Existing Agricultural Distribution System Adapted for Healthcare Delivery in Rural India

Rationale / Objectives

Access to public health services in rural areas was a challenge due to lack of funding, shortage of skilled healthcare workers and absenteeism. People often used the services of private healthcare providers, 84% of which were not qualified to practice medicine (based on those surveyed). Concerns about lack of preventive services, unnecessary medicines being prescribed, and the high out-of-pocket cost to the rural population for questionable care from private providers prompted ITC Limited to develop a healthcare delivery system to improve access to healthcare. ITC wanted the model to be sustainable.

Project/Program Description & Major Achievements

ITC repurposed its previously developed 3-tiered farm-to-market supply chain model for healthcare delivery. To ensure sustainability, clinics charged fees, and partnerships were established with health insurance companies. The complete model was implemented in Maharashtra (a state in India) in 2009 and was instrumental in informing future projects.

Lessons Learned

ITC had difficulty sourcing doctors and other staff that were both qualified and willing to work rurally. Additionally, retaining health workers posed a challenge due to low pay and uncertainty regarding what was expected of them. The Village Health Champion had to be adequately trained and was instrumental in creating demand for services. Telemedicine did not prove to be a cost effective means of connecting the rural population with specialty services due to lack of an appropriate platform, high implementation costs, poor connectivity, and lack of availability of doctors on demand. The hub clinic was not easily accessible by public transportation, which reduced revenue. Owing to these and other challenges, the model was not sustainable.

Further Description

The three-tiered concept was previously developed to reduce inefficiencies in getting agricultural produce from farms to markets. With this supply chain already established, drugs and other supplies could be brought to rural areas. For healthcare delivery, the first tier (choupal level) constituted primary level services (preventive and curative) delivered by a trained Village Health Champion, a woman who served as the patient’s first point of contact with the system. The Village Health Champion was responsible for creating a database that profiled the health of the community in order to tailor services to the needs of the region. At this level, the choupal portal and radio were also used to disseminate wellness and health awareness infomation. The doctor could respond to frequently asked questions and deliver health talks via the choupal kiosk. The second tier or hub level involved a primary care clinic (Choupal Saagar) with a telemedicine facility (for specialist consultations and training), pathology lab and pharmacy staffed by appropriate medical professionals. Other staff provided assistance to the choupal level. The third tier consisted of networks and partnerships with hospitals, specialists, insurance companies and others to provide services not available at the hub clinic. ITC provided the infrastructure and access to an established network, and facilitated insurance schemes, while the partners were responsible for all aspects of healthcare delivery.   

Major Achievements

While innovative, ITC’s healthcare delivery model did not prove to be financially sustainable. The achievements were in the form of lessons learned.