Home delivery: Doctor at the door
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Home delivery: Doctor at the door

In 2000, the last time WHO ranked the world’s healthcare systems, India came in at 112. Way below Kazakhstan (64), Estonia (77), Bangladesh (88) and even Azerbaijan (109). We did come in ahead of Tonga and Yemen (116 & 120 respectively).In some states, they've found a simple fix: A mobile unit kitted out like a clinic. Complicated cases can just get on board and head to the nearest hospitalm, reports Jaya Shroff Bhalla.

india Updated: Jul 22, 2009 00:23 IST
Jaya Shroff Bhalla
Jaya Shroff Bhalla
Hindustan Times

Forget absentee doctors. Here’s how to take modern healthcare to every Indian doorstep: A network of mobile hospitals. For 7 per cent of India’s health budget.

When Vanyi went into labour last month, the 24-year-old didn't call an ambulance or check in with her doctor.

There are only dirt roads in Parikkal, her village in north-eastern Tamil Nadu, and there isn't a clinic for miles.

Instead, she put on her slippers, called for her mother and began to walk to the nearest primary health centre - 18 kilometres away.

Once there, she sat down outside to wait till she was about to give birth. The health centre at Illedu has only four beds, and two were already occupied. The nurses could not spare a bed while still was still only in the early, if excruciating, stages of labour.

In a country where about 53 per cent of all births are unattended - that's 14.4 million births every year, the highest for any country in the world - Vanyi (who goes by only one name) is one of the lucky ones. View Larger Map

She had her child brought into the world by a nurse.

In 2000, the last time WHO ranked the world's healthcare systems, India came in at 112. Way below Kazakhstan (64), Estonia (77), Bangladesh (88) and even Azerbaijan (109). We did come in ahead of Tonga and Yemen (116 & 120 respectively).

At Illedu, there was no doctor to check on Vanyi as she waited.

No doctor has ever lived at Illedu.

On paper, the health centre has a trained medic. But he won't live in this nowhere village with no schools, no potable water and no electricity. Instead, he lives 220 kilometres away, near the state capital of Chennai.

The nurses say he comes in "almost every day". The villagers say they barely ever see him.

It's the same story across most of India's seemingly impressive network of 23,236 primary health centres.

A 2007 national survey by the World Bank showed that the average rural government doctor was absent from his clinic two out of every five days.

"What doctor would want to work in this mess?" says P Bhanumati (43), the nurse on duty, crinkling her nose as she looks around the tiny centre.

The centre, once a solid construction of 10 rooms, is now in disrepair. The CT scan room is deserted and damp. There is no doctor around, but an operation theatre is being constructed, scattering debris and dust all over.

This facility is the only medical unit for 30,000 people from 13 villages in an 11-kilometre radius.

Just a half hour drive away, though, it's quite a different story.

"I no longer have to travel to bigger towns for treatment," says Usha Rani (43) of Odukkam village in Salem district.

Instead, she just waits for the clinic to come to her.

Every week, a mobile unit rolls through the villages in Kancheepuram, Villupuram and Salem districts.

Inside is gleaming modern equipment, trained attendants, and the offer of a free ride to a larger hospital if further treatment is necessary.

Patients and doctors meet 'virtually', via a satellite link set up in collaboration with the Indian Space Research Organisation.

The mobile unit is run by two non-governmental organisations - Madras Diabetes Research Foundation and World Diabetes Foundation.

The van is stocked with medicines and has an electrocardiogram (ECG) machine to measure heartbeat, a Doppler machine to check blood flow and devices to monitor blood pressure and sugar levels.

It rolls through 42 villages about once a week, and focuses on diabetics. But it's a model that could easily be replicated across the country. https://www.hindustantimes.com/news/images/Untitled-2.jpg

"Mobile health units are a good way to help aid the rural pockets," says Health Secretary Naresh Dayal. "But we at the Centre can only give suggestions and sanctions. Health is a state subject and it is entirely up to a state to adopt a solution."

And mobile units would work out cheaper than constructing a separate centre for each village and posting a doctor and staff there.

Four such air-conditioned vans in each of the country's 566 rural districts - complete with all the machines in the Chennai van plus a weighing machine and small laboratory facility, an inverter, a driver and four attendants - would cost the government 1,411 crore in the first year.

That's just 8.53 per cent of the Rs 16,534 crore allocated to the Ministry of Health and Family Welfare in the 2008-09 Union Budget.

And the cost would drop drastically thereafter, as equipment is a one-time expense. The recurring costs would include maintenance of the vans, fuel, medicines and employee salaries - a total of about Rs 900 crore.

Service on these vans could be made compulsory for students whose medical education has been subsidised by the government.

For villagers like J. Dasaradan of Kottakadu village in Salem district, a mobile unit could mean the difference between life and death.

"I always wanted to be close to my roots and work on my ancestral farms after retirement," says the 54-year-old diabetic. "But the lack of medical aid kept me away. The van has come as an answer to my prayers."

The problem

Crores of your money are being spent every year on brick-and-mortar public health centres that are then left to gradually crumble in disrepair.

Most are poorly equipped-and many have no doctor in attendance much of the time. About 38 per cent of doctors at India's 23,000-plus primary health centres are absent on any given day, a 2007 World Bank survey found.

We suggest

A network of state-of-the-art mobile healthcare units, each one equipped with an electrocardiogram machine to monitor heartbeat, a Doppler machine to measure blood flow, a blood sugar testing machine, blood pressure monitor, weighing machine and a small laboratory facility. This facility would actually be a step up from most primary health centres.

Each van - complete with Web camera, 26-inch LCD TV, air-conditioning unit, inverter, computer and satellite antenna - would cost Rs 23.30 lakh.

Four vans for each of the country's 566 rural districts would cost about Rs 528 crore.

Ideally, there should be three doctors on each van - a total of 6,792 doctors. At a salary of Rs 25,000 per month, salary costs would be about Rs 203 crore a year.

Each van would need a staff of about 12 people: A driver (Rs 8,000 per month), two attendants (Rs 10,000 each), six nurses (Rs 15,000 each) and three lab technicians (Rs 14,000 each). These salaries would come to about 435 crore per annum.

At the rate of about Rs 1 lakh worth of medicines per van per month, that's about 272 crore per annum.

In all, the network of tertiary vans catering to India's rural masses would cost the government about 1,411 crore, or 8.53 per cent of the Rs 16,534 crore allocated to the Ministry of Health and Family Welfare in the 2008-09 Union Budget.

The vans could travel a maximum of 300 kilometres per day, treating up to 60 patients. At the end of the day, the vans would return to their base stations in the nearest large districts, town or city.

The problem of doctor absenteeism would be solved because doctors would no longer need to travel to, or live, in the remotest areas. Instead, they would get to work in a well-equipped centre, treating scores of patients every day and returning to their cities or town at the end of the day.

Related links:

Around the world

Government Speak | Naresh Dayal

Overview on Hospital Accreditation

WHO Accreditation Presentation

Health and Wellness centers

Services provided by the Institute of Human Behavior and Allied Science Organisations

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First Published: Jun 21, 2009 13:37 IST