WHP currently administers a network of 12,274 rural entrepreneurs (as on July 22nd 2019) in 13 districts of Bihar (pop 40 million) and 8 districts of Uttar Pradesh (15 million). The entrepreneurs, who are local inhabitants fully attuned with the social, financial and religious norms of their community, bear the full investment to join the network. Branded and promoted as ‘Sky Centres’, the providers are able to screen patients and to facilitate real time consultations with city based medical doctors. The skills needed at the village end are minimal. Since the equipment works even where only a 2G coverage is available, the network can serve even deep interior parts. (Refer to the ‘Technology’ section for more details.)
WHP’s team visits each village to select entrepreneurs on the basis of pre-fixed criteria, which include location and their standing in the community. Each entrepreneur, almost always a man, is trained with a woman member of the family. This sensitises the network to gender needs and expands the range of services.
WHP charges a fixed fee from the entrepreneurs for each consultation. An annual fee is also charged for technology upgrades and support services. Each client is registered under a unique identifying number with vital demographic details. All records are stored in the internet cloud making referral to higher centres and retrievals possible. The system can also map the morbidities to generate spatial epidemiological data. (Refer to ‘Epidemiology’ for further details.)
The project was implemented between 2011 and 2018 under a $23 million grant from the Bill and Melinda Gates Foundation.
Lessons and results:
WHP’s experience shows that the entrepreneurs’ network is not useful for replacing simple-to-treat primary health services delivered by rural provider with those from city doctors. For low end curative care such as diarrhoea and pneumonia–which is what rural providers focus on–the rural market is inelastic and clients are unwilling to incur higher expenses or longer durations for consultations from formally qualified doctors. However, the system delivers good results with crucial services which, however, are not available from rural providers—such as for tuberculosis, ante-natal care or family planning. WHP extends the support of the field team, registration and liaising with the government to create a complete ecosystem.