Wendy Wang

Consider further explaining how the different parts of the WHIMS system interacts with each other.

You also might consider providing greater details regarding the impact of your solution, given that the solution has been implemented to some degree in the past. Are there specific indicators you collected to measure this impact, that you can share?

Also consider providing greater explanation for what makes your solution different from the other similar, existing solutions (other integrated health camps and clinics) for improving rural health.

Sujay Santra

1. How different parts of WHIMS interact with each other?

Despite a compound annual growth rate of 17 percent in India’s health care sector, access to care in rural India is far from the visual treats. With low doctor to patient ratio, India’s rural healthcare system suffers shortfalls in access to care, medical information, quality treatment, and digital disparity. Although, digital innovation is making a hay-way into India’s rural villages, but such technologyoffer low flexibility and coverage given the disrupted internet connectivity. With the total urban population much lower than total rural population (where 70% of the India’s total population resides in rural villages), the Urban-Rural Digital divide is actually more acute than what the penetration numbers portray.
How iKure addresses the gap:
iKure leveraging the power of ICT has developed a medical collaboration cloud hosted platform called Wireless Health Incident Monitoring Systems-WHIMS that presents an unprecedented potential in collecting and diffusion of clinical, preventive and diagnostic health data even in zero to low bandwidth, allowingcontinuous data entry and data synchronization both in offline and online mode. Its key components seamlessly integrate and communicate across range of technology enabled medical devices to offer integrated solutions to rural health.
Key Components of WHIMS:
• Open API: WHIMS has open API which allows device/software easy integration. This specific feature of WHIMS allows doctors/health workers to integrate with several Point of Care (POC) diagnostic devices that can be used to track and monitor illnesses, disease surveillance, measuring & monitoring body vitals, & identifying underlying conditions and recovery.

• Mobile APK: WHIMS has an android app version which can be installed in smart phone with intuitive graphics that can be easily used by the health workers even with basic education. Additionally WHIMS provides and “offline” mode for smartphone clients allowing patient’s data to be updated during field visits without a data connection and synching back to the server
later when connection is restored.

• Web interface: WHIMS has web interface that are used in hub, especially by doctors to view the patient’s data. Due to disconnected nature of HTTP request / response and ability of relational database management system (RDMS), WHIMS can handle multiple users simultaneously.

• Cloud interface: WHIMS is deployed onto the cloud server running on the
LAMP stack to store offline health data captured by the Community Health Workers.

• System Security: Architecture and the design of WHIMS has been done in such a way that no one can view clients' health data without proper authentication. Administrator and creator user rights is assigned through the integrated security system. Only administrator user can add or remove other creators and perform other administrative tasks.

• Data Security: Database rows representing patient data is anonymized using the process adhering to laws and specification.

• WHIMS software is now on the verge of its 2.0 version which will integrate Artificial Intelligence (AI) and Internet of Things (IoT) for real time data analytic on disease survillance.

