OUTPUT BASED AID (OBA) FROM GOVERNMENT
WHP’s project in Rajasthan successfully demonstrates an Output Based Aid model, an approach advocated and finally abandoned over a decade ago by international donors. The main challenge was inability to monitor service delivery.
In Rajasthan, WHP is co-locating entrepreneurs in 10 of the government-run primary health centres (PHCs) to play a force multiplier role. Almost all the PHCs are in remote areas where hiring (and retaining) doctors poses a serious challenge.
Local entrepreneurs bear the entire frontend investment to join the network and facilitate consultations with city doctors for patients referred by the PHC staff. Such use of triaging principles allows simple illnesses to be handled by electronic consultations thereby freeing the doctors and quasi-medical staff on duty to attend to morbidities that require in situ attention (such as minor surgeries or physical examinations).
Each consultation is stored in a central server enabling the government to monitor them in real time or offline. The government, through an intermediary agency, pays WHP per consultation which is used to offset all the costs including payment to the village entrepreneur. The patient gets the service free. Since the teleconsultation system is aligned with the pharmacy and diagnostic lab at the PHCs, all resources are used optimally.
Project started in 10 Primary Health Centres of Rajasthan Government with support from WISH Foundation in 2016. In its second phase starting July 2017, WHP is implementing it in 10 sub centres which are one level below PHCs and located close to a cluster of villages.
LESSONS AND RESULTS:
To harness the current public sector resources optimally, a strategic shift in operational paradigm is necessary. PHC doctors and ANMs can primarily be used for services that will use their physical availability—such as basic surgeries, institutional deliveries, ANCs and PNCs, clinical family planning services, immunization—while the rest of the cases requiring treatment with only medicines can be dealt with through a telemedicine system. The telemedicine system also serves as a filtering process so that clients and patients who need higher level care can be organically referred. Such an approach gives complete control to the administrators to ensure that all kinds of services are delivered in a planned and monitored way. In 12 months of operations, 23,000 consultations were delivered through teleconsultations.