Healthcare delivery systems in India need a thorough look by reformist in India. Ehealth may be a probable option tool to help integrating hospital and community care

1. REFORMING SYSTEMS FOR
HEALTHCARE DELIVERY
EXPERIENCE FROM INDIA
Dr Alakananda Banerjee
Founder Chairperson: Dharma Foundation of India
Vice President: All India Senior Citizen Organisation(AISCCON)
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2. CONTENT
1. Healthcare Challenges in India
2. Reforming systems for health :global vision
3. Community health workers in rural India
4. Community health centers and Active Ageing
5. mHealth and Active Ageing
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3. HEALTHCARE CHALLENGES: INDIA
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Population
1,326,801,576 (July 2016
est.)
Density
382 people per.sq.km
(2011 est.)
In million
India currently has the
largest illiterate population.

4. HEALTHCARE CHALLENGES: INDIA
• High proportion of out-of-
pocket expenditure on
health
• Weak public health systems.
• Unavailability of doctors and
nurses.
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INITIATIVES BY GOVERNMENT OF INDIA

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http://bipartisanpolicy.org

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Partners for Health Reform plus
http://www.who.int/management/country/alb/ToolkitsforStrengtheningPHCAlbaniaHIS.pdf

7. PRESENT COMMUNITY
HEALTH WORKERS IN RURAL INDIA
1. ASHA(Accredited Social Health
Activist) are local women in
rural areas and urban slums of
India, trained to act as health
educators and promoters in
their communities.
2. Anganwadi workers (children)
3. ANM:Auxillary Nurse Midwife
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Key components of the National Rural Health Mission / NRHM,India

8. IMPLEMENTING COMMUNITY HEALTH
CENTRES AND ACTIVE AGEING IN INDIA
ELDERS AS SUPERVISORS OF
URBAN COMMUNITY
• Lifetime experience
• May have valuable time
• Elder resource an
important part of the
community .
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9. EMERGENCY/ ACUTE
CARE!! DoctorAHP
Trained Community
Supervisor to take care
of Small Group
through individual
home visits, visits old
age homes and
conducts small group
meetings
Elder from small group
who needs help in health
emergencies
call/messages CS with the
problem that she/he has.
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OUR MODEL
COMMUNITY CENTRE
Doctor
CS
Patient/elder
in community

10. PROBABLE ROLE OF MULTIDISCIPLINARY
TEAM/COMMUNITY CARE CENTRE AND URBAN
ELDERS IN SEMI RURAL/RURAL AREAS
• Health Promotion and Education
(TB,HIV,malnutrition,sanitation,
NCD)
• Early recognition of problems
and timely intervention
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11. INTERVENTION AND OUTCOME
MEASURES
• Need assessment toolkit
• Training Module
• Process guidelines
• Monitor frailty ,falls, activity and
participation of elders participating
in program
• http://www.who.int/management/ToolkitsforStrengtheningPHCAlbaniaPHC.pdf
• http://www.who.int/ageing/publications/AF_PHC_Centretoolkit.pdf
• http://phcperformanceinitiative.org/
• http://www.mohfw.nic.in/showfile.php?lid=2171
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12. MOBILE PHONE USERS IN INDIA
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13. SCOPE
mHEALTH AND ACTIVE AGEING
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Service providers: CS
Service User:
Patients/caregivers
PROBLEMS FACED

14. INNOVATIVE mHEALTH APP
For a common person
REFORMING HEALTHCARE DELIVERY IN INDIA
• No Medical Terms 
(Please I can do Google Search)
• Easy to use 
• Help: Monitoring and assessing health condition 
• Informative :Indications and contraindications 
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15. INNOVATIVE mHEALTH APP
FROM EMPOWERMENT TO ENGAGEMENT
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Use technology with
common/ natural
language
Health Status:
Morbidity
Vitals
Health Functions:
Changes in Activity and Participation
(within the community)
Result of medical intervention
http://icfmobile.org/

16. SCOPE
mHEALTH AND ACTIVE AGEING
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Service providers: CS
PROBABLE SOLUTION

17. mHEALTH AND ACTIVE AGEING
PROPOSED ACTION STEPS
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Self-care
Mutual help
Secure
mhealth
mhealth facilitates
http://icfmobile.org/
Service providers: CS

18. INNOVATIVE LOW-COST POINT-OF-CARE TESTING (POCT)
FOR COMMUNITY CARE CENTRES AS ADJUVANT TREATMENTS UNDER eHEALTH:
MONITORING AND EVALUATION/EARLY DETECTION
• An appropriate adjuvant treatment with tDCS may be needed to
facilitate postural training in elderly using telemonitoring with EPOC EEG
headset, MS Kinect and Wii Balance Board under an e-Health paradigm,
which needs further investigation. [“Effect of Transcranial Direct Current Stimulation on
Cortico-Muscular Coherence and Standing Postural Steadiness,”Proceeding (764) Biomedical Engineering /
765: Telehealth / 766: Assistive Technologies - 2012]
• Mobile phone based daily tele-monitoring (using Google drive or
Dropbox cloud storage) of quantitative EEG (EPOC EEG headset),
whole body kinematics (MS Kinect), and CoP trajectories (Wii
Balance Board) during functional reach tasks (e.g. Tai Chi training
etc.) to identify cognitive-motor aspects of balance in community-
dwelling elderly https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3800576/
• Low-cost ground reaction force line Biofeedback for static posture
training-Smart Mirror. http://epics.ieee.org/projects/low-cost-ground-reaction-force-line-
biofeedback-for-static-posture-training-smart-mirror/
• SynPhNe – A wearable device for enhancing brain and muscle
function.http://www.mae.ntu.edu.sg/Research/ResearchAreas/Documents/BiomedicalandSports/Reh0
01/Reh001.html
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19. OBJECTIVES
mHEALTH AND ACTIVE AGEING
• Translate Need Assessment and
Toolkit Guidelines/Training Module of
Community Health Model and Active
Ageing into mhealth technology
• Empower to engage people about
health.
• Create technology which
involve/improve human interactions.
• Maximum reach to grassroot level.
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20. BENEFITS
mHEALTH AND ACTIVE AGEING
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EVIDENCE BASED PRACTICE

21. EMERGENCY/ ACUTE
CARE!! DoctorAHP
Trained Community
Supervisor to take care
of Small Group
through individual
home visits, visits old
age homes and
conducts small group
meetings
Elder from small group
who needs help in health
emergencies
call/messages CS with the
problem that she/he has.
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OUR STAKEHOLDERS
COMMUNITY CENTRE
Doctor
CS
Patient/elder
in community

22. THANK YOU
CREATING
A
HEALTHY
INDIA
dharma.dfi@gmail.com
www.dharmafoundationofindia.org
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