Health System Strengthening
Public and private sectors have together helped in addressing the health needs of India, such as improvements in life expectancy and decline in infant mortality. Today, the healthcare sector of India faces the challenge of ensuring equitable healthcare access to the people and raising the service quality. Towards this, LEHS|WISH is working to redefine the healthcare delivery paradigm using innovation as its vehicle for change. With a clear focus on Comprehensive Primary Healthcare, LEHS|WISH partners with the state governments under the Public Private Partnership (PPP) model to transform the Primary Healthcare System.
LEHS|WISH endeavors to cater to a population located at the last-mile in hard to reach geographies, and urban-slums, having limited availability and accessibility to primary healthcare services. The LEHS|WISH supported health centers are driven by technology-led solutions with increased efficiency, reduced out of pocket expenses, and minimal dependency on non-qualified health providers. These Health and Wellness Centers are equipped to cater to patients with all kinds of medical conditions, with access to qualified medical officers and specialists, as needed. There is round the clock availability of services, with active involvement of frontline functionaries, community engagement, and availability of free consultations and medicines.
The approach has been evidence-based, wherein LEHS|WISH did pre-assessment of the needs and expectations of the community directly at the village or slum level. Secondary data collection was also conducted, and based on the priority identified by the key stakeholders, LEHS|WISH has been designing, managing, piloting and demonstrating the trials of innovative approaches. The healthcare basket of LEHS|WISH includes twelve mandated comprehensive primary healthcare services, including RMNCH+A, which is an important priority area, as well as communicable and non-communicable diseases in rural as well as urban slum populations. It also provides low-cost diagnostics and trainings to local healthcare workers and informal care providers. LEHS|WISH is continuously engaging with the community to develop a sense of ownership, understanding, and channelizing the energy of all stakeholders.
LEHS|WISH has partnered with the state governments of Rajasthan, Delhi, Assam, Uttar Pradesh, and Madhya Pradesh under different Public Private Partnership models to upgrade the non-functional and low-performing Primary Healthcare Centers; as well as provide strategic advisory services as per the needs of the respective states.
LEHS|WISH was the first non-profit organization in Rajasthan to partner with the government under the Direct Implementation model to transform the under-performing and low-performing Primary Health Centers (PHCs). In a five-year Memorandum of Understanding (MoU) with the Government of Rajasthan, the model was curated by LEHS|WISH in 2015, and implemented in remote, rural and tribal areas with difficult terrain, high levels of poverty and poor health indicators. Currently managing thirty-one Primary Health Centers (seven urban and twenty-four rural) in fourteen districts of Rajasthan, LEHS|WISH aspires to increase the scope of critical health services while delivering quality comprehensive primary healthcare.
The LEHS|WISH managed centers serve as‘ Centers of Excellence’ for the Government of Rajasthan.
For two years in a row (2016 and 2017), the Rajasthan Government honored LEHS|WISH with the leadership award. The efforts of LEHS|WISH, especially those addressing women’s health issues, were acknowledged and appreciated by the then Hon’ble Chief Minister of Rajasthan, Ms. Vasundhara Raje Scindia at the State Conclave in 2017.Encouraged by the success and impact of rural model, the Rajasthan government invited LEHS|WISH to pilot the upscaling of their urban clinics. Currently, LEHS|WISH is supporting six urban PHCs spread over three health districts, namely, Ajmer, Jaipur I and Jaipur II. These PHCs are providing RMNCH+A and other critical services to the surrounding communities.
LEHS|WISH is committed to completely transform the Primary Health Centers into Health and Wellness Centers, and revolutionizing the uptake of healthcare services in the state.
LEHS|WISH provides techno managerial support to Delhi Government’s Aam Aadmi Mohalla Clinics (AAMC) across the urban slums of Delhi. This is a unique and innovative concept of the Directorate General of Health Services (DGHS) under the leadership of the Government of National Capital Territory of Delhi (GNCTD). A network of one hundred community clinics or AAMCs was launched in 2016 with LEHS|WISH as the Technology and Knowledge Management partner. The aim of this unique concept was to ensure the provision of quality primary healthcare services at the doorstep of the residents of Delhi. With the scale-up of these clinics, currently, four hundred and eighty-two clinics have been made functional with plans to expand to 1,000 clinics. Thus far, thirty-six of the current clinics are running in two shifts.
LEHS|WISH has designed and deployed several innovative, med-tech tools to increase the efficiency of health facility processes, supply chain and administration. These include a customized dashboard for easy documentation and reporting of clinic’s workflow; training to doctors to use android based tablets to record patient information; data management; monitoring community expectations; and demonstration of innovations and Point-of-Care Devices (PoCDs) to scale up the public health system.
LEHS|WISH successfully created and demonstrated an automated Medicine Vending Machine (MVM) that dispenses medicines on location, eliminating the need to travel to a pharmacy, and records the type and number of medicines dispensed. Customized digital data tool has been developed to assist in analyzing the health patterns, create patient-centered solutions, address prevalent diseases in the catchment area, and help in policymaking. There is also a focus on the supply-side grievance redressal system by identifying inefficiencies and supporting improvement in those areas. For this innovation, LEHS|WISH received the 2019 Best Innovation in Healthcare Award from Hon’ble Health Minister, Dr. Harsh Vardhan at the Ayushman Bharat Summit.
