June 2018
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Waves of change in rural health in Andhra Pradesh

ICTpost Media Action

Health care expenditure is one of the prime reasons which lead people to the vicious cycle of indebtedness

Health care expenditure is one of the prime reasons which leads people to the vicious cycle of indebtedness

Aarogyasri covers 80% of the population of Andhra Pradesh offering 942 procedures with end to end cashless delivery of service. e-Office provides a completely paperless, online and transparent electronic office system to handle around 41 departments of this scheme.

The Indian government faces a constant challenge in providing affordable and efficient healthcare to its population especially the rural poor. Even though government hospitals cater to the needs of Below the Poverty Line families (BPL), a large proportion of them need further specialized care that is far too expensive and therefore beyond their reach. In order to find a holistic solution to this problem, the government of Andhra Pradesh has designed and initiated a unique scheme called the ‘Rajiv Aarogyasri Community Health Insurance Scheme’ in April, 2007.

Aarogyasri allows BPL families to get treatment, if needed, from either government or private hospitals. Under the scheme, BPL families can avail health benefits through affordable insurance, the premium for which is financed by the government. The scheme aims to achieve ‘Health for all’ by assisting poor families through the provision of free insurance through a unique PPP model that allows the patient to avail medical care at both public and private institutions. To streamline administrative and logistic issues, an intelligent tracking system – Aarogyasri e-Office was developed to track a patient right from the point the patient approaches the primary health center to when he is released from the hospital.

The Aarogyasri Health Care Trust was especially set up for the purpose of delivering quality tertiary healthcare to the underprivileged population. In order to meet the challenge of meeting the requirements of a massive scheme covering more than 7 crore people the system has to work for 24 hours and for this a unique and real-time workflow namely e-Office was designed.

The e-Office system, while handling 10000 workflows, also handles complex administrative activities exclusive for the scheme such as Aarogyamithra (health officer) shuffling, attendance capture on real item, payrolls based on the performance of the various roles. The system is a workflow-oriented integrated system which addresses all the needs of the target groups. Each phase of a patient’s journey through the system, from in/out patient registration, surgery updates, discharge updates, claim settlements etc., are routed through the ICT. Decision-making has therefore become simple and the data analysis helps the administration in driving the scheme to become more effective and economical.

The website is developed using Java/J2EE technology. The usage of Java enables portability. The ability to run the same program on many different systems is crucial to World Wide Web software, and Java succeeds at this by being platform-independent at both the source and binary levels. The necessary hardware and software along with high Internet bandwidth is used in the deployment of the application. The sizing of the system has been done based on the number of users, concurrent users, and volume of attachments being uploaded and downloaded.

Accessibility & Inclusiveness

In order to facilitate the beneficiaries, facilitators known as “Aarogyamithras” (Friends of Health) are placed in each PHC/CHC/Area Hospital/District Hospital and Network Hospital. An Aarogyasri Kiosk and uniform provides them with easy identification. They form the face of this insurance scheme. Over 3000 Aarogyamithras work in the field, while others are placed in the hospitals.

The Aarogyamithras placed in Network Hospitals facilitate registration of patients, admission, evaluation, pre-authorization, treatment, discharge and post discharge follow-up of patient. All the Aarogyamithras are connected by Closed User Group mobile phones with a centralized toll free call centre (1800-425-7788) for better coordination and communication. Any patient/relative can also call this number for referrals and advise. Further each hospital has a dedicated Aarogyasri Medical Coordinator who is essentially a doctor and an Aarogyasri medical camp coordinator. It is for all these employees that the e-Office system needs to work seamlessly.

Government schemes need to adopt ICT practises in order to keep track of how allocated budgets are being spent. All ICT tools available need to be implemented on the ground and Aarogyasri has, like many other e-government initiatives, crafted a system that not only tracks the volume of people getting treated through public health insurance but tracks all details about their health, procedures and so on. This will help not only run the operation smoothly but inspire confidence in the general public due to its transparent nature.