Healthcare on wheels - an idea whose time has come

Lack of access to affordable and quality medical care is a challenge in rural India

healthcare-on-wheels1 In the long term, public-private partnerships seem to be the best way of providing comprehensive healthcare delivery on wheels in underserved areas.

Healthcare delivery on wheels is fast becoming popular. According to Mobile Health Map Project, an online platform that aggregates data on mobile health clinics in the United States, expanded coverage and delivery reform could make mobile clinics partner with hospitals and insurers to improve care and lower costs in the areas of preventive care and care of those with chronic diseases. MED-1, a hospital on wheels, with a one hour set-up time and 48 hour sustainability, and with operating theatres, critical care beds, investigation facilities, pharmacy and satellite communications for off-site consulting, was so successful in delivering emergency healthcare during Hurricane Katrina that post-Katrina, orders for MED-1 poured in from other governments. Reduced costs and flexibility of deployment have resulted in even ‘Wellness clinics’ opting to go ‘on wheels’ in the USA! In Africa, governments and NGOs are operating mobile clinics and hospitals. American manufacturing firm, Odulair makes hospitals and clinics on wheels complete with solar power, customized for African conditions.

Lack of access to affordable and quality medical care is a huge challenge in rural India. A mere 23,000 primary healthcare centers attempt to serve 700 million people across 636,000 villages. Sixty-six per cent of Indian villagers lack access to critical medicines; 31 per cent travel more than 30 kilometers for medical care; and rural health centers, where they exist, are short of trained medical personnel.

Historically, Dr Ida Scudder of Vellore was the first to take the mountain to Mohammed. She began “roadside clinics” in 1906, taking a small team out in a bullock cart to local underserved villages, running clinics under a shady tree for all comers. Her admirer, Sri Sathya Sai Baba, launched a ‘healthcare on wheels’ programme in 1956 when he started the first general hospital in Puttaparthi. A ‘medical van’ took doctors and nurses regularly to villages offering curative services and health education.

In 2005, Baba commissioned Siemens India to custom build a healthcare–on-wheels bus with a high power supply generator on board; and the first proper Mobile Hospital Service began in Puttaparthi in 2006. The mandate: to offer on a regular basis, every medical service other than surgeries which required general anesthaesia, in remote villages. Baba also answered the wish of villagers who wanted the attention of ‘specialists’; he insisted that besides what villagers ‘needed’, what they wanted had to be provided, too.

healthcare-on-wheels2 In 2013, the Puttaparthi Mobile Hospital won the CNBC- INDIA Award for innovation in transforming lives, in the field of healthcare.

With just three eminent and well known specialists who volunteered, the mobile hospital began. The doctors were simply overwhelmed by the love and gratitude of the villagers. The word got around and thereafter there was never a doctor shortage.

Technically, the bus had an ultrasound with colour doppler and 2D echocardiogram, digital x-ray and biochemistry and clinical pathology labs on board besides a pharmacy which dispensed a month’s supply of medicines for chronic diseases. All services, keeping with Sathya Sai policy, were delivered totally free of cost. Patients from 30 to 50 villages would converge at a nodal point. Villages upto a radius of 50 kilometres around Puttaparthi were covered. On the fixed dates, at each nodal point, dedicated volunteers ensured that literally overnight the ‘hospital’ came up! The ‘hospital’ typically comprised of the bus, classrooms of the village school and tents. Tents and verandahs became waiting areas; classrooms became consultation rooms; and the bus had on board, laboratory, minor OT and pharmacy—all powered by the on board generator.

The previous evening, villagers were regaled with videos of sports and epics intertwined with health education talks and all-faith bhajans. The next morning, out patient consultation services, investigations, minor surgical procedures, and dispensing of medicines were done at the ‘hospital’. For complicated cases, the doctors assumed responsibility to arrange for treatment while volunteers chipped in with man power. In 2013, the Puttaparthi Mobile Hospital won the CNBC- INDIA Award for innovation in transforming lives, in the field of healthcare.

By 2017, the Puttaparthi Sri Sathya Sai Mobile Hospital had treated 873,367 patients, performed 56,786 diagnostic procedures, 209,263 biochemical tests, 21,355 X-rays, 25,823 ultrasounds and 9,608 ECGs—all totally free of charge. The Sathya Sai Global Health Mission duplicated similar mobile clinics in Sri Lanka, Indonesia, Africa and South America. The successful model was also copied by devotees across India, from Kerala to Delhi.

After Sri Sathya Sai Baba’s time, his students have scaled up services to the next generation healthcare on wheels program. A bus has been designed with features to help in total rural development—‘SAI WHEELS’. It stands for Societal Advancement and Improvement by Water, Healthcare, Educare, Energy, Love and Service. Powered by solar energy with a battery backup option, and equipped with the latest medical devices and applications, a functional classroom, mobile library, hands-on science lab, computer stations, and a high definition TV monitor that provides access to online educational media, an RO water unit, etc, the SAI WHEELS’ maiden project operates in villages clustered around Muddenahalli in Karnataka.