2. Impact of our solution:

We are offering healthcare services in India’s diversified rural terrains for more than six years. Our first stage impact survey was conducted in 2015 in the catchment areas in Birbhum and Paschim Midnapore Districts, West Bengal. Foundation of iKure’s Impact Assessment has been created using elements of two established approaches - the Shujog Framework™ and the Impact Reporting and Investment Standards (IRIS) methodology. The Shujog Framework is an evaluation tool that enables sustainable management of social enterprises (SE). It tracks how effectively an SE is performing to realize its mission, thereby also pointing to ways to enhance the effectiveness. Impact Reporting and Investment Standards (IRIS) is taxonomy of generally-accepted performance metrics that leading impact investors use to measure social, environmental, and financial performance of their investments. Impact was studied upon four groups of iKure stakeholders, iKure Patients, iKure’s voluntary health workers, iKure’s community based employees, Community surrounding the iKure hub and spoke centre.
The survey reported that each group of stakeholders enjoyed increased access, lower cost and time to access healthcare services resulting in increased income and improved health.This report is developed to further analyze the sustainability of iKure’s impact in terms of its social return on investment (SROI) and a contextualization of the realized impact on each group of stakeholders. In addition, it details the reach and depth of iKure, the long term value creation for its stakeholders, and concludes with an analysis of the fit between iKure mission and actual impact.
Based on this impact assessment conducted the following accomplishments have been achieved by the iKure.
Impact on iKure’s Patients
• Patient impact 1: Up to 65% of the ikure patients experience increase in access to formal health care
• Patient impact 2: 90% of the patients coming to the ikure clinics experience medical cost savings of USD 4.9 or more
• Patient impact 3: Up to 98.9% of the working ikure patients do not have access to formal sick leave; their daily wage is approx. USD 1.10, and the loss in workdays without medical attention is 1 day . They have experience in reduction in man-days lost due to illness:
• Patient impact 4: 100% of the patients saved time and money to reach formal care
• Patient impact 5: 24% of patients treated at ikure will experience saving of upto 2 man days at work
Impact on iKure’s community health workers
• CHW impact 1: Self Sustainable livelihood and assured monthly income through iKure’s health supply chain network.
• CHW impact 2: Experiences increased knowledge and skills in relevant field
iKure’s Community Based Employees
• Employee impact 1: community based employees experience a wage increase of USD 60 per month
• Employee impact 2: experiences increased knowledge and skills in relevant field.
Impact on Community
• 47.47% of the people participating in ikure spot and health camps from the local communities benefit from early detection of diseases/ailments
• early detection of diseases saves at least 1 day of work
Gender Outreach
Gender Performance Indicators shows how effectively iKure is serving women and the level of a gender focus alignment across the entire organization. A high level of Diversity is often correlated with profitability, efficiency, and innovation. According to data published by the World Bank, 62% of projects that included substantial gender indicators delivered positive outcomes, as compared to only 30% of those projects that did not include gender indicators. Women as a percent of total clients provide a snapshot of iKure’s outreach to women clients. Proportion of Repeat Women clients indicate the effectiveness of iKure in serving women and their endorsement of the service that iKure provides. iKure’s commitment towards staff diversity is shown with percentage of women represented in, staff, management level and within healthcare workers.
It has been projected in 2015 impact assessment report that iKure will yield a 160% social return in 2015 based on projections for the value of changes to the beneficiaries’ economic capital (income) and human capital (knowledge). In this report it is projected that every dollar spent on iKure activities in 2014, including cost of goods sold, salaries, and administration costs, yields at least $1.60 of social return for the iKure stakeholders–on top of financial returns that iKure may generate and also projected to grow to $3.68 by 2016.
iKure has already crossed these projection over the time and committed to gain more SROI in coming years as iKure patients experienced major part of the social impact created. The key drivers for ensuring social impact is savings in lost man days due to common and chronic illness and delivering reduction in health care costs. The impact can be maximized through scaling up of iKure model and innovating on cost reductions for the same level service delivery for formal healthcare.

3. How our solution different from the other similar, existing solutions (other integrated health camps and clinics) for improving rural health?

WHIMS integrated health solutions:

Our WHIMS enabled technology solutions for rural health offer unique value proposition with respect to any other existing public care delivery model. As a first step, iKure’s healthcare model addresses the fragmented approach to rural health through integrated care delivery modes. To ensure quality care at each delivery mode, we build the capability (both technology and clinical) of the CHWs to provide technology enabled health system support, improve health practices at the household level, and bring integrated actions for health at community level. These cadres are mobilized by iKure for different handholding of their designated roles in performing household visits, community level health camps, and facility based hub and spoke clinic set up
Different levels of delivery modes to ensure continuum of care:
• Household visits: Integrated with several Point of Care devices (POC), WHIMS can capture health data at the door-step of the patients without manual error. In fringe area it operates in offline mode but at the Hub it updates the personalized health data in cloud server in online mode. The data from the WHIMS app is stored on to a cloud for periodic monitoring and review by medical personnel followed by recommendations for further referral and diagnosis. The internal triggers in the App also alerts CHWs of the potentially high risk health condition, and CHW in turn, is able to counsel, forewarn and prepare patients for appropriate medical intervention.
• Hub and spoke clinic set up: iKure’s WHIMS facilitates seamless coordination, communication and escalations between rural patients and urban doctors supported through hub and spoke clinic set up. Spokes clinics located at a maximum distance of 5 km from the most remote locations, act as an outreach points that offer services like consultation with doctors, diagnostic services and provision of medicines. The mobile application also allows CHWs to capture patient’s health records and transmit them wirelessly to the Hub clinic, facilitating effective communication and coordination among healthcare providers. The Hub clinics usually located within a 25 km radius from the spokes offer pathological services, telemedicine with specialist doctors, eye/dental care and physiotherapy services, enabling patients and doctors to contact one another using internet based video links and potentially eliminating the need for expensive and long distance care.
• Tertiary referral linkages: iKure has effective referral linkages with hospitals such as NRHM, Mission hospital, AIIMS etc, through which critical patients are seamlessly escalated for tertiary referrals.
• Outreach health camps: Distance of PHCs from villages, influence care seeking behaviours. iKure addresses the gap by setting up of outreach camps, which expand the coverage of essential services in unserved terrains. The CHWs medical staff are available at these camps to provide general doctor consultation with basic medicines and specialized doctors consultation at periodic intervention. These camps offer counselling and conduct awareness building programe through certified doctors who sensitize patients on health and nutrition practices, water, sanitation and hygiene issues.
Monitoring and tracking:
• Digital health cards: At the first level, iKure ensures registration of every patient by digital health card in the cloud server. Each target recipients are issued a unique identification number through Digitized Health Card that is encrypted with Quick Response (QR) code. This ensures authenticity of technology aided patient’s health data collection up to the last mile. Each Patient assigned with Digitized Health Card is authenticated through a biometric scanner to avoid overlapping of personalized medical record and quick access to the electronic health record whenever needed. The subscription based digitized Health Card is like a prepaid wellness card where patient can choose their plan according to their healthcare need at a subsidized rate compared to market price.
Community integration:
• Community Health workers: Trust within communities drives powerful positive feedback mechanisms pertinent to effective rural health. iKure empowers rural village women as CHWs that open doors to health services, addresses socio-cultural barriers, enables collection of accurate wellness information, and provides a conduit for the lifestyle and education interventions vital for effective preemptive and preventive action. iKure’s CHW serve as respected and inspirational leaders for their communities and organizational culture. iKure has trained 330 village women as CHWs delivering care across six states in India.
Socioeconomic Diversity of Customer Base
• iKure’s footprint within India represents a staggering scope of diversity across the spectrum of health determinants, power structure frameworks, and business operating contexts. iKure’s holistic approach towards health are supported by community-based interventions that operate with populations of different primary language, historical culture, geography, diet, political power, literacy rates, ethnicity, employment and health services history. It has touched 2300 villages across the length and breadth of the country’s rural population.
Impact Assessment and Trend Analysis
• Big Data analysis in healthcare has in fact, now become the driving force for creating opportunities in developing optimal treatment pathways, improving the medical loss ratio and better managing clinical decision support systems. Analytics on the data stored in WHIMS cloud space has proven to generate insights that not only lower total costs, reduce inefficiencies, and identify high risk population and also can predict a patient’s future healthcare need. This is further resulting in development of meaningful insights such as identification of various patient risk factors, grouping of patients based on varied health conditions, provision of actionable information to physicians at the points of care and most importantly, measurable progress on healthcare outcomes. We are also working with The MIT Sloan School of Management USA, on trend analysis by developing a tool for behavioral nudges leading to lifestyle modification for Chronic Disease Prevention for cardiovascular risk factors, hypertension and diabetes.

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