IndoHealMap

All health systems in low- and middle-income countries face two major problems - shortage (the availability problem) and wastage (the distribution problem) of capital and resources. These two problems together lead to suboptimal healthcare provision and poor population health, reflected by high mortality and morbidity burdens. 

In India, approximately 2.5 million people die due to non-utilization and poor quality of healthcare services. There are several pieces of evidence that indicate a healthcare inaccessibilty across the country. For example, only 37% and 68% of people have access to in-patient and out-patient facilities, respectively, within a 5 km distance from their residence. The problem becomes even more intense in rural areas where only 27% population have in-patient facilities within a 5-km radius. 

The provision of healthcare services in India is clearly skewed toward urban centers and the private sector. For e.g. urban residents, who make up 28 % of India’s population, have access to 66% of the country’s available hospital beds, while the remaining 72 % who live in rural areas have access to just one-third of the beds. Similarly, the distribution of healthcare workers, including doctors, nurses, and pharmacists, is highly concentrated in urban areas and the private sector. Thus, the physical reach of any healthcare facility and healthcare resources is a challenge in rural areas. Previous studies have found significant associations between access to healthcare centers and increased mortality risk in India. The incidence of premature deaths, infant and child mortality and malnutrition are all significantly higher in rural areas due to inaccessible healthcare. Additionally, there is a lack of organized,  comprehensive, usable indicators like travel times and population coverage which better characterize and measure the geographical access to health resources. 

IndoHealMap is a health informatics solution that aims to improve healthcare accessibility and equitable resource distribution in India using precision public health approaches.  We use a suite of technologies such as geographic information system (GIS), Bayesian modeling, network and complex systems analysis, predictive modeling, and machine learning. The solution has three parts: 

1. An open-access GIS platform for geolocations of health centers and health system resources including available health workforce, beds, medical equipment/devices, drug and vaccine stocks, etc. This geodatabase adheres to FAIR (Findable, Accessible, Interoperable, Reusable) data principles and can help several governmental and nongovernmental players to understand the health system needs, aiding data-driven decision-making. 

2. A suite of analytical tools that provides insights about healthcare accessibility using pipelines of existing and in-house algorithms. We will provide high resolution (at 500 sqm or 1sqkm resolution) estimates and visualization on travel times from various regions to nearby health centers, population coverage of health systems,  resource- and location-based supply-demand, prediction of optimal locations for upcoming centers, etc. We use in-house algorithms along with novel implementations of existing algorithms to solve these complex problems to deliver knowledge products for local health planners and administrators, high-level policymakers, and for-profit and nonprofit health service delivery partners, among others. 

3. IndoHealMap has a dynamic data update and feedback system making it a solution with growth potential. Health facility staff such as healthcare providers and hospital administrators, local community leaders engaging with the extended health systems and citizens who are consumers of the health systems can provide feedback on the local data which will be used for verification and updating of the GIS platform and analytical insights based on it. 

There is a general lack of organized comprehensive updated health resource data in India that hinders conscious, well-informed, and evidence-based decision-making regarding the utilization of healthcare resources. IndoHealMap acts as a tool for health policymakers to aid the decision regarding the meaningful distribution of available healthcare resources and logical utilization of new resources.

The utilization of our solution by policymakers will serve at least 0.9 billion people living in remote and rural areas of India. Currently, these people have to travel long distances to access health care either due to a lack of hospitals nearby or due to inadequate infrastructure and human resources in the available local hospitals. These people also suffer from indirect healthcare costs and the loss of earnings as a result of travel time. Such hinderances may lead to people avoiding seeking healthcare, and therefore, the rural population is prone to suffer from poor health outcomes, morbidity, and mortality. 

Our solution will bring healthcare near these people rather than moving them near healthcare. It will thereby enhance healthcare utilization and improve rural health outcomes, increase general productivity due to good health and protect them from financial losses. 

Our team leader Siddhesh Zadey has completed his Master of Science in Global Health at Duke Global Health Institute, USA. His Master’s thesis focused on developing indicators to measure access to surgical care in rural India. He has spent an ample amount of time understanding the problem of inaccessibility to healthcare in rural India. He has communicated with several grass-root organizations in the country like the Redwing Labs and the Association of Rural Surgeons of India to take feedback regarding scalability and the need for solutions like IndoHealMap. 

A very important part of IndoHealMap is a citizen and local stakeholders' engagement in creating updated, verified, and dynamic databases of the local healthcare resources. ASAR organization consists of several doctors and healthcare workers working in different parts of India at different levels of healthcare. The IndoHealMap team refers to them heavily to develop a contextual understanding of the ground-level problems resulting in maldistribution of healthcare resources. The healthcare workers associated with ASAR also share personal experiences of patients who face difficulties accessing healthcare and how it affects their day-to-day lives. Such shared experiences act as inputs from the community whom we are trying to serve.

