Partnerships with other NGOs

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Inequitable healthcare delivery affects approximately 55 million Indians annually. No single organisation has the wherewithal to deploy solutions effectively at that scale. Therefore, Dakshas was designed to be an open, plug and play platform. A platform where organisations could plug collaborate. This design also helps contain costs of healthcare delivery, as no wheel is reinvented. 

From offering technical support to providing health care services, Dakshas has a diverse set of collaborators and partners. In this article, we talk about the scope of collaboration with 5 non-profit organizations that Dakshas frequently collaborates with.

Pratham

Dakshas has collaborated with Pratham, a non-profit organization that works in education for the underprivileged children. Pratham provides General Duty Assistant (GDA) training to village youth, as per NSDC protocols. They are then posted as Nurse assistants to care for abandoned and bedridden elderly  in OAH(Old Age Homes) associated with Dakshas. 

Pratham selects the candidates from the villages and trains them as  “General Duty Assistant (GDA)”, as per the “Health care assistant” protocol and guidelines from the NSDC(National Skill Development Corporation). Dakshas  provides further training to these trained GDAs and assigns them to the partner OAHs(Old Age Homes) as per the requirement. In addition, Dakshas is also responsible for performance evaluation of GDAs, monitoring their daily work and acts as a mediator for the caregiver’s grievances between OAH and Pratham.

Elder Spring

Elder Spring is an initiative under Vijayvahini Charitable Foundation, which works primarily in Geriatric care. Dakshas collaborates with the Elder Spring Response system; providing healthcare services pertaining to elderly care; guiding rescue of medically unstable, abandoned elderly; and supporting their hospital care. Dakshas also provides physiotherapy and medical support to the Old age homes that are affiliated with the Elder Spring. Dakshas monitors vitals of OAH seniors regularly in real time, using the specially designed dashboard software.

Dakshas also facilitates train Front-line Rescue volunteers from Elder Spring how to rescue abandoned elderly, with medical issues.

United Care Development Services (UC OR YouSee)

Dakshas also volunteers with UC, a non-profit organization which conducts frequent health visits and camps across the state. Dakshas participates in the outreach rural health camps by providing physiotherapy screening and check up on a monthly basis. During the screening process, UC also provides portable digital X-ray, enhancing diagnostic capability.

All patients of Dakshas are also given an unique patient identification number through UC’s open source software called “Health4all”, developed by the UC volunteers for electronic medical records.

Virtusa 

Dakshas has collaborated with Virtusa to develop mobile based technology platform, to empower preventive and primary musculoskeletal care in remote areas. A screening and decision making tool will be available for general physicians, along with telemedicine-based orthopaedic specialist consultation. This will enable any primary care doctor to provide orthopaedic care, under specialist guidance. 

Aman Vedika Foundation

Dakshas collaborates with Aman Vedika foundation in their “Street Medicine ” program, where Aman Vedika’s doctor, nurse and field workers, provide basic healthcare to the abandoned or homeless people on the streets.  Further specialist consultation, laboratory tests and treatment is carried out at Dakshas’s pain clinic in the Vivekananda Health Centre, Ramakrishna Math. 

Dakshas’ Team Building Program

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As an organization which is relatively young and expanding, Dakshas seeks to identify young graduates with potential for career growth and have a sense of empathy for social causes. With the mission of identifying such young professionals, Dakshas conceptualized and developed the  “Dakshas Intern Mentor Program”.

 The program has two major components. In the first component, the potential candidates for the program are shortlisted and hired through a rigorous selection process. The selection process first identifies the prime skill set, work experience (preferably 1-2 years), aptitude for the social sector, the alignment of their values to that of Dakshas, and lastly, the commitment for the program.

 The second component of the program commences after the selected candidates are assigned to their post the selection process. In this component, each candidate will be an “Intern” who  will be assigned a “mentor”. Our mentors are seasoned professionals in his/her respected fields, and one who has been supporting Dakshas since the beginning. 

 The mentor will offer support and advice to the intern. Apart from refining their skills, the intern will also develop skills like leadership, teamwork, time management, knowledge, communication, delegation, etc. 

 As a growing organization, it is imperative of Dakshas to groom the future leaders, and learn from them. The learnings from the interns will eventually help the organization in its future trajectory.

Role of Dakshas in Ayushman Bharat

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Ayushman Bharat is a flagship scheme of the Government of India, which was launched as per the framework recommended by the  National Health Policy 2017 [1]. The scheme was introduced to achieve the vision of Universal Health Coverage (UHC) in the country and to meet Sustainable Development Goals (SDGs), and its commitment of  “leave no one behind” [2]. The major components of the programme are the Health and Wellness centres and the Pradhan Mantri Jan Arogya Yojana (PMJAY) [2]. The scheme encompasses three major objectives; equity in access, quality, and financial risk protection [1].

