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eHEALTH
Instant-on CIoud connected ViIIage HeaIthcare Centre

Author:
Dr. AnjaIi Nanda, B.D.S
174-C, Mayur Vihar
Ph-1, Pkt-1, Delhi-110095
E-mail: anjalinanda0503@gmail.com
Phone No.: 07838836855

Bio: Dr. Anjali Nanda is pursuing Post Graduate Diploma in Health Administration with
specialization in Health nformatics. She is a dental surgeon with rich clinical experience
in both rural settings and urban areas in ndia. She has been a part of research projects
involving urban poor and has a good understanding of their healthcare needs and the
healthcare delivery process. She is interested in pursuing a career in public health
informatics.


Co Author:
Dr. Jaijit Bhattacharya, PhD
Director Government Affairs
Hewlett Packard ndia Sales Pvt. Ltd
Tower-d, 6
th
floor, GBP
MG Road, Gurgaon, ndia

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E-mail: jaijit.bhattacharya@hp.com
Phone No.: +91.9818213076

Bio: Dr. Jaijit Bhattacharya is an e-Governance expert and is Director, Government
Affairs, Hewlett Packard ndia. He is an e-Governance advisor to Government of Sri
Lanka and has been conducting training for ADB institute in Tokyo on Public
Expenditure Management and has helped World Bank develop curriculum for their e-
Leadership program. Dr. Bhattacharya has developed business models and strategies
for leading companies in the T, media and computer hardware industries. He is the
author/co-author of four books on e-Governance including the first book on e-
Governance in ndia, 'Government On-line Opportunities and Challenges'.

Co-Author:
Ms. Ritu Ghosh
Hewlett-Packard ndia Sales Pvt Ltd
Tower-d, 6
th
floor, GBP
Gurgaon, ndia
+91.9818316299
ritu.ghosh@hp.com

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Bio: Ms. Ritu Ghosh is the Government Affairs Specialist, HP ndia and is currently
driving the education and environment initiatives for Government Affairs Team, ndia.
She is an CT public policy expert with over 13 years of experience. She has been
driving initiatives for the adoption of CT as the transformation tool in emerging and
developed economies. She is a research associate with ndian nstitute of Technology
and has set up the Centre for Excellence in e-Governance at T Delhi campus with an
objective to carry research activities and showcase the latest technology initiatives and
innovation to the government.

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eHEALTH
Instant-on CIoud connected ViIIage HeaIthcare Centre

Abstract:
ndia's achievements in the field of health have been less than satisfactory and the
burden of disease among the ndian population remains high. Primary healthcare
infrastructure provided by the government is inadequate in terms of coverage of the
population, especially in rural areas, and grossly underutilized because of the dismal
quality of health care provided. n most public health centers which provide primary
health care services, drugs and equipments are missing or in short supply.
This paper describes the cloud connected Village Health Centre (PHC) which can
provide a unique solution for the current challenges faced by ndia's Primary Health
Care system. This solution consists of a standard shipping container converted to a
Village Health Centre and connected via satellite, to bring much needed primary
healthcare to those in need. t aims upon harnessing cloud technology for providing
specialist medical care to remote areas, to aid in disease surveillance by tracking
disease patterns and risk factors ,disaster management and a means of providing
efficient collection, storage and analysis of patient data . t aims to provide adequate
physical infrastructure and facilities, availability of medical personnel, sufficient
quantities of drugs, tracking performance from captured data to take remedial
measures. There by ensuring the delivery of quality health services.

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t is an innovative, low cost, cloud enabled health care infrastructure that can be rapidly
rolled out to provide specialized as well as basic healthcare including ante natal and
post natal care and is fixed with basic equipments such as Ultrasound and Labor room.
Furthermore all supply-chains such as trucks, trains, roadways etc are aligned to
handling shipping containers so it can be easily transported to remote rural areas. Data
collected will form a health database and can be used for further research and
development. This is made possible through electronic reporting of data using rapid and
reliable diagnostic tools and remote sensing for collection, storage and analysis of
health data. Thus, nstant-on cloud connected Village health Centre presents a
compelling solution to the challenges faced by the ndian health care delivery system.


I. INTRODUCTION - ViIIage HeaIth Centre
Commission on Macroeconomics and Health of the World Health Organization (2001),
have argued that better health care is the key to improving health as well as economic
growth in poor countries
1]

.

