Standardised, affordable 'drop-in' ICU facilities for India's small towns

CIPACA a health start-up in the south, claims to have saved about 106,000 lives over five years with its ICU services

While most developed nations have more than 10 ICU beds per 100,000 people, India has only 2.5 such beds, about 80 per cent of which are in Metropolitan cities. This, when about 70 per cent of the Indian population lives in rural areas. It was while treating a patient that the magnitude of this gap between urban and rural became evident to pulmonologist Dr Raja Amarnath, prompting him to quit the large hospital chain he was attached to, and start an enterprise called CIPACA to make tertiary-level standardised ICU services accessible and affordable to rural India.

Today, the start-up has created a network of health care professionals that has saved nearly 106,000 patients, bringing down the mortality rate to less than six per cent, from 40 per cent in the past in the areas in which operates acrosss Tamil Nadu, Puducherry, Andhra Pradesh and Odhisha. The firm caters to about 200 ICU patients and 400 Emergency patients every day.

Amarnath hails from a family of farmers. His father was a cultivator and his mother was a teacher. After finishing his studies from Government schools, Amarnath took admission in a Government Medical college in Andhra Pradesh. The young and aspiring doctor felt that while the teaching standards were good, he was nevertheless upset about the lack of treatment facilities. After completing his MD in Pulmonology and DM in Clinical Care, he went to London on a fellowship in Intensive Care, before joining a leading private hospital as a consultant in 2011.

Life was smooth sailing for Amarnath over the next few years, until he came across a lady whose husband had been admitted for lung related issues at the hospital where he as a consultant. While chatting with him, the wife collapsed and it was found out that she hadn't eated for several days to save money for her husband's treatment, on which she already spent over Rs 10 lakh. Amarnath also realised that she would have had to spend less than half that money, had proper medical facilities of the kind seen in large metros were available back in her place. The couple had to give up their house, land, everything for the sake of treatment.

"This was the trigger that led me to start CIPACA," said Amarnath, whose mission is to set up at least one ICU in every Taluk. The model is that while the hospitals offer space; CIPACA takes care of critical care facilities and medical personnel and makes standardised tertiary-level ICU services accessible and affordable. 

Amarnath says today infrastructure is not an issue. Even though the remote parts of the states he operates in have hospitals and beds, the problem is recruiting doctors, nurses and maintaining those teams, training them, retaining them, and more importantly getting quality output from their work.

CIPACA’s model is described as a ‘drop-in ICU concept’, under which it just requires space and basic infrastructure in any hospital. Based on the requirements by the hospital, it provides ICU equipment, ICU doctors, nurses and other manpower with operations, technology and guidance. CIPACA currently has around 800 committed technical personnel, half of whom  are permanent employees including 150 doctors, 250 nurses and technicians and other operational personnel.

How the model works

• A hospital in particular areas approach CIPACA, asking for ICU care facilities to be established at its place.
• CIPACA’s clinical team visits the institute and assesses the existing and required infrastructure
• CIPACA’s Business Development Team then takes the analysis forward and draws up a list of infrastructure requirements.
• The enterprise then signs an agreement depending on manpower, processes and protocols to be followed during and after implementation
• The enterprise needs 30 days’ time frame to set up its services in the new unit. 

Amarnath says the continuous interaction between the field force deputed in a given unit and the backend force via specialised software in which tele-medicine and tele-ICU are key components, gives rise to a broad care plan. At the individual patient's level, every single one of them is monitored real-time, 24x7 basis. 

Current operations at CIPACA, which is now a five-year-old enterprise, include management of ICU operations across 12 hospitals. It has more than 300 Emergency & ICU beds, which help save more than 100,000 lives every year. Every month the organisation adds new projects.  

The tertiary facilities aren't as expensive as in large cities or corporate hospitals and are a boon for the critically ill who don’t want to go to a government hospital and yet cannot afford a corporate one. Hospital partners see some kind of middle path in which CIPACA offers the same equal treatment at substantially lower costs.

It is estimated that an ICU bed costs Rs 60,000-1,00,000 a day at large hospitals in metros big cities, while in tier-2 towns the estimated cost is Rs 40,000-60,000. CIPACA-managed hospitals, on the other hand, charges Rs 10,000 a day for a patient on ventilator in a small town. 

“We are on a mission to establish at least one ICU in every taluka. Within the next 3-5 years, we aim to make ICUs available at least 500 talukas in rural India. We want to achieve this by collaborating with local hospitals - it may be private hospitals, trust hospitals, teaching hospitals or government hospitals," says Amarnath.

In 2021, he wants to take rope in another 25 hospitals and take the number to 1,000 hospitals in future. 

Currently, the operation-driven model is also looking at public and CSR funding to establish quality ICUs at the taluka level and to support patients. The firm aggregates different sources and mobilises them in rural areas and sets up ICUs. It opted for a revenue sharing model with the hospital partners.