use of FDA schedule K, 13-use of medicines by
CHWs etc• Use of FDA schedule 23-village shop remedies
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Standard Operating Procedures
• Use of basic clinical protocols-in print and software based (already developed)
• The remote paramedic uses protocols and also consults hub end medico on mobile or net-conference if necessary
• Basic entries are made in standard formats• Standard monthly reports in print, using
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Health Information in Local Language (HILL)
Free Primary health information on 1000 topics
on Net, Tabs, mobile platforms
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What is ready
Arogyavidya.net (marathi)
Bharatswasthya.net (Hindi)
Gujrathi in process thru a different group
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Help lines are also Available
• In Maharashtra, thanks to NRHM, the 104 helpline is available 24 hrs, with hub at pune
• This can be used by any health worker anywhere with a mobile call.
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What needs to be done
• Develop mobile apps for HILL contents• Develop applications on tabs
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Building HILL network in India
• Each language source should be developed by one agency/group
• Basic unit with a translator doing it from Hindi or English(to be built)
• Each unit will network with local doctors to edit/develop own content
• The project cost is about 10-15 lakh per language
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Integrating efforts on Health kiosks
• Many people are working on parallel lines, we can add by integrating and providing tech support..model building
• Start a parallel activity on HILL-in more languages and with more contributors
• We are willing to start a hub in Nashik..to support kiosks in north Maharashtra.. With CSR support
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