1. Healing Touch: Universalizing access to quality primary healthcare
HealthonWheels:MobiHeal
Team Vincent
Indian Institute of Technology Kharagpur
Gaurav Rungta Keshav Pratap Singh
Sunit Kumar Swain Ahmad Faraz
Anirban Majumdar
सर्वे सन्तु निरामयााः ।
‘Let all be free from illness’

2. Rural Healthcare System In India
1 CHC
4 PHC
24 Sub
Center
Community Health Center(CHC)
A 30 bed Hospital/Referral Unit for 4 PHCs
with specialized services
Primary Health Center(PHC)
A Referral Unit for 6 Sub Centers 4-6 bed
manned with a Medical Officer In-charge and
14 subordinate paramedical staff
Sub Center
First point of contact between PHC and
patient manned with one Health
Worker(F)/Auxiliary Nurse Midwife & one
Health Worker (M)
Community Health Center(CHC)
Number of CHC : 4809
Population / CHC : 1,73,235
Primary Health Center(PHC)
Number of PHC : 23887
Population / PHC : 34,876
Sub Center
Number of Sub Centers : 148124
Population / Sub Center : 5,624
Avg. Rural Area (sq. km) Avg. Radial Distance (km) Avg. number of Villages
Sub Center 21.05 2.59 4
PHC 130.54 6.44 24
CHC 648.43 14.36 133
As can be observed from the data in Table 1, the distance required to be traversed by the rural population to reach a
medical facility is too high considering the lack of proper means of transport.
Table 1
India has a three tier system for providing quality health care to it’s rural population
Scenario Problem Solution Structure Impacts
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3. Rural Healthcare System In India
Scenario Problem Solution Structure Impacts
Fig 1 : Shortfall in number of ANM at Sub
Center and Primary Health Centre
Fig 2 : Average rural population covered
by a sub center
• About 75% of health infrastructure,
medical man power and other health
resources are concentrated in urban
areas where 27% of the population live
• Only 10 % of the health budget allocated
for rural areas
• 70% of families spend 60% of their
annual income on health
• 93% of the amount spent on primary
healthcare is on curative and emergency
care
• Almost 80% of Indian states are lagging
behind in terms of primary healthcare
infrastructure and skilled workforce
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4. Problems Currently Faced In Primary Health Care
ProblemScenario Solution Structure Impacts
• Rural Areas face a scarcity of Emergency Medical services for common medical contingencies like
snake bites, pesticide poisoning, mechanical accidents etc.
• Inadequate number of Primary Health Centers [PHCs] and Sub Centers compared to the number
required for proper delivery of medical services
At present a PHC is supposed to cater to the medical needs of 24 villages with an average cumulative
population of approximately 35,000
• Lack of connectivity and inadequate transport facilities add to the difficulties to the rural residents
A rural patient on an average would require to travel more than 6 kilometers to reach the nearest Primary
Health Center
• Lack of skilled manpower in Primary Health Centers
A Sub Center is manned with 2 Health workers for an approximate population of more than 5000 people
• The rural health problems can attributed also to lack of health literature and health consciousness,
poor maternal and child health services.
• The availability of drugs in PHC, Sub Centres remains a major concern for the Primary Healthcare
System
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5. Proposed Solution
We plan to introduce a unique ‘Mobile Health Unit’ called “MobiHeal” per 3 subcentres. Therefore each MobiHeal will cover
on average 12 villages spread over an area of 42 sq. KM.
What is ‘MobiHeal’ ?
• MobiHeal is a ‘mobile health unit’ cum ‘ambulance’.
• A motorized vehicle with sophisticated life support system for emergency situations which can be used by a trained ANM
as a moving clinic on daily basis.
• A single solution to cater the most two important health problems of rural India – lack of emergency services and
presence of medical clinic at root level.
Apart from life support, proper medicine inventory will be managed in MobiHeal, also sample collections for tests etc can be
done in it as well.
Staff requirements for MobiHeal:
• One trained ANM/HW who can apart from giving basic prescriptions to the villagers can operate the life support system
in emergencies.
• Two drivers: These two drivers will be working on shift to be available 24X7 on beat.
SolutionProblemScenario Structure Impacts
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6. Services
•The need: Presently there is no proper ambulance facilities in villages. Patients in
emergency situations have no proper means of transport to reach the nearest
CHC which is located on average 15 km away.
•The Impact: Due to availability of the ambulance at sub-Center level, the
travelling time to reach the patient reduces by a large amount. Availability of life
support will be vital for patients health before he reaches CHC.
Emergency service:
In case of emergency situations which require
immediate medical attention, these life
support equipped ambulances will take the
patient to the nearest CHC directly.
•The need: Due to lack of proper modes of transportation, it is difficult for villagers
(especially women and children) to go to nearest medical unit. Therefore often it
is too late before they get proper medical attention.
•Impact: Through MobiHeal for the first time in history of India, medical facility
will be available at village level. Now the villagers don’t need to travel to get
medical services, but the services are themselves coming at their door regularly.
This will provide solution for diseases often neglected among the people as well.
Daily usability:
Bringing the PHC facilities to root level –
MobiHeal will be used as a moving clinic and
will cover the 12 villages over 3 days.
MobiHeal clinic will set itself up for 2 hours at
each village at a scheduled time and will be
coming back to the same village every 3rd day.
SolutionProblemScenario Structure Impacts
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7. Awareness
The personal on the unit will organize camps
on various topics like sanitation, AIDS, birth
control etc.
Infant immunization
Vaccines will be available on the unit.
Periodic checkups of infants and children
prone to various diseases.
Pregnancy and related care
Medical care for pregnancy and child birth
After delivery care for both mother and child.
Birth Control Program
Subsidised sterilization surgeries such
as vasectomy and tubectomy.
The facility will be available on the unit itself
when the surgeon would visit the villages on
decided dates.
Anti-epidemic programs
• Act as the primary epidemic diagnostic and control
centers for the rural India.
- They will identify suspected cases and refer for further
treatment.
Auxiliary Functions
The mobile unit will undertake the following additional services as well:
SolutionProblemScenario Structure Impacts
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8. Proposed Funding
Government Sponsored
- The government includes the program in it’s budget for
primary health care.
- It sets up the centers at state and local levels and pays for the
setup and operating costs.
Private sponsored
- Money is raised from private parties and philanthropists.
- The scheme is implemented by independent organizations or NGOs.
- Maintenance of the machinery can be done through insurance
premiums using the concept of microfinance.
Project Funding
Social Impact Bonds
-The money is raised from private parties and the
results are monitored by the outcome funder.
- As per results, the government pays the private
investors with returns. If the project fails to deliver, it is
not liable for any payment.
- Work similar to the girl education bond created in
Rajasthan.
Corporate Social Responsibility
- With the new ‘Companies Bill’, the CSR money can be directed
towards this scheme from the companies.
- Can include a portion of the CSR as return (say 7-8%) by the
government on successful completion of the project.
- Creates a monetary incentive for the companies and the
government spends only a fraction that too only on successful
projects.
Funding for the project can be arranged from different sources both public and private
StructureProblemScenario Solution Impacts
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9. State Head Office
Regional OfficesTechnical &
Maintenance
Central Toll Free
Helpline
Training Center Financial Division
Awareness CampsQuality ControlMobile units at
Sub center level
• Responsible for
training and
recruitment of the
employees
• Imparting skills which
help in providing
regular treatment as
well as tackle
emergency situation
• Proper maintenance
of MobiHeal units and
medical instruments
• Providing technical
support to the whole
organisation.
• Regional offices
will coordinate with
their respective CHCs
and work for smooth
functioning of the
organisation.
• Toll free state
helpline to provide
quick response to
emergencies.
• Manage the funds
flow
• To audit the
finances of the
organisation
• Monitoring and
eradicating the
flaws of the system.
• Organizing camps
with volunteer
support
Proposed Organization Structure
StructureProblemScenario Solution Impacts
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10. • If we consider the cost of implementing the MobiHeal model over average area covered by
CHC i.e. ~650 sq. km.
Fixed Cost: One Time Cost
Per CHC 8 MobiHeal units are required 25*8 lakhs Rs. 2 Crore
Variable Cost: Annual budget required
Staff: Drivers' Salary (Two Drivers per MobiHeal) Rs 5000 per driver/month Rs 9.6 lakhs
Skilled Medical Practitioner Rs 12000/month Rs 11.5 lakhs
Fuel Charges: Estimated fuel cost annually Rs 10 lakhs
Miscellaneous Charges: Emergency medical
inventory Rs 3 lakhs
Maintenance of instruments & MobiHeal Rs 16 lakhs
Total Variable Cost Rs 50.1 lakhs
If its a private funded scheme, the annual variable cost can be covered by charging a nominal premium of (50.1
lakhs/1.72 lakhs) ~ Rs 2.5 per person per month, thereby establishing a self sustaining model.
StructureProblemScenario Solution Impacts
Cost Analysis 9