The concept of Mohalla Clinics has received global recognition and appreciation for providing free primary health services and reducing the financial burden on the marginalized sections of the society.
In the Northeast, in the state of Assam, LEHS|WISH provides technical support to the Government of Assam for strengthening and improving the urban primary healthcare system. LEHS|WISH works closely with the state government as part of the consortium led by USAID India. The program works toward strengthening the urban health system, setting up health and wellness centers, pilot and scale up the Electronic Health Records (EHR), and healthcare innovations.
As per recommendations of National Health Policy 2017, and directives issued by the Ministry of Health and Family Welfare, Government of India, LEHS|WISH is working toward the transformation of urban primary health centers into Digital Health and Wellness Centers (d-HWCs). It is working toward changing the existing processes by introducing high end technology and innovation along with maintaining robust EHR.
In Assam, LEHS|WISH successfully piloted ENJECT, the self-retractable syringe. More than 1040 people were administered various injectable drugs through these self-retractable syringes. The Smart Hospital team considered ENJECT to be a user-friendly innovation. Two of its most visible advantages are non-requirement of hub-cutters and prevention of needle injury.
For COVID Vaccination Promotion, LEHS|WISH Assam team collaborated with the National Health Mission (NHM), Assam, Directorate of Health Services (Family Welfare) (DHS(FW) and the film fraternity of Assam. One hundred renowned actors, actresses, directors, producers and technicians lent support to the COVID Vaccination Mission by getting vaccinated at the prestigious ‘Jyoti Chitraban’.
Jointly with the National Urban Health Mission (NUHM), Assam, LEHS|WISH organized visits to urban slums and communities of Kamrup (M) with the objective of strengthening the MAS (Mahila Aarogya Samiti) and Decentralized Health Planning at the base of the pyramid. LEHS|WISH is supporting the state government in developing Grading/Assessment Sheets for MAS and a Guiding Document/SOP on the subject. This is yet another example of LEHS|WISH technical support solicited by the government toward improvement of Urban Health Indicators.
In 2017, LEHS|WISH entered the state of Uttar Pradesh in partnership with the Ministry of Health and Family Welfare, State Health Mission, and private players, where we launched an innovative model for the eradication of dengue. This was an innovative ‘district model’ approach for the eradication of a vector-borne disease.
Based on National Vector Borne Disease Control Program (NVBCP), this three-year community-based Dengue Prevention and Control project was implemented in Gorakhpur district. LEHS|WISH integrated long-term strategies in this project, including case reporting and management, entomological surveillance, anti-larval, and anti-adult measures. Along with this, a complete support mechanism for the frontline workers was developed, e.g., capacity building, behavior change communication, inter-sectoral convergence, community awareness, supervision, and monitoring coupled with legislative support and forming coordination committees.
The project concluded in September 2020. During its implementation period, LEHS|WISH conducted 121492 door-to-door source reduction, branding and communication activities;3080 environmental management activities focusing on maintenance of sanitation and hygiene; 3935 sensitization meetings with different stakeholders; 3733 capacity building, CMEs, and inter-sectoral meeting facilitation; 15712 Health Camps; and four research studies.
Furthering NHP2017’s recommendations on Health and Wellness Centers, LEHS|WISH has established ten Model Health and Wellness Centers in the districts of Shravasti and Fatehpur, which are primarily driven by technology. In both these districts, LEHS|WISH is supporting five facilities (one PHC and four sub-centers). These districts cover one hundred and five villages with a population of over hundred thousand. The model has been successful in promoting the acceptance of telehealth as an important component of primary healthcare support in the state, with plans to scale the model in the near future.
LEHS|WISH partnered with the Government of Madhya Pradesh in 2017 to pilot an optimized urban Primary Healthcare Center model. The model offers technical support to improve primary healthcare and key RMNCH+A components in the state. It provides health support, policy advocacy, and scaling up innovations to meet the quality assurance standards of urban PHCs. During this three-year project scheduled to be completed by July 2021, LEHS|WISH will establish ten technology-enabled PHC-based Health and Wellness Centers in Bhopal, Jabalpur, and Vidisha, catering to a population of approximately 550,000.
In addition, LEHS|WISH is supporting the National Urban Health Mission in various activities, such as the formation of an Urban Health Coordination Committee. This Committee provides inter and intra sectoral coordination, facilitates linkages with Urban Local Bodies (ULBs), smart city activities, National Urban Livelihoods Mission (NULM) to strengthen NUHM with focus on hygiene, sanitation, and livelihood options. There is a clear focus on urban poor; preparation and implementation of urban city health plan; technical insights for baseline/situational analysis and rapid assessments; and integration of MAS, SHG, and area-level federations.
In 2019, LEHS|WISH concluded a tripartite agreement with NHM Madhya Pradesh and AIIMS, Bhopal for demonstrating a comprehensive telemedicine model in the state of Madhya Pradesh. Based on preliminary learning from the state of Assam, LEHS|WISH developed the model of telemedicine that helps in overcoming geographical barriers to provide quality and improved healthcare facilities in remote areas to isolated and marginalized communities.
Sanjeevani Clinics is another urban healthcare solution designed by LEHS|WISH with the Government of Madhya Pradesh as part of our Techno Managerial support. These clinics ensure strengthening of the health system, integrating technology and innovations, data-based decision making leading to expanded coverage and reach, improved delivery of medicines, diagnostics, and reporting.