Wadhwani Initiative for Sustainable Healthcare (WISH) has been transforming primary healthcare through partnerships and innovations. Through its unique model based on identification of innovations, first-of-its-kind public-private partnerships, sustainable long-term financial model and leveraging of efficiency, WISH has delivered consistent success.
In countries with under performing primary healthcare, diseases that are easily managed with proper diagnosis and medication become debilitating, even deadly. They rob families of income and have ripple effects through already vulnerable poor communities, where lost income can mean lost economic activity across the community, and lost educational opportunities for children. It is a situation that plays out all too often across India – where over 6 million people fall into poverty every year because of healthcare costs.
Making basic healthcare available and affordable is the key to changing these realities. Primary healthcare is the first point of care and is critical for people’s health, including preventive, promotive and curative care. While significant global resources have been focused, very effectively, on curbing specific diseases like smallpox, family planning, safe motherhood, HIV/ AIDS, tuberculosis (TB) and malaria, relatively little has been done to strengthen primary care in an integrated manner, the backbone of an effective healthcare system.
WISH has developed a unique, innovation-led model to transform underperforming primary healthcare systems in India and can be applied to low-income countries around the world.
The WISH model is built on four key strategies:
- Identify the most promising healthcare innovations, offer innovators a platform for health technology assessment, provide test-beds for further validation, then facilitate the process of scaling up within the public system. We identify, field test in our health centres and bring to scale the most promising innovations – devices, technologies and processes – that save time and money, improve access and quality of care, and ensure transparency and accountability in the delivery of healthcare services to the nation’s most vulnerable populations.
- Develop first-of-their-kind PublicPrivate Partnerships (PPPs) that bring together state governments, international agencies and best-in-class private sector healthcare partners. Building these partnerships ensures the sustainability of our work, both financially and in terms of long-term impact and success.
- Leveraging efficiency, accountability and economies of scale, provide primary care services for an operating cost of under $2 per patient served. Over time, cost-savings will increase further as effective primary and promotive care prevent illness and bring down the number of costly emergency hospital visits.
- Build a sustainable long-term financial model for primary care delivery. The government provides all the facilities and infrastructure, medical equipment, medicines and consumables. During the initial 6-month pilot period, WISH covers 100 per cent of all other operating costs, largely for doctors and other personnel expenses. Once the model proves successful, the government takes over 80 per cent of the operating cost for the following 5 years, with WISH covering 10 per cent, and other donors the remaining 10 per cent. After 5 years, all management, progress monitoring and accountability systems are transitioned to the government, which covers 100 per cent of all costs. Regular third-party evaluations are built into the model.
A Showcase of Success: The WISH Model in Rajasthan
In early 2015, the WISH team presented its model to the Government of Rajasthan (population of 69 million). Our approach was welcomed and the Government signed a 5-year agreement with WISH to establish a high-quality primary healthcare delivery system in 12 of the highfocused districts in the state with a total population of 20 million. These districts are in remote areas with difficult terrain, high levels of poverty and poor health indicators.
As of today, WISH’s programme is fully functional with the Organisation managing 32 underperforming public health institutions (PHCs) and 162 sub-centres (SCs) across 16 blocks in 12 districts of Rajasthan. WISH has introduced a variety of technologies, systems and process innovations, increasing efficiency, cost-effectiveness and health impact.
In less then 2 years, all of these 194 centres were made fully functional – cleaned and painted, fully staffed with doctors and other personnel, functioning medical equipment, essential medicines in stock, and assured availability of services. These centres treat all conditions that patients come in with, but they focus on family wellness, maternal and child care, and promotive healthcare.
As a result, patient demand has skyrocketed. Outpatient volume surged from under 29,000 patients in June 2015 to over 70,000 patients in August 2016. Similarly, Institutional deliveries have increased from 280 per month to 497 per month. Child immunisation levels are growing, as are antenatal and postnatal visits.
Here’s how the four strategies in the WISH model played a key role in this transformation:
- Identify and scale up the most promising healthcare innovations.
WISH teamed up with the World Bank/ International Finance Corporation (IFC) to conduct a national search and identified nearly 200 high-impact innovations; this list keeps growing as innovators approach WISH. The organisation identified 15 most promising innovations and provided them grants, management and technical assistance. These include:
- Point-of-care diagnostic devices that reduce cost per test by 70 to 80 percent: A low-cost Glucometer, a non-invasive anaemia screener, a portable breast cancer screening device, and a mobile pathology lab that can do 37 tests and yet fits in a suitcase.
- HealthATM: At locations without doctors, these kiosks provide basic diagnostic services, telemedicine consultations and an integrated vending machine by which the remote physician can dispense precise
- mHealth: Cell phone and tabletbased apps that digitalizes data reporting, monitoring/supervision and standardised behaviour change communication delivery.
- Electronic Medical Records that track health encounters, ensure adherence and monitor the effectiveness of programmes.
The Rajasthan Government has included several of these innovations in its Program Implementation Plan for 2016-17, which makes them eligible for large-scale procurement by the state agencies. Several other state governments have approached WISH about introducing these innovations.
- Work with government to establish an effective PPP platform. WISH staff worked closely with the Rajasthan Government to formulate PPP policies and establish a standard operating procedure (SoP). Having seen the remarkable results in the WISH-managed public health centres, the Government is bringing this model to an additional 1,000+ health centres. The WISH-managed public health centres will be used by the government as “Model Centers” to assess the performance of the others. Several other state governments have now approached WISH about introducing its model more broadly.
- Provide high-quality primary care for under $2 per patient visit. Due to the efficiency and accountability systems in the WISH health centres, the operating cost has come down to $2.30 per patient within a short period of one and a half year. Our goal is to bring this to under $2, which would make this one of the most cost-effective programmes in the world. Overall cost savings are significant, with reduced illness, fewer work days and school days lost, and significantly reduced emergency hospital visits.
- Build a sustainable financial model for primary healthcare delivery. The Rajasthan Government is providing all the facilities and infrastructure of the 194 WISH-managed public health centres, medical equipment, medicines, and covering over 70 to 85 per cent of the operating cost. WISH is contributing 10 to 15 per cent of the operating cost, and other donors are being approached to provide the remaining 10 to 15 per cent of the operating cost. In 5 years, the centres will be transitioned to the Government, along with management, accountability and third-party monitoring systems established by WISH.
The United States Agency for International Development (USAID) has committed $2.5 million in support of this programme in the states of Rajasthan, Madhya Pradesh and Odisha, and other additional states like Delhi, Haryana, Himachal Pradesh and so on to further scaling this partnership as we make progress. WISH has entered into another corporate partnership with the Aditya Birla Finance Ltd (ABFL), for managing 2 PHCs in the district of Udaipur.