As per the government sources, PMJAY is the world’s largest fully government-funded health insurance scheme which provides coverage to nearly 10.74 crore poor families by providing financial protection for selected secondary and tertiary care hospitalisations [2]. So how does a small organization contribute to the gargantuan national level health insurance scheme like PMJAY? It turns out, Dakshas plays a very significant role!

One of the major components of the PMJAY is the reimbursement of the pre- and post-hospitalization costs for the beneficiary. However, as per the reports, there were certain discrepancies where a comparison of the cost of select procedures and the reimbursement tariffs offered under Ayushman Bharat shows that only 40-80 per cent of the total cost is covered by the tariff and this is lower than the variable cost (which includes cost of materials – drugs, consumables, implants, patient food, linen and clinician payout). As a result, many private hospitals are starting to opt-out of the PMJAY insurance program.

However, partnering with Dakshas would allow hospitals and specialists to contain these costs substantially. Most of the preventive and primary care would be shifted to community and clinics. The protocols save the specialists 80% of the time on evaluating such cases. Those patients who need detailed specialist evaluation are referred with preliminary workup, counselling and after primary treatment. Almost all patients seen by specialists would need some sort of investigations and/or interventions. Similarly, all patients referred to hospitals would require admission and or surgical intervention. Surgical process and efficiency is enhanced with Dakshas’ checklists for operation theatres. Specialists only have to focus on their core surgical contribution. Postsurgical care and rehabilitation are again shifted to clinics, close to the patient’s residence. 

All these processes will allow specialists and hospitals to focus on their core activity. The resulting increased efficiency and cost control will enable wide-spread adoption of Ayushman Bharat.

References
1. Gupta, SubodhSharan, and VikashR Keshri. “Ayushman Bharat And Road To Universal Health Coverage In India”. Journal Of Mahatma Gandhi Institute Of Medical Sciences, vol 24, no. 2, 2019, p. 65. Medknow, doi:10.4103/jmgims.jmgims_44_19.

2. Bharat, Ayushman. “About Pradhan Mantri Jan Arogya Yojana (PM-JAY) | Ayushman Bharat”. Pmjay.Gov.In, 2020, https://pmjay.gov.in/about-pmjay. 

Support in the Dakshas Ecosystem

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Source: Britopian.com

Dakshas started with the intention of making the concept of UHC(Universal Healthcare) a reality. Despite a few hurdles and pitfalls on a few occasions, the organization managed to sustain all these years and is still going strong, and has plans to expand to program. 

Throughout this journey, Dakshas has managed to procure a huge ecosystem with diverse stakeholders. The major players in the Dakshas ecosystem are its partner hospitals, doctors, and the patients. So how does Dakshas support its players in the ecosystem?

1. Benefits for the Patients

Well, one of the first things the patients think about is the cost. This is where Dakshas comes into action. 

Dakshas’ healthcare delivery model ensures that patient’s out of pocket expenditures are kept at minimum, simultaneously providing quality care. The entire evaluation, basic care, follow-up and peri-surgery care is done by the Dakshas. Costs are kept at a minimum cost. This means that the patient will bypass exorbitant costs that will allow more citizens to access basic and high-end hospital care.

2. Optimal Utilization of  Partner Hospitals :

As mentioned previously, the partner hospitals and doctors constitute one of the major players in the Dakshas ecosystem. Patients are referred to hospitals when they need admission, procedures and surgery. They are already pre counseled and connected to the hospital consultant. Their planned care is matched to already available unused beds and operation theatre time. Any gaps in their affordability is taken care of. 

This allows hospitals to focus on their core expertise, taking care of patients will advanced illnesses or those that need procedures. It also allows hospitals to deploy their otherwise unused bed and surgery capacity. 

3. Increased Revenue for the Doctors:

    It is a fact that many surgeons are stuck with nonclinical and clinical work that could be done in primary care, instead of focusing on complicated cases and surgery. There are so many repetitive tasks they have to do, that could be automated. Dakshas allowed them to save 1458 working hours over 22 months. Firstly, most of the primary care and pre-operative processes are done by the Dakshas team, which reduces the extra burden for the surgeon. This means each patient who opts for Dakshas services is  evaluated systematically, records organized, primary care is provided and counseling is done. Patients are escalated to surgeons only when they need procedures or admissions. This allows surgeons to use their time optimally.

