Dr Sreeram Sistla, Dr Satish Khalikar, and Dr Turlapati Narasimhaprasad, public health consultants, Tata Trusts give more details to Viveka Roychowdhury on the telemedicine programmes and initiatives of the Trust across India, as well as the new areas of public health that may be explored in future. While the Trusts believes in strengthening public health systems, community participation and empowerment go a long way towards sustainability
Given that Tata Trusts had introduced telemedicine services way back in 2015 with the government of Andhra Pradesh, what are your views on the recently launched National Digital Health Mission (NDHM) announced by PM Modi on Independence Day?
The National Digital Health Mission (NDHM) is a much awaited digital reform for Indian healthcare system which will be healthcare provider friendly while at the same time patient centric one. The mission seems to be designed to cover patient welfare, private healthcare providers along with data driven decision making for public sector healthcare providers, through its six building blocks, viz. Health ID, Digi Doctor, Health Facility Registry, Personal Health Records, e-Pharmacy and telemedicine.
Health ID and Personal health records will give freedom to patients from standing in patient queues carrying heavy record files, as well as from expenses borne out of repeated tests/ treatments due to loss of old records. This will help healthcare providers focus on actual service delivery rather than wasting resources on paper work and repeated procedures.
Health facility registry, Digi doc and e-pharmacy will enable standardisation in identification, quality and certification of healthcare providers, benefiting and enabling patients to make the right choices while also helping healthcare providers with a wider patient base.
Telemedicine is an important building block in NDHM enabling improved access to services for patients, who are based out of remote locations. Telemedicine has emerged as a viable alternative during COVID 19 pandemic times with virtual consultations helping millions. NDHM has the potential to boost its utilisation more and reduce Out-of-pocket patient expenses.
Tata Trusts’ experiential learnings in extending healthcare using telemedicine technology stands testimony to the ease with which health records can be maintained assuring security and confidentiality as conceived under NDHM.
Tata Trusts is piloting telemedicine programmes in extending primary healthcare services in rural parts in the states of Andhra Pradesh, Uttar Pradesh and Telangana. Besides 3.7 lakh telemedicine consultations in these states, technology enabled affordable diagnostics and pharmacy services are provided to rural population reducing their out of pocket health expenses.
Since it is aligned with the government’s focus on NCDs, it is run under the Ayushman Bharat. What has been the experience of working as an implementation partner to a government funded scheme?
Being implementation partner for 20+ states and union territories, Tata Trusts, with its legacy of philanthropy, was appreciated for its technical support at the National and State level as well as the efforts taken on-ground in villages.
One of the key takeaways was the scale at which we got an opportunity to work on Government. funded schemes, that enabled us to reach out to the masses and create a huge impact.
How much of the Tata Trust’s funds are allocated to health projects? What are the other areas that the Trust focuses on?
The total disbursals made by the Trusts during the year 2018-19 were Rs 4,661.06 million, of which healthcare institutional funds disbursals were Rs 1526 million (32.7 per cent of total fund disbursal) as per the annual report.
(Ref: Annual report SDTT 2018-2019: https://www.tatatrusts.org/Upload/PDF/annual-report-sdtt-2018-19.pdf)
Through the healthcare projects, the Trusts have reached out to more than 6.24 million individuals across 29 states and seven union territories.
The focus areas of Tata Trusts besides health are nutrition; education; water, sanitation, and hygiene; skill development; sports; disaster relief; livelihood; environment and energy; and social justice.
What are the criteria to choose projects to fund? Scope of impact, number of lives touched, etc.?
The redefining of our approach and our purpose — an exercise that began in 2014 — has resulted in Tata Trusts shifting from only grant-giving to also include direct implementation. It has led to partnerships with like-minded foundations, research institutions and the government. It has given us the capability to influence the discourse on India’s social development agenda. It has broadened the canvas of our operations. Most important of all, it has improved the quality of life of the people we reach.
Tata Trusts, with its legacy of philanthropy, follows the principle of “nurturing the interventions aiming for social welfare” at the center. We believe in developing proof of concepts through chosen projects which will later be adopted by the community as well as the government.
Credibility and intent of the organisation, alignment with common goals of the Trusts towards society, potential of community adoption, quantitative & qualitative deliverables are key criteria while choosing a project.
As learnings for other philanthropic organisations, how does the Tata Trust ensure economic sustainability of such CSR activities?
Tata Trusts believes in strengthening public health systems. Most of the programmes and grants of the Trusts supplement Government initiatives.
The programmes should be planned such that it addresses the most pressing needs of the society, and merges seamlessly in to the mainstream. Community participation and empowerment go a long way towards sustainability.
Looking ahead, how do you see the work of the Tata Trust impacted by the COVID-19 pandemic? Has the pandemic opened up new areas of public health where the Trust feels that it can make a sustainable meaningful difference?
Tata Trusts, in fact, has been actively supporting India’s efforts in tackling COVID-19. Tata Trusts has adopted a four-pronged approach following Chairman, Ratan Tata’s announcement earlier in March, 2020.
Personal Protective Equipment: Tata Trusts has been donating to State Governments and individual hospitals Personal Protection Equipment, including coveralls, N95/KN95 masks, surgical masks, gloves and goggles. Thus far, PPE supplies have gone out to about 32 states and Union Territories.
Community outreach: A pan-India community outreach has been done to induce adoption of health practices, as promoted by the Government of India, in rural areas to prevent the spread of Covid-19. The exercise is expected to have covered about 21 million people in 21 states. For wider deployment by any interested organisation, the Trusts have made publicly available, through social media, about 300 such videos and audio messages, in different languages, and dialects like Dongri, Kumaoni, Ladakhi, Garhwali, Santhali, Mundari, Kutchi (Gujarat) and Koborok (Tripura).
Training of healthcare staff: Tata Trusts and the Tata group have also tied up with two renowned medical institutions to assist health care professionals augment skills in critical care in the management of Covid-19. The two institutions are Christian Medical College (CMC) Vellore and Care Institute of Health Sciences (CIHS) Hyderabad. The curated 22-hour on-line training programmes are meant for specific staff chosen by identified hospitals and are provided free of cost. As on date, staff from over 356 hospitals in 26 states have been trained.
Four COVID-19 treatment centres in Maharashtra and Uttar Pradesh: Tata Trusts has upgraded four government hospital buildings, two in Uttar Pradesh and two in Maharashtra, into Covid-19 Treatment Centres, and has handed them over to the respective administrations. The facilities, including both in-patient and out-patient wings, are permanent and supplement existing health care infrastructure in these locations. In Maharashtra, the Trusts-developed Centres are at Sangli (50 beds) and Buldhana (104 beds), and in Uttar Pradesh at Gautam Buddha Nagar (168 beds) and Gonda (124 beds). The Treatment Centres in Uttar Pradesh are in collaboration with a partner organisation. The decision to upgrade existing infrastructure was to bring speed and make use, wherever possible, of existing capabilities and services.
Each hospital is armed with critical care capabilities, minor operation theatres, basic pathology and radiology, facilities for dialysis and blood storage, and telemedicine units.
The construction was done by Tata Projects, the design was by Edifice Consultants, and equipment have been sourced from leading manufacturers.
New areas of public health that may be explored in future:
- Mobile laboratories for wider coverage, mobile skill labs for capacity building
- Leverage technology and strengthen supply chain in public health system
- Virtual capacity building and clinical oversights
- Critical care environment in rural health
- Operationalising standard treatment guidelines – create systems of care
- Virtual clinical consultation and care extending from institutions to home care
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