HYDERABAD, India — Hyderabad’s nerve center for the now-national emergency telephone number 108 was a hive of activity, featuring yellow and orange chairs surrounded by low walls in a sprawling honeycomb-like arrangement. I marveled at the calm efficiency of the young men and women, called communication officers, who are trained to answer and dispatch ambulances, police and fire vehicles. Some 15-20 minutes after the call is put in, ambulances manned by trained emergency medical technicians —a massive program here has trained more than 35,000 people—would find women in labor, a road collision or other emergencies reported by the Emergency Management Research Institute (EMRI), the public-private partnership responsible for running this free public emergency transport service in nine states.
Was I actually in India? My work trips here had typically revolved around visits to public hospitals where dedicated doctors stood stoically, caring for a steady flood of patients who had waited too long to seek care. Families pawned wedding jewelry to pay for treatment of a simple childhood disease like pneumonia. According to the 2008 World Health Statistics report, 76% of health costs are paid out of pocket. Fear of paying for hospital care drives many families to delay or refuse treatment and risk death. Or they choose to seek care from an unlicensed provider, or “quack”, who often charges on a sliding scale based on a family’s income, but whose services may or may not be medically correct.
EMRI , one of India’s first ever emergency transportation services, is one of more than 600 programs and policies catalogued on the Center for Health Market Innovations (CHMI)’s interactive web platform at HealthMarketInnovations.org. CHMI is working to identify and analyze health market innovations, programs and policies—implemented by governments, non-governmental organizations (NGOs), social entrepreneurs or private companies—that have the potential to improve the way health markets operate, and improve the quality and affordability of care for the poor.
We were in India to meet our CHMI partner organization, ACCESS Health International, and visit promising programs that may be adapted in other settings to serve more people. In the tech hub Bangalore, we met a visionary engineer who is producing remote diagnostic kits called ReMiDi to supply to rural kiosks. Manned by locals, kiosks are a convenient place for a farmer to come check out why he’s having persistent pain in the shoulder, or a strange lump in his stomach. Patients connect via two-way video conferencing over broadband internet with well-educated urban doctors. One promising program on the verge of scaling up to serve rural people in Bihar, a state formerly considered lawless and desperately poor, is World Health Partners.
While World Health Partners and other remote eHealth programs typically charge small fees tested for affordability, there are times when families must seek care in hospitals. Neonatal care—an essential focus given the devastating toll of newborn mortality—can be very costly. The Nice Foundation, also in Hyderabad, features the same life-saving equipment that can be found in a leading international hospital. Yet we saw low income tribal women sitting in a gleaming white waiting room beside the city’s rising middle class, thanks to the state’s Aarogyasri health insurance program, which provides free treatment for families below the poverty line.
Program implementers, entrepreneurs and creative policy makers across India have seen the potential for improved health status, protection against risk, and customer satisfaction, and they are making radical changes that affect millions. The exciting part is realizing the problems and opportunities inherent to India’s health market are not unique. With CHMI’s new partners working across 18 countries in Latin America, East Africa, and Southeast Asia, we think these promising new program designs can be adapted in other countries.