Surgeons save time and effort so that they can focus on complex problems, quality  interaction with patients who need it and surgical interventions. All other administrative, investigative and peri-operative processes are taken care by Dakshas, so surgeons can focus on their core expertise- the surgery itself. 

Thus, Dakshas could be one path to restore trust and satisfaction for all stakeholders in the health sector.

External clinicians connect (Surgeon – team tie ups)

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One of the integral components of the Dakshas program is to design an intervention that is adopted by the health sector at large, especially hospitals and clinicians. Since its inception, Dakshas has 8 partner hospitals, 5 surgeon-anesthetist teams, 5 clinics and 10 Old Age Homes (OAHs) as implementation partners. Collaboration with external organizations has been a core value at Dakshas so the program can scale. Infact, Dakshas has always been designed to make healthcare delivery better for patients, doctors and hospitals. 

If we look at the impact factor here, a total of 1458 work days were saved by specialists over the last 22 months (Jan 2018-Oct 2019). Thanks to Dakshas’ robust primary care process. Patients are evaluated systematically, records organized, primary care and counseling is done. Only those patients who need specialist advice or intervention are escalated. This, in turn, saves time and effort for the surgeon, so that he can focus on complex problems, surgical interventions and increase interaction with patients who need it. All other administrative, investigative and peri-operative processes are taken care by Dakshas, so surgeons can focus on their core expertise surgery itself. 

Most of the surgeries are planned interventions. In exchange, external clinicians, working in the partner hospitals, are happy to offer their unused time and services for Dakshas’ patients at a concession. Patients are transferred back to primary care clinics once fit for discharge. Further post-operative care happens in a low cost setting, close to their home. 

The curious case of ‘Plasterophobia’

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It looked like any ordinary day – the same room, the same operating table, the same pain. The patient waiting for medical care even nursed a common injury – a fracture – and the solution was also simple – she needed a cast. But the moment I uttered the word plaster she screamed and jumped from her chair as if she had seen a cockroach. (Now, the truth is that I, too, would have done the same if it was a roach!)

With some effort, we calmed her down and I spoke to her attendant, explaining that she needed a plaster to set right the fracture. But when I mentioned the word plaster she became restless and started screaming again. It dawned on me that she had an irrational fear of putting any part of her body in a cast.

I tried to reassure her saying that it was not unusual for a patient to feel anxious, but it would help her heal. She was unconvinced. Instead, she shared with me that when she sees her hand or arm enclosed and immobile, or even if she sees someone else’s in a plaster, she imagines that the individual’s life or soul is trapped inside and s/he will suffocate and die.

Now, what she was experiencing was something uncommon. It was a psychological phenomenon similar to claustrophobia, which I termed PLASTEROPHOBIA.

The essence of the matter was that she had a phobia and probably needed some psychiatric help, but I had to put that plaster! What came to my aid was my Indian skill of JUGAD. There is a material called fibreglass, which works in a way similar to plaster but the colour and consistency is totally different. We showed the patient the pink-coloured fibreglass and made her touch it to feel the jelly-like consistency. That reassured her and she agreed to go through the procedure. Then, instead of a cotton bandage, we used a long sock (what we call a stockinette) to wrap the forearm. I requested her friend to keep her engaged in conversation throughout the procedure. I quickly prepared the cast out of fibreglass, manipulated and placed the limb in the desired position, and quickly wrapped it with the crepe bandage. She cooperated fully since she was under the illusion that her ‘nice’ doctor had done away with the ‘plaster’!

Unfortunately, just when everything was going smoothly, an enthusiastic aide loudly enquired, “Is the plastering done?”

No sooner had the word plaster reached her ears than she became restless again and was yelling and jumping. The entire staff had to hold her hands and legs so that I could complete the job.

When everything was done and I had explained what medicines she needed to take and was bidding her goodbye, at the door, she turned back, smiled and said, “What do you think I am going to do? Keep it this way? Nooo.. I am going to remove it as soon as I go home!”

Medical camp conducted in Nampally Vyayamshalla

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Dakshas team members took part in a comprehensive medical camp that was conducted in the Nampally Vyayamshalla school.

The school, which caters to a lower income group of 700 students, was sent a set of pre-screening questions prior to the medical camp. The subsequent results from the pre-screening questions revealed that 24 students had musculoskeletal problems.

 Of them, a few were found to have calcium deficiencies and birth abnormalities. 

Students’ parents, who were also present, and were counselled on how to proceed with medical care. The school and the Dakshas team have also followed up with the students to ensure that they receive the required medical care and, in certain instances, also extended financial support.

Quite a few medical conditions can be prevented, and having regular screening greatly helps in identifying issues that can be treated before they begin to affect the quality of life of the person.