The aim of the VHC is to overcome the ndian healthcare - need gap.
t is dedicated to improving the health of rural ndia by delivering health care services to
underserved rural population. To provide preventive, promotive, curative and
emergency care and to act as a referral unit.
t aims upon harnessing cloud technology for providing specialist medical care to
remote areas, to aid in disease surveillance by tracking disease patterns and risk
factors ,to help in disaster management . t will act as a means of providing efficient
collection, storage and analysis of patient data to provide accurate reporting of health
indicators and assessing unmet health care needs of the community. Thereby ensuring
the delivery of quality health services and also acting as a tool for public awareness.

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II. CURRENT HEALTHCARE SCENARIO IN INDIA

ndia has nearly 741 million rural people (72% of the total population, source: Census of
ndia, 2001)
2]
.The Tendulkar Committee report states that 42 per cent of rural people
in ndia are below the poverty line
3]
.Most of the poor living in rural localities are
isolated from the benefits of formal health care (both public and private) and many of
them access untrained local 'private practitioners' incase of any illness
4]
.

n terms of access to health care, tribal areas in the country remains one of the most
disadvantaged and vulnerable group of the population. The access and utilization of
health care remains sub- optimal and health and nutrition indices in the tribal population
continues to be poor
5]
.

About 75% of health care infrastructure, medical manpower and other health resources
are concentrated in urban areas where 27% of the population lives. Contagious,
infectious waterborne diseases and reproductive tract infections dominate the morbidity
pattern, especially in rural areas. Moreover, non-communicable diseases are also on
the rise. The basic nature of rural health problems is attributed to poor maternal and
child health services
6]
.
Primary health care is a vital strategy that remains the backbone of health service
delivery in ndia
7]
. The emphasis put on primary level of care is justified from the point
of view of cost-effectiveness and feasibility of implementation. Many ill-health conditions
can actually be prevented at this level by implementing primary prevention and
promotion measures before they manifest or progress to a higher degree of illness.
Primary Health Care remains an important force in shaping health care in both the
developed and developing world
8]
.

The basic health care infrastructure in rural areas in ndia has been developed as a
three tier system. t is based on the following population norms- one PHC covers 30,000
of the population and one subcentre covers 5000 of the population. PHCs are the

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cornerstone of rural health services. t acts as a referral unit for 6 sub-centres and refers
out cases to Community Health Centres (CHCs-30 bedded hospital) and higher order
public hospitals at sub-district and district hospitals
9]
.

. SHORTCOMING OF EXISTING INDIAN PHC's
Primary Health Care infrastructure provided by the government is inadequate in terms
of coverage of the population, especially in rural areas, and grossly underutilized
because of the dismal quality of health care provided. n most public health centers
which provide primary health care services; drugs and equipments are missing or in
short supply
10]
.
Timely and accurate information related to regular monitoring of the health status of the
population, medicines and equipment availability is currently lacking in the health
system in the country. Health workers generate a lot of data in the village, send it to the
PHC, where it is compiled in the form of monthly reports and transferred to the
secondary level. n addition, a lot of data that the health workers collect is redundant or
never utilized adequately. Efficient management of data is difficult in the currently
existing manual system, and often involves duplication of efforts and wastage of time
11]

.
The primary health care system in ndia is dysfunctional. While extensive, it is wasteful,
inefficient and delivers very low quality health services. This is especially true for rural
areas, and with regard to women's and children's health
12]
.

IV. CONCEPT OF VILLAGE HEALTH CENTRE
The existing physical infrastructure in PHC's and the number of existing public health
facilities is inadequate to meet the health care demands in the vast majority of the
country.

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The aim of Village Health Centre is to act as a solution to the shortfalls of ndian Primary
Health Care centres and to provide health care which is accessible to those who need it
the most. The goal of VHC is to provide basic, equitable health care for well being of the
rural population and within their easy reach thereby meeting the severe lack of health
facility in such places.

V. NEED FOR LOW COST INNOVATIVE HEALTH CARE INFRASTRUCTURE
To tap into the unrealized potential of these nearly universally deliverable containers,
other initiatives to provide Primary Health Care services in shipping containers have
taken place in many parts of the world.

n 2010, a Massachusetts-based initiative that converts used shipping containers into
mobile health clinics opened its clinic at Grace Children's Hospital (GCH) in Port-au-
Prince, Haiti; following the 7.0 magnitude earthquake that struck Haiti on January 12,
2010, 80% of Grace Children's Hospital was destroyed and most patients were
receiving care under weathered tents. The main aim of these mobile health clinics is to
provide high-quality care to underserved women and children
13]

.