We are looking for financial, technical, and advisory help from the Solve Team. We also expect to get introduced to a network of social entrepreneurs working on creating societal impact.

1. Financial: We are looking for a seed fund/grant to speed up our solution and conduct further pilots to test the scalability and accuracy of our solution. 
2. Technical: As we move ahead with our solution, we plan to add health resources distribution at a higher resolution. Given the expanse of the problem and the dense population that it affects, developing precise solutions will require advanced technical inputs. We expect to get such technical help from the Solve Team. 
3. Advisory: We are a team of dedicated, solution-oriented, motivated people who have the skills to create a solution for the problem at hand. We are looking for expert guidance with respect to several aspects of social entrepreneurship.
4. A network of social entrepreneurs, we believe, is rare to find. We want to be part of such a network that will provide guidance, encouragement, and opportunities for collaboration. 

IndoHealMap is a data-driven technology-based novel solution for the management of health system resources in India. It is embedded with several innovations. 

1. It is the first open-access geodatabase platform for healthcare access based on fair data principles i.e. findability, accessibility, interoperability, and reusability. 
2. It is the first platform to provide insight into health system resource management in India, although such solutions have existed in High-Income-Countries previously. 
3. It is innovative in its bottom-up approach which allows citizens and local stakeholders to participate in the dynamic development and verification of healthcentre and health resource data inputs. The existing solution across the globe follows a top-bottom approach where data inputs are from a centralized health system data library usually managed by government bodies.
4. Inputs from local stakeholders and citizens make the solution truly dynamic rather than static or periodically updated solutions existing in the global market. 

For the upcoming year 2023-24, we aim to deliver our solution (IndoHealMap) to at least one non-profit, for-profit, and one government partner each in one state of India. With the involvement of such partners, we hope to make the health system of the state data-driven. We currently have a small team of eleven people from various backgrounds - data science, health systems science, engineering, medicine, and health policy working on IndoHealMap. This team has been able to put together a geodatabase of over 500,000 places and conduct several analyses that provide first-ever estimates for timely access to surgical care, COVID care, etc. The continued work of the team along with the partnerships being formed by the physicians and the health policy members in the team with the various grassroots and governmental organizations should help us achieve the impact goals. To expand the work, we are also currently recruiting software developers for the IndoHealMap project. 

Our five-year impact goal is to provide IndoHealMap solutions to profit, nonprofit and governmental organizations working on health delivery in three states of India. We are targeting two geographically small-sized states and one large state based on the population needs and feasibility of collaboration with local partners. Within five years, we will have a completely functioning platform that can deliver tailor-made knowledge products (i.e. analytical insights about healthcare accessibility) desired by the partners while providing the healthcare providers and people in the targeted health systems a mechanism to offer on-ground data calibration. Our ongoing collaborations with Redwing Labs, Association Rural Surgeons of India, Lancet Commission on Reimaging India’s Health System, Green Governance Initiative, and several other groups will help us provide channels to deliver the solutions and assess the implementation.   

We are using different levels of indicators to measure our progress. Our indicators fall under the overarching purview of SDG 3 - Good Health and Well Being specifically target 3.8 which aims to provide access to healthcare services to all. 

1. Number of for-profits, non-profit and governmental organizations we have collaborated with and delivered our solution to
2. Number of engagements with our collaborators i.e. number of meetings relevant to our solution
3. Number of knowledge products delivered to the collaborators
4. Number of knowledge products implemented by collaborators
5. Number of citizen engagement or inputs in database development and verification
6. Number of engagements from local stakeholders (local health workers or local administrative bodies) in database development 
7. Database expansion measures in terms of the number of health centers added and number of health resources added 
8. Days to healthcare access dashboard development
9. Number of academic articles published on healthcare access in India by our team

IndoHealMap is an easy-to-use, interactive, comprehensive, digital map that provides updated health-system resources information to the health policymakers in India. This includes information on the location of healthcare centers, availability of health workforce, medicines, and equipment/devices. Our immediate goal is to facilitate policy decisions that allow equitable, logical, and need-based distribution of available healthcare resources. It will also assist in estimating the need for new healthcare resources and deciding where to place the new resources for their optimal utilization. These immediate are linked to our long-term outcomes of enhancing healthcare accessibility for the people, ensuring universal health coverage, and thereby improving health-related outcomes of India. To test our theory of change, we have tried a pilot with Redwing Labs (a drone-based health care delivery solution), by providing them with a precise public health center mapping of Telangana state. Our state map is now being used to identify remote “hotspots” that will be provided vaccines through drone-based delivery.

