7 th National Summit on Good Replicable Practices
7 th National Summit on “Good & Replicable Practices and Innovations in Public Healthcare Systems” National Tele-consultation Services in Tamil Nadu (e. Sanjeevani. OPD) Dr. J. Radhakrishnan. , IAS Principal Secretary to Government Health and Family Welfare Department Government of Tamil Nadu
e. Sanjeevani OPD § A citizen-centric initiative for uninterrupted services during Covid-19 pandemic § An online OPD (patient to doctor) integrated telemedicine solutions § Launched by Government of India on 13 th April’ 2020 across the country § Government of Tamil Nadu implemented on 13 th May’ 2020 § At present - more than 1100 registered doctors available across the state § Till date, Tamil Nadu completed more than 3, 50, 000 consultations
Epidemiological Curve : Total Cases-Discharge. Death Discharge Cases 182182 Death 184185 169561 173678 155692 3387 149417 126920 2734 133882 2198 1602 67970 57393 590 11499 October Sept April 357 146 August 25 July 2 March December (Upto 27 th) November October Sept August July June May April 17 1241 June 124 May 2199 March 33948 December (Upto 27 th) 20010 1028 37317 32255 November 67834
Inputs 1. Human Resources 2. Infrastructure & equipment 3. Drug Supply Chain 4. Capacity Building 5. Information, Education and Communication
Human Resources § State Level Team : Overall implementation of the program § District Officials and Second level Medical Officers : Facility Level Coordination § Field staff like Staff Nurses, VHNs and Self Help groups for reaching general public § At present, more than 1100 registered doctors (including specialists like obstetricians, ART MOs and TB MOs) available for providing consultations
Infrastructure & Equipment § Ensured an ambient environment with exclusive room, devices and internet facility for teleconsulting doctors to provide consultations § Provided the hardware and software requirements to the doctors as recommended by CDAC, Mohali • Desktop/Laptop with camera • Wi-Fi/Fiber net connection • Headphone with microphone § Requested district administration to send a proposal, if additional support necessary
Capacity Building § Virtual training programs conducted at various level § Initial orientation and program outline by CDAC, Mohali for ü 2 nd level medical officers üMaster trainers & other e. Sanjeevani OPD doctors § State Level Training for district officials & field staffs on awareness creation § District Level Training for all field staffs § Training to HWC 2 nd VHN for multiple registration § Training to General Public for App installation and utilization
Drug Supply Chain • Suitable instructions to Government Health facilities including PHCs, HSCs to provide drugs for e. Prescription generated via e. Sanjeevani. OPD • All Private Pharmacies providing drugs for e. Sanjeevani. OPD e. Prescriptions : through Department of Drugs Control Administration
Information, Education & Communication § Hon’ble CM paid special attention and inaugurated the program § News through print media • Frequent press release by Hon’ble Health Minister • Press release by collectors at District level § Videos through news & you tube channels § Messages in social media § Pamphlet/leaflet/OPD Tickets/Wall posters/Banners/Miking
Pamphlets/leaflets/OPD Tickets
Videos through news & you tube channels
News through leading print media in local language at state and district level
Process § Trained district officials, Medical officers and field staffs § Implementation monitored at various levels including state, district and block level by appropriate authorities § Management Information System (MIS) ü Daily district wise e. Sanjeevani OPD performance review with key conclusions and recommendation : to all district collectors, health officials by O/o NHM, TN ü MIS : Helped in creating awareness on the status of the program implementation to the administrators and field staffs for planning on improvement § Short term evaluation done for assessing quality of consultations & to understand technical challenges
Outputs § Tamil Nadu conducted more than 3, 50, 000 consultations till date § 19/38 districts in Tamil Nadu have crossed more than 5000 consultations § COVID symptomatic patients identified and shifted to facility for further care § Increased High risk AN mothers followed up § NCD patents/TB/PLWHIV follow up § Introduction of AYUSH OPD
Outcome § Improved accessibility to quality health care § Improved outreach of the specialist services to the rural people § Reduction in the service delivery time § Creation and transmission of Electronic Health Record (EHR) § Timely access to the right clinician resulting in cost reduction § Creation of database for disease patterns § Reduced burden on Secondary and Tertiary Healthcare System
Month-wise Consultations Month wise Consultations e. Sanjeevani. OPD, 2020 80000 No. of Consultations 70000 68035 65430 71338 66274 58466 60000 50000 40000 30000 19627 20000 10000 0 350 1168 May June July August september October November December (25. 12. 20)
Age wise consultations 35000 No. of Consultations 30000 25000 20000 15000 10000 5000 0 0 -10 11 -20 21 -30 30 -40 40 -50 Age 51 -60 61 -70 71 -80 81 -90 91 -99
District wise Consultations SALEM MADURAI VILLUPURAM TIRUVANNAMALAI CHENGALPATTU RAMANATHAPURAM VIRUDHUNAGAR NAGAPATTINAM ERODE TIRUNELVELI DHARMAPURI KARUR THE NILGIRIS MAYILADUTHURAI THANJAVUR KRISHNAGIRI THOOTHUKUDI THIRUVALLUR RANIPET KANNIYAKUMARI TIRUPPUR KANCHIPURAM THIRUVARUR THENI CHENNAI KALLAKURICHI ARIYALUR DINDIGUL VELLORE PUDUKKOTTAI NAMAKKAL TIRUPATHUR SIVAGANGA COIMBATORE CUDDALORE TIRUCHIRAPPALLI PERAMBALUR TENKASI 13308 11570 11404 11073 9923 9505 9283 8226 7254 6606 6503 5992 5689 5471 4641 4444 4443 3866 3275 2848 2844 2712 2547 2340 1990 1743 1590 1530 1469 1203 1098 1014 0 10000 18336 16675 20000 32224 23271 30000 59747 38075 40000 50000 60000 70000
es rr pe ra pi ec tio n e ch 543 nf yi th a in pa t 797 to r To o an gn 581 er ld ou Sh in 617 Pa 507 Pr e a gi rit is th ar te o ya l in in pa pa 1110 M ck ba ee 1271 Os Lo w ng hi 541 Kn io n 836 Itc ns he 6500 rte ac s 7000 Up Diagnosis pe Hy ad es in 746 He dd 3000 Gi rit is st r 2000 Ga ve 633 Fe d 833 co l 558 ld 679 1255 m on 1000 1071 Co 1500 1327 m No. of consultations 2500 Co al pa Ac in ut e ga st rit is Ac ut e UR An I te A na lle ta rg lc y ar e st at us Ba ck pa Bi in la Ba te ra ck ll ac ow he er le gp ai n in do m Ab Common conditions- Counselled/treated/referred 6657 6065 6000 5500 5000 4500 4000 3500 2288 2622 1659 1271 790 848 500 0
Key Challenges • Inadequate Internet connectivity in remote areas • Technical Errors during peak OPD hours reducing patients interest • Establishing linkage with private pharmacies, labs and other follow up services
Future plans • Including other Specialists, Super specialists and Dental, AYUSH doctors • Integration with Ayushman Bharat HWCs- MLHP facilitated consultations for needy patients with specialists • Linking 133 Hubs, HMIS, Outreach camps, pharmacy, Lab services(EDSS), Emergency care system with e. Sanjeevani. OPD for rapid response when required • Integration of Tele-medicine and Tele-mentoring services • Developing SOP for integrating tele-consultation services by Hub and Spoke model
Thank you
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