Health KiosksA nano-model for

Primary care and health information at remote and

unserved locations

Primary care and Info services

The Context• Health care gaps remain in rural parts of many

northern states in India and many rural clusters in southern states, despite expansion of public health care network.

• Even in cities, we find shortage of primary care because of market forces in favour of high tech and specialist care.

• Govt is introducing The National Health Mission to include urban areas

• Health kiosks can provide a nano-solution on primary health care-on every front

Basic Tasks in Health Kiosks

Primary care for <40 minor and common ailments

• Common ailments

• First Aid

Screening for major ailments

• Cancer, anemia, TB etc• Diabetes, hypertension• malnutrition

• Local language

• On tabs and mobile platform

National Health Programs

Locating Tele Health Kiosks

Community locations without private or public care in 3-4 km radius

• Need based, on request of Gram-panchayats or organizations, industrial floors

During events like yatras, pilgrim centers

• We can convert existing health sub-centers, anganwadis (afternoon), samajmandirs. Also, ashramschool premises, petrol pumps etc

Infrastructure

• Small rooms, makeshift (fiber models available) or rented

• Cupboards cum tables (kappatables)• 2-3 plastic chairs• Hand wash• Basic equipment• Tab or computer, cell phone

Kappatable

MedicinesAllopathic Ayurvedic Homeopathic

1albendazole arogyavardhini arnica 2antacid chandrakala belladona3amoxicillin Sitophaladi Ipicach

4aspirin kutajghanavati arsenic alba

5chroquin Guduchighanavati Merc Cor6Cetrizine sootshekhar Hepar sulf7Doxycyclin Tribhivan kirti China 30

8Eye-ear drops Triphala Hinguastak calendula9Fersolate neemtail

10Gential violet 11Miconazole

12paracetamol 13OP 14Condoms

Some 40 illnesses

bodyache nuasea cough wounds burning urinebackache vomiting throat sore allergy vaginitisheadache hiccoughs cough& phlegm ringwormcommon cold abd pain ashthmadysmenorrhea constipation child pneumonia boil/pus FIRST AIDtoothache acidity dogbite snake bitefevers jaundce scabies dog bite

indigestion anemia sore eyes scorpion stingdiarrhea ear infectiondysentryworms

Fever Aspirin/Pamol Tribhuavnkirti, Guduchighanvati Belladona Tulsi kadha, w arm w ater, tepid sponging

old injury pain/muka mar Aspirin/Pamol Arnica 30

Toothpain Aspirin

RS Common cold paracetomol* tribhuvankirti allium sepa ST3/ST3/LI19/LI4 Lemon grass tea

URTI Aspirin/Pamol Sitophaladi, tribhuvan***, Ginger+honey or jaggery

URTI-productive Cozal+pamol Sitophaladi, Milk+haldi, Jeshthimadh, adulsa

childhood LRTI Cozal+pamol Milk+garlic

LRTI adults Cozal+pamol Steam inhalalation

Tonsillitis Cozal+aspirin/pamol Mirc IR

Asthma attack# Salbutomol-inhale/tab Sitophaladi Rein17/LU7 Breathing exercises,

GIS Acidity Gellucil** Sootshekhar***

Hiccoughs Jaggery

child dirrhea ORS Jaiphal (balghuti)