Protégé of late president Abdul Kalam and Silicon Valley entrepreneur, Arvind Thiagarajan, has created a ‘Sai Kalam smart steth’ as part of this technology-for-service initiative. This stethoscope, with built in echocardiographic facility, enables trained grassroots health workers to detect murmurs indicative of congenital heart disease, the commonest birth anomaly in India, and the data is forwarded to cardiologists in base hospitals. The SAI WHEELS bus delivers a dual ‘mobile’ advantage—that of a mobile hospital that reaches the needy along with mobile phone augmented ‘smart-steth’ technology.

healthcare-on-wheels4.jpg Over a dozen dedicated organisations today deliver healthcare on wheels to rural India.

Inspired by SAI WHEELS and following the Puttaparthi model, the youth of West Bengal banded together as Aarogya Vahini, and launched a full time, five days a week, healthcare on wheels service with the aim of reducing the non communicable disease (NCD) burden in the underserved areas within a radius of 60-70 kilometers around Kolkata, in 2017. A Tata trailer chassis with a complete medical unit aboard was used. Besides consultation cubicles, equipment for measuring and monitoring chronic conditions such as diabetes and hypertension, laboratory services with biochemistry, clinical and histopathology equipment, ophthalmological equipment to check refraction and retinal disease, stations for women wellness checkup and oncology counseling, dental care and health education are available on board.

Community Health Workers connect Aarogya Vahini to the community at each nodal point. A project director, MBBS doctors, specialist doctors, epidemiologist, nurse-midwives, lab technician, phlebotomist, pharmacist, medical records officer, driver, cleaner and a trained house keeper complete the team. Patients with NCDs receive holistic treatment as well as medicines for a month. Volunteers from the public join as ‘Aarogya Bandhus’ to provide escort services to sick patients.

Their Kolkata centre, Sri Sathya Sai Amrutham, coordinates activities besides running specialised outpatient services, for people of the North-East. Networking with tertiary care centres, telemedicine consultations and subsequent treatment are arranged for patients. By mid-2019, over a 100 general surgeries and 120 plus cataract surgeries had been facilitated. Between the on-wheels medical services and the Kolkata centre, over a lakh people receive quality, compassionate healthcare, through Aarogya Vahini. All Aarogya Vahini services are provided totally free of cost to beneficiaries.

Their inspiring first year performance led to Tata Trust donating a second medical van. Donations from individuals and corporates help fund Aarogya Vahini. On public’s request their services are now extended to Jharkhand and Assam. Aarogya Vahini that has taken on COVID-19 and Amphan cyclone relief work, besides continuing medical services observing COVID_19 norms, recently won the prestigious “Dr Abdul Kalam Award for Excellence Towards Nation Building” award.

Over a dozen dedicated organisations today deliver healthcare on wheels to rural India. Mobile 1000, launched by the CSR arm of Wockhardt, provides primary healthcare services to remote areas, pan India. From semi-urban bases, the team—a general physician, a pharmacist and a driver—sets out, with primary diagnostic equipment and medicines for common illnesses on board. Complicated cases are referred to the nearest hospital. They typically cover about 100 patients over four villages every day. The company’s Mumbai command centre tracks operations and detailed digital medical records are meticulously stored.

Covering 25 villages in weekly cycles, it reaches 22,500 people a year at USD 2.4 per person, a cost that is lower than the NRHM’s USD 3 per person because the Mobile 1000 program uses generic drugs. The end-to-end operation of each van costs USD 50,000 a year. Mobile 1000 runs on a philanthropy model; over 80 per cent of the money to run Mobile 1000 comes from public sector undertakings (PSUs) like Gas Authority of India and Indian Oil Company. The foundation is also working on collaboration with several state governments including Kerala, Tamil Nadu and Karnataka. The Mobile 1000 program won the ‘Inclusive India’ award for best social work in the area of primary healthcare for providing regular and concentrated health-related activities in villages, promoting health-seeking behaviour.

The commendable mobile medical program of the Government of India, across rural villages, unfortunately suffers in part from inadequate planning and red tape. In the long term, public-private partnerships seem to be the best way of providing comprehensive healthcare delivery on wheels in underserved areas. To maximize efficient and effective country-wide deployment of such services, the need of the hour is for these various stake-holders to come together.

Singapore-based AVPN is a unique funders’ network, a platform that cuts across private, public and social sectors embracing all types of engagement to improve the effectiveness of social investment by members across the Asia Pacific region. In 2018, they brought together organisations working to fight malnutrition in India, to brainstorm and develop best practices.

It is time a similar engagement happened among all agencies involved in healthcare delivery on wheels. The possibilities are tantalizing. Indeed, healthcare on wheels for underserved rural India is an idea whose time has come.