IndoHealMap is a health informatics solution for precision public health. It depends on a suite of technologies including geographic information system (GIS), network and complex systems dynamics, Bayesian modeling, predictive algorithms, and machine learning.  The geodatabase is a GIS platform while the analytical insights about healthcare accessibility use pipelines of existing and in-house algorithms that solve problems such as least-travel cost, resource- and location-based supply-demand, and prediction of optimal locations, through various geostatistical models. These analyses are run on cloud-based services, where their results are stored. The front end for the users is a simplified data and visualization dashboard hosted on the web. 

IndoHealMap team forms part of a larger social research organization ‘Association for Socially Applicable Research’, ASAR, India. Two of the three co-founders at ASAR are female. The management team consists of a mix of members of different ages, social groups, and gender. Our members and interns are mainly students from different fields - medicine, engineering, public health, data science, economics, basic sciences, arts, literature, law, commerce, and management.  

We are very dedicated to enhancing diversity, equity, and inclusivity at ASAR. We aim to incorporate at least one leader of the scheduled tribe, scheduled caste, other minorities, and backward caste each by 2023, who will lead a team dedicated to the social problem-solving of their community. Our goal is to create a technical team with at least 40% females by 2025. 

Our member/intern interview process is geared towards providing opportunities to students/graduates from local universities. We provide need-based scholarships to members for the advancement and dissemination of their social research. We have regular intern and member meetings to create a culture of inclusion, harmony and celebrate our diversity. We take continuous feedback from our team regarding their perceived sense of inclusion and take suggestions to enhance team participation and ownership of the organization. We also invite current leaders and problem-solvers of different social groups and communities to interact with our teams and present as role models for social change.

IndoHealMap is a product for developing precision public health solutions in India. Our target customers are the Ministry of Health and Family Welfare (MoHFW) India, state health ministries, and NGOs working in healthcare delivery. We aim to communicate our product to potential customers through a) our website b) our network of NGOs working on healthcare delivery c) formal proposals of our solution to relevant state and central ministries. The MoHFW is also a key stakeholder in the development of the IndoHeal Map because a large amount of initial success depends on accurate high-resolution data of healthcare resources which is not usually publicly available. Citizen and local health bodies also have a crucial stake in updating and verifying the health resource data inputs in our solution. The Government of India will be interested in this solution because it is actively looking for healthcare solutions that will enhance the global agenda of Universal Health Care (UHC) and improve national health outcomes. IndoHeal Map provides solutions that will allow optimal utilization of existing health resources and logical need-based placement of new resources to allow ease of healthcare access for people and thereby enhance UHC. 

The beneficiaries of the product are people living in remote rural parts of India who suffer due to inaccessible health care. Implementation of the solution protects beneficiaries from discomfort and financial losses due to long-distance travel and improves health, morbidity, and mortality outcomes by providing timely access to health. The success of the solution can be measured by short-term and long-term outcomes. Short-term favorable outcomes include a reduction in the number of intercity/interstate referrals for primary and secondary health conditions. Long-term favorable outcomes will be morbidity and mortality indicators in rural remote areas. 

We expect our revenue to come from donations and grants, the sale of analytic solutions to NGOs, and government bodies. The revenue will be spent on procuring technical tools for advancing our solution, providing payment to the volunteer team working on creating the solution, and conducting pilots.

Our financial sustainability plan involves procuring funds from multiple sources.

1. In order to expand our IndoHealMap solution, we are looking for a seed grant or scholarship to complete a market deliverable product. Till we receive such a grant, we hope to function on donations from friends and family and others dedicated to the cause.
2. Since the solution will be marketed through existing NGO networks and direct proposals to relevant ministries, we are expecting minimal customer acquisition charges.
3. Once the product is developed, the geodatabase will be open to access and free of cost. The citizen engagement tool will also be not charged. Our main income will be from the healthcare accessibility analytic insights that we provide to our customers on a fee-for-service basis. The fee structure will be such that for-profit and governmental organizations will be charged for our analytic services while they will be delivered for free to non-profit bodies.

Some examples of how our solution has been sustainable so far are:

1. Association for Socially Applicable Research (ASAR) is currently led, managed, and run by volunteers. We invest our time and energy in identifying skilled and highly motivated volunteers who envision to make difference in society by using their skills and knowledge. So far we have been successful to recruit people on a pro-bono basis. However, we value the time and hard work that our teams dedicated to building solutions like IndoHealMap. Therefore, we wish to honor them with decent pay and keep them motivated for going ahead. 
2. We provide free-of-cost skill-building and training to college students in data science through training sessions and learning modules. Trained students are then assigned small parts of the IndoHealMap project like data curation, assimilation, and analysis as part of hands-on training under the supervision of experts. The supervised work then forms part of the larger work of our solution with due credit to students and interns who contributed to it.
3. The expense of tools required to execute our solution is met through three modes a) donations b) crowdfunding c) paid workshops and training sessions. We procure up to $700 per month through these sources.