As there is a definite need-gap in delivery of primary health care services in ndia so a
VHC is required to provide remote village communities access to basic health care.
VI. DESIGN OF A VHC:

To convert a standard shipping container into a Village Health Centre to bring much
needed Primary Health Care for remote rural populations. t is designed to meet the
local needs and conditions.
The layout of the VHC is shown in figure 1.

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VII. OPERATIONS OF VILLAGE HEALTH CENTRE

W Each patient will be provided with a unique identification number and a smart card at
the time of first visit, the same will be used every time the patient returns and will help in
recording of their medical information.
W The data recorded for each patient at the time of first visit to consist of demographic
details, address and other contact information, allergies, past medical history,
medication in use, chief complaint at the time of visit.
This data would be recorded in a centralized health data base. Adequate security
measures will be taken to ensure protection of the patient's health information.
W Data will be recorded by trained personnel at the VHC. Patient will be provided
adequate care according to their medical condition. A health maintenance report will be
prepared for each patient and UHD will help in keeping track of progress.
W Visit D will be generated by the system for each patient visit
W Report of each visit will be generated at the VHC consisting of: the demographic details
and other relevant patient information, visit D and the notes of each visit. This
information will be stored in the server for review and transmission purposes to the
specialist centre.
W The data will be transferred to the specialist hospital for review of cases, consultations,
two way communications with patients and doctors at the VHC.
The operations of the village health centre are shown diagrammatically in figure 2.
VIII. SERVICES PROVIDED IN VHC

W OPD services

W Emergency services

W availability of essential drugs

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W Mother and Child health services

W Referral services :

W n-patient services

W Education about Prevention and control of locally endemic

W Health Education and Behavior Change Communication (BCC)

W Laboratory services

W Record of Vital Events and Reporting

W Ambulance on call

Other services5rovided
i. Maternal and Child Health Care including family planning

ii. Medical Termination of Pregnancies

iii. Management of Reproductive Tract nfections / Sexually Transmitted nfections

iv. Nutrition Services

v. Disease management

W Communicable Diseases

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W Non Communicable Diseases: Health Promotion and EC Activities

vi. Telehealth Services via cloud computing:

W Real-time support to physicians

W Tele consultation
W nformation dissemination
W Research
W Emergency care
W video conferencing

vii.Patient safety measures
W Medication delivery system to have five "Rights - Right patient, Right medication, Right
dose, Right route, and Right time
W Complete, accurate electronic medical record systems (EMRS)
W Using decision support systems and minimizing reliance on memory
W Prevention of nfection by hand washing/gloving by clinical staff and surface sanitation

IX. CENTRALIZED MEDICAL RECORDS
A health data base is proposed to be generated by electronic reporting of data using
rapid and reliable diagnostic tools and remote sensing for collection, storage and
analysis of health data. The information collected will becomes available in the "cloud,
from where it can be processed by expert systems and/or distributed to medical staff for
analysis as shown in figure 3.
This data will be invaluable for research purposes by providing information regarding
health indicators and patterns of diseases. t will also be useful in planning for
preventive health care services.

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X. COST ANALYSIS
Targeting 1 VHC per 10 villages would imply need for 60,000 VHC in ndia. Total cost of
60,000 VHC would be Rs 12,000 crores. Running cost on an average per district would
be Rs 12 crores per annum (assuming 10 persons required per VHC with average
salary of Rs 10,000). Backend Health Cloud cost would be Rs 500 crores and running
cost Rs 15 crores per annum.
Highly improved access to health infrastructure can be provided to the 800 million
deprived in ndia at a one-time cost of Rs 12,500 crores plus Rs 12 crores per annum
per district.

XI. ConcIusion:

Thus Village Health Centre presents a compelling solution to the challenges faced by
the ndian health care delivery system. t is a low cost solution and ensures delivery of
high quality health care.
The advantages of the VHC are that existing shipping containers are used as base for
an nstant on Healthcare centre, this is a significant opportunity as all supply-chain such
as trucks, trains, roadways etc are aligned to handling shipping containers. As a result it
can be transported easily to remote rural areas. t plans to provide essential health care
services and will be connected to Health Cloud Computing via satellite. Thus it can
dramatically increase the reach of healthcare thus bridging the ndian healthcare need
gap.

