Kiosk-Based Clinics

Arogya Ghar

Arogya or Kiosk-based Clinics aims to treat common ailments and preventable diseases in rural Rajasthan at a $0.25 per visit cost. These Kiosks would be equipped with computerized best medical practices for these ailments.

The clinics would be owned and operated by social entrepreneurs, high school educated girls and boys graduates, who are trained for several weeks.

Research by World Bank economists revealed that:

• Qualified medical staff and physicians found villages unrewarding, economically;
• Public health care centers suffered from widespread absenteeism;
• People view ailments as normal aging process; and
• Prevailing societal taboos discouraged women from seeking health care.

Arogya’s Approach: Make medical knowledge, if not medical professionals, accessible to rural populations. That is, computerize the medical protocols for common ailments and preventable diseases. Rethink the best medical practices. Reduce them to simple interactive algorithms. Use Internet to spread the computerized knowledge. Caution: Plain mimicking of best practices on computers would deprive the benefits toadied by health information technology ─ ease of use, clinical and demographic data gathering, guarding against absenteeism, and building longitudinal patient records.

Kiosk-Based Clinics: The need of simplified best practices, wide availability and on line interaction prompted us to adapt kiosks for primary care. Aarogya will be a walk-in clinic equipped with self-service kiosks and computerized disease protocols, published by the National Institutes of Health and the World Health Organization. Kiosks will capture clinical (vitals, history, medication, diagnostics, drug names, manufacturer’s name) and demographic (name, age, unique health identifier or UHI) data. The data will be deposited into IIHMR repository[3].

Health Care Delivery Process: Patient walks in the clinic, no appointment is necessary. Kiosk assigns a unique health identifier (UHI) to the patient. The health worker enters the symptoms. Kiosk compares the symptoms with the knowledge-database of the common ailments. If there is a strong match, kiosk will display treatment plan. If the match is weak, Kiosk will prompt the health worker or nurse to capture additional symptoms. Kiosk will run a match again to either identify a disease or to reject. In case of rejection, the data will be sent to the back-up physician at IIHMR.

Novel Features: Local social entrepreneurs will build, operate and own (BOO) Arogya. With 6 – 8 week training at IIHMR, they can operate Kiosks. Coding Medical Knowledge: We will code the medical knowledge into a database consisting of symptoms for common ailments, treatment protocol, medicine compliance, images for ailments, normative data, immunization protocol, commonly used drug names, and frequently used acronyms. Revenue Generation: A statistically large repository will generate new wealth and will defray the costs of care to the vulnerable population. Unique Health Identifier (UHI): Kiosk will assign each patient an UHI similar to a ration card number. The UHI will be unique among all clinics.

Kiosk will generate a barcode label and Arogya ID card with patient demographic information. Multiple Languages: Kiosk will provide instructions in multiple languages to cater to multi-lingual and multi-cultural population. The graphically-driven (human body) Kiosk will require minimal language proficiency for health workers to enter the data – demographics, chief complaint, symptoms. Feedback: Physicians will track the performance of the local health workers from the captured data and will take remedial measures, if required.

Growth in Capability and Capacity: Arogya has innate ability to grow in both capability (more ailments) and capacity (more patients). Consider two examples: The growth in capabilities may be along several dimensions such as child development and immunization, telemedicine, and chronic disease treatment. That is, Arogya may be equipped with a protocol for child immunization, for example, for measles, mumps, rubella, hepatitis B, TB, diphtheria, and tetanus.

Arogya will assign a unique health identifier (UHI) to each child and will maintain a health maintenance report for every child. UHI will help track every child. For chronic diseases, such as Asthma and diabetes, Arogya may create a daily diary for each child or adolescent. The daily diary will record lung capacity or sugar level. These diaries would be reviewed by a pediatrician located in the nearby town or at IIHMR. In case of non-preventable diseases, Arogya may send the clinical data to specialists, a simple form of telemedicine.

Sample Immunization Report
Arogya Ghar, Chhapoli, Rajasthan

Child’s Name: Ram Pal Meghwal
DOB: January 01, 1998
Age: 9 Years
UHI: 93825100678

Asthma Management: Consider another example of medical knowledge computerization: Automation of asthma monitoring and treatment illustrates Arogya’s innovative ways vividly. The National Institutes of Health has published 149-page thick guidelines for diagnosis and management of asthma.

The guidelines for pediatric asthma, therein, are based on three parameters: child’s age, weight and peak flow meter readings. Thereafter, it details the various patterns and associate diagnosis. For example, the following pattern of peak flow meter is indicative of allergy. That is, deploy graphic displays or advanced technologies for health personnel to diagnose pediatric asthma and to codify clinical knowledge.

Figure 3: PFM Pattern Indicative of Infection

The growth in capacity entails replication of Arogya from one village to another village in a region or from one region to another. IIHMR has the management capacity and training facilities to train up to 1,000 health professionals per year. Our experience with Aakash Ganga, DM2006 winner, has equipped us with the structure to organize social entrepreneurs and to form a federation. We are working to couple Arogya Ghar with the National Rural Health Mission, a health program sponsored by the government of India. Replication from one region to another region may require modifications of medical protocols. We have access to physicians to modify the protocols.

Benefits: Arogya advances WHO’s and UNICEF’s mission in numerous ways at a minimal cost. For example, Arogya will:

• Reach populations that medical staff wouldn’t.
• Avoid publication and distribution delays that could be months, even years.
• Provide instantaneous knowledge dissemination in case of disease outbreaks, adverse reactions, new advances, and emergencies.
• Gather accurate health care data for population studies and research.
• Make critical data available for governments to formulate public health policies.
• Revolutionize capacity building through local social entrepreneurs – akin to the micro-financing revolution.
• Build a self-sustaining model by creating new wealth to defray cost of care to the vulnerable populations.
• Enable online tracking of individual patients, disease spread, drug reactions, and new strands of bacteria.