The Dakshas team conducts camps in rural areas every Sunday with the coordination of United Care Development Services, a Philanthropy Exchange platform. They see around 25 patients a day. Most of the patients have problems with their back or knees, which are due to daily activities. Along with prescribing medicines, patients are taught exercises to alleviate the condition and given advice on activity modification. Those who need follow up or surgical intervention are identified and a follow-up is done by the team to ensure that they receive care.

Dakshas’ work in partner institution: NS Old Age Home

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Every month, an organisation that Dakshas works with, will be featured in the blog. As of today, Dakshas works with 8 old age homes, 6 clinics and several hospitals.

NS Old Age home in Mehdipatnam, is one of the eight old age homes that Dakshas works with. The institution takes care of 24 abandoned or below-the-poverty line, aged residents and includes four bedridden patients. The institution has a co-ordinator in-charge, a cook and two caregivers.

The caregiver, who has received Multipurpose Health Worker training under Dakshas’ Multipurpose Health Worker program attends to the regular hygiene and health needs of the four bedridden patients.

 In addition, Dakshas also sends a supervising physiotherapist to help with the tasks. 

General physiotherapy is done for those who need it. Exercises are done three times a day, each session lasting for 30 to 40 minutes. The supervising physiotherapist demonstrates the exercises, which are repeated by the residents with the help of the caregiver.

Every Saturday a doctor of a different specialization visits the old age home. As of today, visits have been made by general physicians, a psychologist, an orthopaedic and an otolaryngologist (ENT).  

Dakshas has also implemented STEADI (Stopping Elderly Accidents, Deaths and Injuries) programme, to prevent the residents from falling, in all the old age home that we are working with. Bathrooms have been equipped with proper lighting, grab bars and non-slip rubber mats. Further, all team members have been trained to follow the programme and to keep an eye out for anything that may cause an injury to the residents. 

Before Dakshas started its work with NS Old Age Home in 2019, the institution did not have any medical support and the need for a caregiver was acutely felt.

Dakshas’ services have helped the Home in improving hygiene, managing musculoskeletal issues and even psychological problems. In fact, of the two paralysed patients that have been receiving physiotherapy, one is now beginning to walk again!

Dakshas’ journal club launched

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Dakshas’ constant endeavour has been to nurture its team. The nurturing happens in terms of growth of knowledge, skills and the individual. One of its initiatives has been the  journal club. The journal club provides a space where its medical professionals meet and discuss the latest trends in their respective fields.

The club consists of six physiotherapists and one orthopaedic surgeon who meet once a week to present and discuss a topic at each meeting. The topics that are  discussed revolve around musculoskeletal problems, new programs, exercises and ways to improve protocol. The club helps the team learn and implement new ideas and changes in the protocol.

Journal clubs came into existence in the 1800s and have widely promoted knowledge sharing. A summary of a paper would be presented by one or two members to the group who has read the paper. Following the presentation, the floor is open to discussion and questions by the attendees who may ask different aspects of the experimental design and critique the methods. Having a journal club at Dakshas  helps our expanding team stay abreast of the latest medical knowledge and protocols. 

Dakshas presentation at N/Core Soiree

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At the culmination of its six-month incubation at N/Core, Nudge Foundation, we had an opportunity to present Dakshas at a soiree organized at the Mumbai Cricket Club, along with 11 other incubatees. These highly charged not-for-profits had been selected from an initial pool of five hundred applications. 

The six month incubation saw us learn the importance and challenges of solving problems at scale. We learnt to grow our ideas, instead of our organizations. How capacity and ecosystems could be built to achieve these goals. An exceptional series of co-founders from successful start-ups shared their learnings. We were each connected to one mentor and a N/Core team member. The mentor set a strategic vision, while N/Core helped tactically. 

Dakshas went through a transformation through the incubation period. We not only opened up our service platform to external clinical entities, but also launched a product initiative that can scale as big as the problem we tackle. We developed a support system of our own, which morphed into an Mentor-Intern program, wherein management grads with a year or two work experience were tied to senior mentors in their respective fields. An internal leadership development program and building  of the core team stabilized the program at scale. Impact analysis was formalized, refining our future trajectory. N/Core is an excellent incubator that effectively communicates its idea of scaling start-ups in a manner that cannot be ignored. 

All this culminated in the presentation on the 28th of Nov 2019, when we presented the ‘new’ Dakshas. It came as a pleasant surprise when the program was selected as the best of the lot by mentor vote, while another impressive venture, Mitti Cafe, was judged the best by audience poll. We now have a goal to link every single poor patient to each unused resource in the health sector. We invite you to partner with us on this journey.