Mizoram TSVCP Project Logo
Mizoram State's Telemedicine Supported Vision Care Project (TSVCP)
Supported by NPCB

Mizoram TSVCP Patient Examination

 

by SATHI

What is the project?

Provision of eye equipment along with computers, connectivity and ancillary telemedicine facilities at fixed centres at block and sub block level. These are run by specially trained Ophthalmic assistants with connectivity to Ophthalmic Surgeons. The system provides

  • a. An effective system for eye care
  • b. Cost effective & efficient delivery of eye care services
  • c. Easy access to eye care services
  • c. Focus on Health care and sensitization about eye care among rural citizens

Project operations and components

  • The key resource is the link worker who maps the villages under each block and encourages citizens to visit the centers
  • The Ophthalmic Assistant (OA) uploads data into the database.
  • The doctor creates a prescription and instructs the OA on the next steps
  • Based on the findings, the doctor can then advise on how to provide treatment whether locally or at the secondary or tertiary hospital
  • Patient undergoes treatment and the patient database is updated.
  • These centres also provide spectacles; prescription medicines and routine follow up.
  • Operating Doctor is regularly updated on the progress
  • Data can be reviewed for audit.

Unlike previous projects, SATHI will own the project for three years. We are also attempting to introduce other telehealth, general health as well as IT components as a value addition. This will put the installed systems and training to better use and help to make it sustainable.

 

 

  1. Technical description

Technology plays a pivotal role in ensuring timely and accurate diagnosis. The project aims to create an effective health information system for rural communities. The tele ophthalmology centers are connected to the Tertiary Care Hospital with a minimum 256 kbps dedicated bandwidth. Emphasis is on low cost and available connectivity. Where none is available, we have installed towers. However still, due to later changes in the locations, not all places have the requisite connectivity.

The application software and database is located at all the locations with backup and synchronization services at the central server. This has been done due to the realization that connectivity is an issue and not available always. The various modules included in the software are for Video Conferencing, Patient Records, Content portal, MIS.

Client server application provided with synchronization as connectivity is poor and we need to keep working even if there is no connectivityStandard off the shelf and well tested services taken with the emphasis on low cost and of the shelf availibility e.g. Medic Aid, Teamviewer, Open office etc. A special software for eSigning of the prescriptions and certificates ensures that only authorized persons provide the care even if not physically present.

  1. Chronology

Launched in November, 2011 and slated to go on till February 2014

 

Creation of a fully trained district level cadre of telemedicine health workers to mobilize user community and coordinate with Health Department. is being completed in August 2012. Further training programs on expansion of services

  1. What does it deliver

Eye care diagnostics and appointment services.

Equipment already installed include, Slit Lamps (with inbuilt camera), Fundoscopes, Snellens Charts along side PCs, Web Cameras, multimedia kit which help in diagnostics and Teleconsulation. Twin UPS systems ensure continuous Electricity supply. Weighing machines, BP apparatus etc for general checkup. Smart Mobiles with high resolution cameras Plans afoot for expansion to a wider range of healthcare services.

  1. Describe the sustainable model

Initial funding is from the central government – via National Program for Control of Blindness (NPCB) but routed through the Directorate of Health Services of the state of Mizoram.

Since funds are restricted and geared to a particular project, we are already looking at that aspect initially. We need to showcase the sustainibility through innovative value add ons like

a. Teledermatology

b. Other healthcare services

c. Other IT services (through our tie up with Spanco)

Unlike previous projects, SATHI will own the project for three years. This will put the installed systems and training to better use and help to make it sustainable.

  1. Detailed Description

The Health Department of Mizoram State awarded Tele-ophthalmology project to “SATHI” under the National Program for Control of Blindness.

Goals:

  1. To reduce the prevalence of blindness from 1.49% to 0.3%

  2. To establish infrastructure and efficiency levels in the program to be able to cater new cases of blindness each year to prevent backlog.

Objectives:

  1. To develop human resources for eye care services at all level in PHCs, CHCs, & DH.
  2. To improve quality of service delivery.
  3. To secure participation of civil societies and private sector.

Strategies:

  1. Develop human resources for eye care.

  2. Promote out reach activities and public awareness.

  3. Develop institutional capacity.

Mizoram Tele Ophthalmology Centre Project

Tele-ophthalmology Centres in the State of Mizoram form the base for effectively utilizing the benefits of Information and communication technologies with the objective of improving access to quality health care in rural areas of Mizoram by adopting the latest developments in technology and medical advancements.

The Project envisages leveraging certain government facilities:

  1. Office space within the identified block offices

  2. Availability of Ophthalmologists from the State Government hospital.

Over and above that – we are ensuring expansion to a wide ranging set of extra services to allow multitasking and value addition, e.g. Teledermatology for which smart mobiles with high resolution cameras are provided.

Primary emphasis is on the needs of the people and not the technology.

