Organizing Referral Services and Continuity of Care for Improved Healthcare Delivery

Group 7 - Organizing Referrals and Ensuring Continuity of Care 2ndMay, 2018

Group 7 Participants Sl. No. Name Designation & State 1. 2. Ms. Anjali Bhawra Dr. Sidda Raju Principal Secretary, Health, Punjab Deputy Director, Andaman & Nicobar Islands 3. 4. Mr. Pravin Bakshi Dr. Anjali Nautiyal MD, NHM, Meghalaya Director, NHM, Uttarakhand 5. Dr. S K Singh Deputy Director, Jharkhand 6. Dr. Bimal Kumar Rai Ms. Gurpreet Singh MD, NHM, Daman & Diu MD, NHM, Sikkim 7. 8. Dr. Kamal Reang Nodal Officer, CPHC, Tripura 9. Ms. Nabanita Dey State Consultant, SHFWS, Tripura

10. Mr. Padam Khanna Sr. Consultant, NHSRC New Delhi 11. Dr. J Das Sr. Consultant, RRC, NE, Guwahati 12. Ms. Pumani Kalita Consultant, RRC, NE, Guwahati 13. Mr. Arun Srivastav Consultant, NHSRC, Delhi 14. Dr. Nobhojit Roy Advisor, PHP, NHSRC 15. Dr. Tomas Zapata HRH, Technical Officer, WHO India 16. Dr. Sadhana Bhagwat NPO (NCD), WHO India 17. Dr. Shailendra Hegde Head, Clinical Domain, Piramal Swasthya 18. Mr. Devesh Varma Chief Technology Officer, Piramal Swasthya 19. Mr. Ankur Gupta Program Manager, ECHO India 20. Dr. Sunil Gupta Executive Director, ECHO India

Q. 1 Tele-health Tele Health Yes it has a role, in enabling specialist consultation and regular patient monitoring needs Technology needs - Expand network availability Hardware innovative solutions need to be used like ones which aggregate, and ones which enable connectivity to either closest or farthest cell tower. Technology solutions should be able to work across networks with online as well offline mode. Problems in border areas- network goes off. Store and Forward. Training of personnel would be critical same system for service and training Simplifying systems like test reports, alerts & notifications on mobile Do we need live transmission always, can it be deferred also it works well in Karnataka

Question No. 2 Mapping for Referral Service Package First Referral Point 1. Care in Pregnancy and Child-birth. DH, FRUs 2. Neonatal and Infant Health Care Services FRUs DH / SDH which have SNCUs 3. Childhood and Adolescent Health Care Services. DH NRCs & DEICs 4. Family Planning, Contraceptive Services and other Reproductive Health Care Services PHC / CHC 5. Management of Communicable Diseases: National Health Programmes PHC / CHC 6. General Out-patient Care for Acute Simple Illnesses and Minor Ailments PHC

Service Package First Referral Point 7. Screening, Prevention, Control and Management of Non-communicable Diseases + TB PHC / CHC DH 8. Screening and Basic Management of Mental Health Ailments DH / CHC 9. Care for Common Ophthalmic and ENT Problems 10. Provision of Basic Oral Health Care PHC / CHC 11. Elderly and Palliative Health Care Services PHC / MMUs (for Physiotherapy) 12. Emergency Medical Services (that can be managed at this level CHC/DH

Question No. 3 - Mechanisms to map referral centres District level mapping to ascertain level of services available at various facilities Mapping of private facilities including empanelled ones Linking the referral points with available services Customising referral centres to add services based on the requirements for functionalising HWCs

Question No. 4 HWCs in Gate Keeping Role Population enumeration will facilitate gate keeping, as it will help in identifying target families Trust building through ASHAs and by ensuring good quality Mid Level Health Providers (MLHPs) Adopting standard treatment protocols Assured Supply of medicines is critical Every GP/ VHSNC be more actively involved in HWCs, should display information on HWC Systems of telehealth can be effective only with 24 / 7 functionality of HWCs. Challenges wrt migrant population may arise would need customised solutions

Question No. 5 Referral mechanisms Functionality of HWCs 24/7 or 9 to 5 ? Identifying referral mechanisms beyond working hours of HWCs Whether referral should be to govt. or empanelled facility ? Continuity of information systems access to patient information at every service point. Unique patient IDs are crucial. Robust & integrated transport systems, including community linked mechanisms

6 - Incentives for accessing HWCs Proximity / Close access Saving money / time Availability of a trusted service provider Assured Quality of services Assured supply of medicines Card for easy access / priority service in hospitals

Question 7 MMUs MMU Variety of locally suited vehicles MMUs offering focused / pre-defined packages Route Chart of MMUs should be displayed at HWC IT systems in MMUs to capture patient data Exploring PPP mode (PPP mode can be for criteria to designate hospitals also) Mobile tele-medicine systems can be tried in MMUs

Q 8 Motivating Frontline Workers Frontline workers be incentivised - - monetary - Non-monetary Training to upgrade knowledge, skills and attitudes also has a critical role Behaviour and treatment by health system Good Infrastructure including regular Water, Sanitation and Power supply & back-up systems

Thank You