XII. REFERENCES
1] Commission on Macroeconomics and Health. 2001. Macroeconomics and Health:
Investing in Health for Economic Development, Geneva, World Health Organization.

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2] Office of The Registrar General & Census Commissioner, ndia. 1 December 2005.
Census And You, Area and Population, New Delhi, ndia
(http://censusindia.gov.in/Census_And_You/area_and_population.aspx)
3] Planning commission, Government of ndia. January 2011. Expert Group on
Methodology for Estimation of Poverty, Prof. Suresh D. Tendulkar, New Delhi.
(http://planningcommission.nic.in/reports/genrep/)
4] Thomas T K, E-Applications in National Rural Health Mission, Ehealth online article.
(http://www.ehealthonline.org/)
5] World health organization, Country office for ndia. August 2008. Principles and
values of primary health care in India ,Geneva, WHO
6] Patil A.V. January 2002. Current Health Scenario in Rural ndia, Australian Journal of
Rural Health, 10, 129135.
7] World health organization, country office for ndia. August 2008. Origin and Evolution
of Primary Health Care in India ,Geneva, WHO
8] WHO, Regional Office for South-East Asia. 6 August 2008. Regional Conference on
Revitalizing Primary Health Care ,Jakarta, ndonesia
(http://www.searo.who.int/LinkFiles/Conference_phc_booklet.pdf)
9] Ministry of Health and Family Welfare, Government of ndia. 8 February 2011. Rural
Health Care System in India.
10] Bajpai, N. and Goyal, S., June 2004. 'Primary Health Care in ndia: Coverage and
Quality ssues', Center on Globalization and Sustainable Development, Columbia
University ,Working Paper No.15
11] Krishnan et al (2010), 'Evaluation of computerized health management information
system for primary health care in rural ndia', BMC Health Services Research
2010, 10:310.
12] Bajpai, N. and Goyal, S. June 2004. Primary Health Care in ndia: 'Coverage and
Quality ssues', Center on Globalization and Sustainable Development, Columbia
University ,Working Paper No.15,pg 28.
13] C2C , where we work: Haiti(online) .May 2011.
(http://www.containers2clinics.org/what_we_do/haiti.html)

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XIII.List of figures:
Figure 1: Layout of VHC

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40 feeL
uoor
uoor
10 ft
16 ft 8ft 6 ft
40 feeL
Lmergency LxlL
8efrlgeraLor
uoor
uoor
LxamlnaLlon 1able C1 1able
CLkA1ICN 1nLA1kL
A
8
C
D
CompuLer 2 for
1elemedlclne
10 ft
A]C CCN1AINLk 1
CCN1AINLk 2
8
f
e
e
L
22 ft
8 ft
8ed for aLlenL
Ma[or Lqu|pment that need to be p|aced |n the Lab
A Cxygen Concentrator
8 LCC Machlne
C AuLoclave SLerlllzer (Lo be ln Lhe non A/C
conLalner
LAYOUT OF MCRO PHC
ab Area
Medlclne
ChesL
Lqu|pment that need to be p|aced |n the Lab
D Nebu||zer 2 |n no
L u|se Cx|meter
I Sp|rometer
Wa|t|ng
Area
1o||et
for
staff
GLNLkAL
S1CkL
Jash 8asln
D|rty Ut|||ty
Wash|ng
Area
Autoc|ave
Camera+ 8|ometr|c
Camera
+8|ometr|c
1o||et

Figure 2: Operations of a VHC

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W CD serv|ces through
remote med|ca|
consu|tat|on
W Lmergency care
W kemote d|agnost|cs
W Lssent|a| In pat|ent
serv|ces
W Mother ch||d hea|th
care
W nea|th Lducat|on
W Invest|gat|on
W 8ook|ng of hosp|ta|
beds |n d|str|ct or c|ty
hosp|ta|s
W keferra| serv|ces
keg|strat|on
UID |ssue
k
e
g
u
|
a
r
nea|th
database
4/3.50
D|sease surve|||ance
Accurate report|ng of hea|th |nd|cators
assess|ng unmet hea|th care needs of the
commun|ty
A|d |n research







Figure 3: Centralized Medical Records

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Connectivity
CIoud
ViIIage HeaIth Centre
Data Centre
Aggregate data to be
avaiIabIe on website
Local Database
Server
1he C|oud Connected
V|||age nea|th Centre