Program Management Agency (PMA)

Administration and management of the Centres is by SATHI in collaboration with local bodies. SATHI is a Non Profit-health care NGO with the following mandate:

  1. Over all monitoring and management of the Centres.
  2. Collect, distribute and account for medicines, consummables
  3. Operations and Maintenance of the Centres
  4. Ensuring uptime of the network
  5. Availability of power back up

SATHI and its project management partner (Ms SPANCO) play a critical role in building capacity and social infrastructure in rural India as part of their contribution to nation building. The company has committed resources with good experience in ICT4development to implement the project in a tangible, functional and sustainable manner.

The roles and responsibilities of the PMA are to:

  1. Provide program management support for the project.

  2. Integrate various stake holders of the project.

  3. Ensure timely intervention for analyzing problems and suggesting solutions.

  4. Ensure the sustainability of the project.

Benefits from the Project

Apart from earning the goodwill of rural citizens of Mizoram, this project provides quality eye-care virtually at their doorsteps.

The benefits envisaged from this proposed project are many.

  1. This project is expected to significantly contribute to the well being of the rural population by introducing a system of eye care for rural citizens.

  2. It aims to enhance capacity of existing eye care systems of the State of Mizoram by structurally integrating primary, secondary & tertiary care.

  3. It provides an accountable, structured framework to enable quality healthcare in the existing system.

  4. It is a scalable model that can cover the entire State of Mizoram

  5. The project will reduce burden on the Secondary Healthcare System by reducing the flow of primary care patients. It also aims to reduce associated costs like transport, food and accommodation.

  6. We hope to achieve the goals set out in “Vision 2020 – The Right to Sight” which is a global initiative for combating blindness being initiated by International Agency for Prevention of Blindness.

  7. The project will be the basis for creating additional facilities, like Dermatology, reproductive health, for child care, pre and postnatal care, monitoring of vaccination in the block etc. To be started after all the Ophthalmology systems (including trained staff) are in place and working. This phase is just about starting as of July/August 2012



Audit and Project Monitoring

The Project deliverables and benefits to the community are outlined in this document. As part of an effective project implementation and operation it is very much essential that the project is evaluated at regular intervals for the planned objectives and deliverables:

  1. A minimum of 10 patients to be screened every working day

  1. Quantitative & qualitative impact of product/ project in diverse locations and people

This project is supposed to improve vision care services as well as decrease the number of blind persons in the state. Despite these being early days, we are already examining over 2000 persons per month ( an average of 20 persons per working day x 20 working days per month x 6 centres). This is being increased to 10 centres. Tele-consultations are being started and so far being provided by our partner centres in Delhi /Faridabad(Ms Aster Eye care)

  1. Background & motivation

Providing eye care services primarily to rural patients in inaccessible locations who would otherwise not have access to such eye health care. By providing services through telemedicine route the patient is saved time and travel cost in going to a higher order healthcare facility. The poor but expensive transport infrastructure of Mizoram and the hilly terrain are obstacles in accessing healthcare in the usual ways.

  1. Usage scenarios and special features

Customized solution based on needs assessment. Additional facilities to follow the vision care support are being installed - starting with teledermatology.

Our centres being in Rural areas an then provide a range of health services. discussions are on e.g. Clean drinking water and a range of CSC type services (thanks to our tie up with Spanco Limited)

User friendly software and continuous training.

We follow the “keep it simple“ principal. So the mandate is Vision care, but add ons are for sustainability as there is much additional value generated.

Users are the population of Mizoram and we are getting them but these are early days yet. This is a good three year project

Patients travel is cut down saving not only on the costs of travel but also helps the environment.Many projects fail when there is a Technology is the solution” approach. The project is unique by its emphasis on need based approach, multi-tasking and capacity building. This is the essence of Change Management

The people of Mizoram as well as the local workforce on site are encouraged to be innovative and provide solutions based on the problems they face.

The 2 week intensive training program which is undertaken by us at the centres run by Aster Healthcare in Delhi and Faridabad is followed up by troubleshootng and maintainance through Teamviewer. A complete training manual and log book helps in Change Management

Regular visits supplement the work done by a resident local co-ordinator in Aizawl.

Sustainability and summarizing

Additional user fee for value addition and sustainability. Thus every one benefits – firstly the population and since they benefit, we get support from the Politicians. Eye services are free as per mandate, but the add on services are charged but definitely low cost – cheaper than even the travel to the specialist centre for the services, for example – cost of travel for even one consultation to Aizawl is around Rs 1000. an average of 5 – 6 pre surgery, surgery and for follow are required. By cutting it to only one – only for the surgery creates a saving of 4000-5000 per case. Even in the single trip for surgery they travel in a group and those costs are shared by all the travelers.

ICT is not a replacement for actual services it is a replacement for cutting down on unnecessary costs provided by the problems of poor accessibility and related travel.If the service provision itself is poor, no amount of ICT will help. However addition of transparency and availability of data will help a great deal. These cannot be seen as primary motives but a long term goals. They will come if usage of ICT improves and that is only possible if there are immediate and visible goals to work on.

This in summary is our way of working,

 

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