Ensuring last-mile connectivity is the key to healthcare in India, says Vishal Phanse of Piramal Swasthya

Tuesday October 02, 2018 , 6 min Read

Vishal Phanse, CEO of Piramal Swasthya, speaks on why their project, Asara, has aligned its mission towards maternal mortality and infant mortality, and how they have dealt with challenges.

Around 2 am, 32-year-old Sunita started experiencing stomach pain – it seemed the baby was coming earlier than expected. As she wailed in pain, Sunita’s family sought help; the nearest hospital was 10 km away, and Sunita was carried on a stretcher made of bamboo sticks and coconut leaves. Several hours later, Sunita gave birth to a boy, marking the first institutional delivery in her family.

In the hilly regions of Araku Valley, 111 km from Visakhapatnam, 24 families from the Landiguda Tribe lived in near isolation until Piramal Foundation’s Asara project, under the aegis of Piramal Swasthya, bridged the gap of last-mile connectivity, and addressed gaps in maternal healthcare.

Vishal Phanse, CEO of Piramal Swasthya, spoke on how the last mile in healthcare is paramount, and often a challenge.

According to the 2011 Census, the Araku Valley is spread across 264.06 square km with 91.5 percent of its population comprising Scheduled Tribes (ST). The valley is situated 2,990 ft above sea level and around 40 percent of its population was not even recognised until the 2011 Census.

Here, Piramal Swasthya’s project Asara has aligned its mission towards maternal mortality and infant mortality.

Started in 2011, the Asara project took four years to find itself in safe waters in the Naxal-hit region, and offers a primary health care system. Secondary and tertiary healthcare gets distributed to government and other private hospitals. The project saw success in the fifth year of operations, as institutional deliveries rose by 50 percent, and there was not one case of maternal mortality.

“We focus on primary healthcare. Piramal Swasthya is all about taking innovation to scale because we believe India has never failed at innovating. However, we need a lot of improvement when it comes to taking this innovation to scale, if we are looking at solving anything which are on the national level,” Vishal says .

Piramal Swasthya looks to supplement government efforts by understanding gaps and plugging them. The organisation chose to focus on maternal and infant mortality. “The biggest lesson for us from Araku was to involve the community from the very beginning. Most of our team members at Araku are locals who have had basic education or beyond. This also opens up employment opportunities, and makes way for a trustworthy relationship”.

Finding their own superheroes

The Asara project has a team of 4,000 individuals spread across Paderu and Chintapalle mandals in Araku valley and aims to cover a population of 2.5 lakh-plus in 1,179 habitations.

Vishal gives us the example of 30-year-old Pramila, an Asara employee who is in the ninth month of her pregnancy. “Pramila is like the soul of Piramal Swasthya. Every day, she travels 22 km by road, and then treks 13-15 km to reach her patients.”

ASARA employee Parimala, who is now in her ninth month of pregnancy, uses the foundation's telemedicine service.

Availability of the right infrastructure is another bottleneck for his team, Vishal says. In India, the doctor to patient ratio is 1:921. Addressing this gap, the foundation set up a telemedicine centre to solve issues of access to doctors.

On why the foundation chose the tribal region for its pilot project in maternal healthcare, Vishal says, “These are villages that have mostly never seen doctor otherwise. So, whether it is a 102-year-old woman or a young mother, she will be part of this system, and that's how we plan reach to 1 million beneficiaries over the next few years.”

With the government

Piramal Swasthya is working in collaboration with Integrated Tribal Development Agency (ITDA) and Integrated Child Development Services (ICDS). Apart from this, it is also in talks with NITI Aayog for implementation of healthcare projects. “We have to work along with the government machinery because they already have all the platforms, and we just have to make sure that they can work efficiently till the end user.”

Patients being carried on a stretcher till the mobile moving vehicle (MMV).

The organisation and the NITI Aayog have entered into a ‘Public Philanthropy Partnership’, where the former will work on setting up mobile medical units. Vishal says once the organisation has a module ready, it would be replicated across 10 Indian states to serve 104 million tribal people.

“We are looking at the next eight years to scale the project, which is now piloting in Araku, to other 10 states. Bringing experts from various pockets is on the top of our agenda.”

The roadblocks

Vishal says taboos and stereotypes often dictate tribal and rural geographies, and the machinery must create a create healthcare-seeking behavior. The Asraa project now has over 85 doctors on its payroll.

When asked about the bottlenecks faced by organisations when working with the government, he says, “No point in finding faults with any government; certain governments are better to work with, and certain governments are more proactive. But the bigger picture is the Indian mandate so our job is to work with whoever it is in the government and create an impact.”

ASARA workers guide people to Araku Valley's Landiguda tribe.

Beyond maternal healthcare

Apart from maternal and child healthcare, the foundation hosts regular check-ups for hypertension and diabetes. Through the in-house tele medicine centre, health centres are opening doors for men too. There are regular outreach programmes and regular monitoring units like the clinical decision support system (CDSS), which is a health information technology system designed to provide physicians and other health professionals assistance with clinical decision-making.

Also read: How Araku Valley's nurse-midwives have brought down maternal mortality rate to zero

Of the 17,000-odd villages in Andhra Pradesh, over 13,000 are already connected by the Asara network. At places where setting up a telemedicine unit is cumbersome, the foundation has deployed mobile medical units with an in-house doctor, a nurse, a lab technician, an assistant, and medical equipment.

The foundation has also partnered with Harvard University, New South Wales University, and Boston-based Dana-Farber Cancer Institute.

In June 2018, data from the office of the Registrar General of India showed a 22 percent improvement in India’s maternal mortality rate. The union health ministry attributed this to the rise in institutional deliveries.

With Araku Valley setting a precedent with zero mortality rate, thanks to the increase in institutional deliveries from 18 percent to 68 percent, the day is not far when India can ensure healthy lives and promote well-being for all.