How Curebay changes rural healthcare landscape in Odisha

Covid-19 showed the world how a pandemic can shatter the healthcare system, and leave it in an abysmal state. Even the world’s best healthcare facilities collapsed when the coronavirus was on a rampage. The Covid surge in 2021 and 2022 exposed the weak leadership of several governments, but it also emerged as a lesson for how to tackle such unprecedented situations in the future.

What are the ways that can help the world more efficiently in future? The answer is to focus on the bottom of the pyramid, like rural, underdeveloped, remote areas, where healthcare facilities are not up to the mark, and regions where there is a lack of resources.

To understand it better, WION got in touch with an India-based startup Curebay, which aims to enhance the rural healthcare infrastructure in the rural areas of the eastern state of Odisha.

Covid impacted urban and rural areas differently. When people were isolated in cities, the situation in remote areas was rather disparate. People in rural areas dealt with multi-dimensional issues in every state when the virus spread. Lack of information, doctor consultation, and vaccine storage are among a few major issues that the governments faced.

Not just Covid, a report revealed that more than 60 per cent of people from rural areas chose to “migrate” out of their state in order to avail treatment for major diseases. The study by Transform Rural India and Sambodhi Research Pvt. Ltd. found that the majority of people used government-run secondary-level facilities (around 60 per cent), about 22 per cent went to a private facility, mostly hospitals, and just over five per cent consulted a private medical practitioner.

The study titled, ‘State of Healthcare in Rural India-2023’, had 6,478 respondents, 75 per cent men and 25 per cent women, across six regions – north, south, northeast, east, central and west.

These are the reasons why we need programmes like Curebay.

Priyadarshi Mohapatra, founder, CureBay was asked about his Skype ID while consulting a doctor during the peak of the pandemic when everything was shut down.

That triggered a chain of thought: “If this is what I am going through, living in Gurgaon, which is such a good healthcare facility, then what would be a billion people living in this country in remote locations going through?”

Mohapatra said a billion people in this country are dependent on public healthcare infrastructure for their basic medical needs. And everybody has sort of left it for the government to solve.

He said the “government has done a phenomenal job in creating a very large network of physical healthcare distribution” in the form of district headquarters, hospitals, sub-centres and the Asha, Anganwadi. But what public healthcare could not solve is the provider-patient ratio.

Weighing in on the pandemic and its impact, Mohapatra said that in the urban regions, “India is pretty much ready.”

He added, “I think our healthcare infrastructure that is present in urban areas is fairly solid. And we have shown it. Like many other countries literally you know crumbled under pressure during the pandemic. India stood up on its own. But I think where India really lagged in providing the service and our infrastructure got a little bit exposed was the rural and semi-urban markets.”

Rural India and healthcare facilities
The patient journey in these remote areas is difficult and the options available to them are very sub-optimal.

Rural India is dangerously becoming antibiotic-resistant in the absence of prescription and the course, because most of the time, the pharmacist hands over medicines to them without knowledge.

Mohapatra said it’s not that they are not aware, it’s because they want to avoid travel as it’s a commercial burden on them.

Sometimes, due to a lack of information and other challenges, patients from rural India end up in places where the quality of healthcare is very inferior, even those that are not authorised. Sometimes at the risk of losing an organ.

So, how will this start-up solve this problem?

A hybrid model:
Part 1: A platform has been designed for the care continuum and aggregated the physical healthcare system, which is doctors, hospitals, labs, pharmacies, and even medtech devices on that platform, so that the ecosystem can collaborate in real-time and deliver healthcare outcomes.

The E-centres employ certified nurses. Either ANM (Auxiliary Nursing and Midwifery) or GNM (General Nursing and Midwifery) as nurse. Also somebody with a degree in pharmacology and a qualified pharmacist.

Mohapatra said that a lot of people walk into the centres asking how to take benefits of the government schemes and the staff members guide them and assist them without any commercial benefit.

Part 2: Part two of the model was physical centres, E-clinics. These centres were designed on the principle of being extremely asset-like and designed for assisted healthcare. These centres had two trained and certified healthcare professionals, one nurse and one pharmacist. They gave access to tech platforms, a few medical-grade devices, and a few point-of-care devices.

How does this work?
The staff will first do a preclinical screening of the patient and within 10 minutes they will speak to a doctor. After that, the staff pick up the prescription and the e-prescription and follow the next steps (tests, etc). The staff at e-centres also ensure that the medicines are delivered to the patient on time, at the best price.

How do staff members reach remote areas?
This programme has an interesting concept of ‘Swasthya Mitra’ — a way to connect the community because primary health care is about community health care not about clinical health care.

Every clinic has 4 to 5 people who are very local and stay in those areas. They are made ‘Swasthya Mitras’. They are provided with a technology platform by which they can go to people and a lot of services can be delivered right at the door. This is also providing employment opportunities.

What are the challenges?
WION also spoke to Dr Shilpa Bhatte, MBBS, MD and the Chief Programme Officer of CureBay to know the challenges faced by the doctors when they see the patients and make the diagnosis.

Dr Shilpa Bhatte said that the biggest and the basic challenge for a rural health care model is for people in rural remote areas to realise that first of all, they need to seek care for whatever they are going through.

She also said that lack of awareness is a big issue. She said that they might be having access to cable TV and the internet, but that does not mean they are aware that they need to take care of themselves.

Dr Bhatte said that people in rural areas need to understand that taking unprescribed medicines for a month or so for chronic diseases or non-communicable diseases will not cure them, and can only be controlled and managed.

“I think there are a lot of myths and misconceptions around how these newer diseases can be controlled or treated, I think that’s another challenge over there, the understanding of what a patient journey is. And do you think you are able to understand their problems because sometimes it’s not easier when you are not seeing them in person,” she said.

The virtual consultation is definitely a challenge, but then she stated that the team designs the programme in a way that all the resources are optimally utilised. She said, “Our training focuses on observation of a patient, inspection, examination and then giving a diagnosis.”

She added that the doctors who are virtually examining the patients will depend on the nurse and the pharmacist to check all the vitals, all the other point-of-care measurements and whatever little time in taking history.

What are the urgent actions?
Mohapatra said that first and foremost we need to take the urban myth out of our mind that rural customers are not willing to pay. He said that “rural customers are absolutely willing to pay if you get the right service at the right price. Today there is no knowledge arbitrage. They are as informed as you and me. They know what are the best services. What prices are available? You need to bring those high-quality services to them at the right price. They are willing to pay.”

“The other thing you need to do is build trust with them. You cannot do one camp and then disappear,” he added. WION