Diarrhea-adult Furazolid+ORS Kutajghanvati Arsenic alba Cofee,

Constipation triphala churna, Arogyavardhini LI4/ST36/ST6 Aamla, Rajgira bhaji,

Constipation-child Gheee/oil by mouth at night

w orms albendazole

dysentery-amebic metronidazole Kutajghanvati Merc Cor Cofee,

dysentery-w ith blood Cozal+dicylomine Kutajghanvati Ghee

Nausea/motion sickness Ipicac Moravala

vomiting/ motion sickness domperidone sootshekhar Arsenic alba

Pain-abdomen-adult Dicyclomine#& para Mag phos

Indigestion, gases Hinguastak churna ST36/P6 for appetite

Pain-abd-baby (criyng)# Hing appl/murudsheng

skin Boil Arogyavardhini Hepar sulf

Inf w ounds Cozal+dressing triphala w ash+neem oil calendula papaya, aloe

Itch/alleregy/insect bite CPM

Fungal infection w hitf ield /miconazole

Scabies-dry Gammsacb

Urinary Burning urine sodamint dhaniya paani, kulatha kadha

Hemopoietic Anemia Fersolate

Other infect disMalaria chloroquin China 30 chirait-kadha

Jaundice & fever Pamol Arogyavardhini Bhi-amalki kalk

conjunctivitis Tetra eye drops

ear infection Cozal+Para+CPM

Wax in ear Hydrogen peroxide

Fem Repr sys Vaginitis GV+Metro pessary# Triphala w ash Crushed garlic petal

dysmenorrhea Paracetomol

Lactation(to boost lactation) Shatavari kalp

Emergencies dog-bite soap w ash

snake bite Elastic bandage

Chest pain (acute)# IsobarbideT+aspirin

Ushnatavikar Burning, piles, nosebleed Chandrakala Barf for nosebleed

Human Resource options

• Select from existing ASHAs• ANMs or male health workers• Ashramschool/Resident school teachers• New Anganwadi workers• Volunteers

Training• A basic training program in technical and

management of kisoks-attuned to the level of trainees

• Training on duty-thru video clips, skype conference etc

Basic services

Primary care

Hub Back Up

Medico support Hub

kiosks

kiosks

kiosks

kiosks

Initial fixed costsestimate source

Shelter/room 30000-50000 Owner-panchayat

Furniture/equipment 10000 Donor/CSR

Consumables-initial 5000 Panchayat/CSR

Training -initial 10000 CSR

Computer/Tab/mobile 15000-25000 CSR

Total 80000-100000

EconomicsItem costs Comments

Info services Free..(from district costs)

Primary care/screening About 10-15/daily at Rs 10 per unit makes about 100-150 Rs per day

Goes to paramedics for part time work

Medicines About 10-20 Rs per day From the client, part may be from Govt system

Referral Free

Maintenance Connectivity, power, clean up etc: Rs 500 pm

Owner agency/panchayat

Different business models can be constructed like pre-paid contributions etc

Monthly MIS

Single page report

Care Preventive services Accounts

Legal issues• Trained paramedic-at present no such cadre• Standard protocols to be used• The use of medicines based on doctor-support at

remote end..on mobile/conf etc• Grampanchayat using 73nd amendment for

endorsing a health kiosk with paramedic support.• Use of FDA schedule K, 13-use of medicines by

CHWs etc• Use of FDA schedule 23-village shop remedies

Standard Operating Procedures

• Use of basic clinical protocols-in print and software based (already developed)

• The remote paramedic uses protocols and also consults hub end medico on mobile or net-conference if necessary

• Basic entries are made in standard formats• Standard monthly reports in print, using

Health Information in Local Language (HILL)

Free Primary health information on 1000 topics

on Net, Tabs, mobile platforms

What is ready

Arogyavidya.net (marathi)

Bharatswasthya.net (Hindi)

Gujrathi in process thru a different group

Help lines are also Available

• In Maharashtra, thanks to NRHM, the 104 helpline is available 24 hrs, with hub at pune

• This can be used by any health worker anywhere with a mobile call.

What needs to be done

• Develop mobile apps for HILL contents• Develop applications on tabs

Building HILL network in India

• Each language source should be developed by one agency/group

• Basic unit with a translator doing it from Hindi or English(to be built)

• Each unit will network with local doctors to edit/develop own content

• The project cost is about 10-15 lakh per language

Integrating efforts on Health kiosks

• Many people are working on parallel lines, we can add by integrating and providing tech support..model building

• Start a parallel activity on HILL-in more languages and with more contributors

• We are willing to start a hub in Nashik..to support kiosks in north Maharashtra.. With CSR support