PPP in primary healthcare brings encouraging results in Raj

A glucometer that scans retina, a mammogram that allows diagnoses of breast cancer without touching, a medicine vending machine and low-cost diabetes testing strips are some of the medical innovations changing the face of primary health care system in Rajasthan.
These apart, cleanliness, availability of staff and medicines and behavioural change among doctors and medical staff has resulted in more patients preferring to go for treatment at several primary health centres (PHCs) and sub centres (SCs) in 16 blocks across 12 districts.
SCALE Rajasthan, a government initiative to rope in private partners to supervise administration at some of its "worst-performing" health centres in remote areas, has seen the number of patients being treated rising twofold in the last six months.

Of the total 2,080 PHCs, the government had, on a pilot basis, handed over the supervision and administration of 30 PHCs and 153 sub-centres to Wadhwani Initiative for Sustainable Healthcare (WISH) which took over the charge around six months ago.
These PHCs and SCS are spread across 16 blocks in 12 districts of Rajasthan including some in the "hard areas" where the state government also found managerial task tough, Dr B R Meena, Director Public Health, Department of Medical Health and Family Welfare, said.
"To begin with, cleanliness is a major change. The moment you reach the health centre, the change is evident. Both inside and outside, the premises are very clean. Also there is a behavioural change in the doctors and the medical staff. They are more courteous in their conduct with the patients," Meena said.

"The health centres given to WISH were all in hard areas. They were difficult to reach and the government's performance was weak in these areas. The outpatient department (OPD), in contrast with the past, now sees more patients," Meena said.

On what made it tough for the government to reach out to the patients in these areas, he said, "Not many were willing to work in such remote areas. The doctors would remain absent or seek transfers. Some would even approach MLAs or other politicians to get transferred....
"On the other hand, since WISH undertook the supervision of these PHCs and SCs, the presence of doctors and medical staff has gone up. The conditions have improved. They keep them motivated and also monitor their presence and performance. That is a major change," Meena said.

"In PHCs, the doctors are not there. If the doctors are
there, the equipment doesn't work. If the equipment works, there is no medicine. Likewise, there are lot of challenges that influence the working of PHCs and SCs," he said.
"Most of the patients could be treated at the primary level itself, thereby bringing down the volume and stress at higher levels of treatment like the district hospitals. The only requirement is timely diagnosis and effective treatment at sub-centres and PHCs," WISH CEO Soumitro Ghosh said.
"In the last six months we have treated over three lakh patients across all centres under our supervision, which otherwise would have remained maybe half or even lesser. If properly screened, 50 per cent of the cases could be retained and treated at primary levels only," Ghosh claimed.

In rural areas, people are still hesitant to go for medical check-up. They are reluctant to take injections or needle pricks for blood tests while women largely find it awkward to go for physical examination like in case of breast cancer.
"However, we have innovative machines like the one which scans the retina instead of pricking a needle. There is a mammogram that can diagnose breast cancer from a distance of one foot. There are medicine vending machines installed at the centres which work like ATMs and dispense the prescribed medicines. And, all this works in supervision of trained staff," Ghosh said.

"All these innovations are scientifically tested and approved with certification by medical authorities," Ghosh said, adding "another advantage of these indigenous innovations is that they drastically bring down test costs."
One diabetes test strip which costs anywhere above Rs 20 in market comes down to nearly Rs 3 per test with the machines used by us, the CEO said.
Rajasthan government has invited tenders for roping in private partners to manage primary health care centres in other districts,
"Besides WISH, we have a couple of other private players supervising work in six PHCs. We have also invited tenders to replicate this model of PPP in primary health care system in other parts of the state," Meena said.

WISH is also in talks to expand network in others states.
"We are currently in talks with the Madhya Pradesh government. We also have proposals from states like Odisha and Himachal Pradesh," a WISH official said.