11. • Each CHC will cater primary medical facility to about 25
villages under them with greater efficiency serving
approximately 170,000 people.
• The availability of staff per person will increase. Also the staff
will be present at their doorstep to fulfill their medical needs.
• The better utilization and reach of primary healthcare funds
to the grass root level through the proposed model.
• The emergency situations occurring in remote areas will be
tackled in a better way and in less time due to the fall in
travelling time.
• The proposed model will increase the exposure of people
with the medical staff thereby improving the quality of
health.
• The major healthcare issues like the pregnancy, child
immunization , birth control, epidemic diseases, etc. will be
handled in a better and professional way by reaching up to
the affected patient.
• Regular checkup and camps will instill a sense of healthcare
awareness among the people of villages.
• Convincing the government/private bodies about
the feasibility of the project.
• Villagers may be skeptical to such a service and
creating trust among the people.
• Imparting skills to the people can be time taking
and may not produce desired result.
• Proper maintenance and inventory management of
local storage centres.
• Ensuring that the ambulance and the toll free
number at always in a working condition.
• Optimizing the travel route of the ambulance and
the grouping of the villages.
Impacts
Challenges
ImpactsProblemScenario Solution Structure
Impacts and Challenges 10

12. • Bulletin on Rural Health Statistics in India (2005), Infrastructure Division, Department of Family Welfare; Ministry
of Health & Family Welfare, Government of India.
• Calculation data taken from www.data.gov.in
• CURRENT HEALTH SCENARIO IN RURAL INDIA, Ashok Vikhe Patil, K. V. Somasundaram and R. C. Goyal; International
Association of Agricultural Medicine and Rural Health and Department of Community Medicine, Rural Medical
College of Pravara Medical Trust, Maharashtra, India.
• Indian Public Health Standards (IPHS) - Guidelines for Primary Health Centres Revised 2012. Directorate General of
Health Services , Ministry of Health & Family Welfare, Government of India.
• National Rural Health Mission 2005–2012 –Reference Material (2005), Ministry of Health & Family Welfare, GOI.
References