| 4. In which ways is the initiative creative and innovative?
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• The project was visualized by visiting a pilot project in Hyderabad by a core team to make the project scalable and operational for the entire state of Gujarat in PPP model.
• The project was launched within 3 Months covering the activities of integration of all the key stakeholders viz. Hospitals, Telelcom service providers, etc. GVK EMRI has Pioneered Emergency Management in India, wherein 108 evolved as framework of Public-Private- Partnership (PPP) mode with Government of Gujarat showing a way forward for other state governments.
• GVK EMRI manages and leverages local government resources for better outcomes to serve the poor with an overall financial burden of Rupee 1 per citizen per month.
• Technology an enabler has taken the operations of 108 service to global standards. Public Switching Telephone Network, Servers, Data networks, Computer Telephony Integration, Telephone ERS, GIS database, specialized applications, Voice loggers are utilized extensively for streamlined operating service.
• World class equipped advance life support ambulances suited for Indian terrain support in expeditious transport and quality pre-hospital care.
• Processes, protocols and set measures ensure uniform qualitative outcomes.
• Capacity building with creation of cadre of Emergency medical Technician (EMT) manning the ambulance guided online by the Emergency Response Centre Physician (ERCP).
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| 5. Who implemented the initiative and what is the size of the population affected by this initiative?
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1. Government:
“108” has strengthened state governments’ efforts of unified multipronged approach in individual emergencies as well as situations of man-made and natural disasters by providing on scene and en-route care with evacuation of the victims to hospitals.
Contribution in increasing institutional deliveries has enhanced progress towards Millennium Development Goals by reducing maternal mortalities.
NDMA document and NRHM National Review states 108 Project as a necessity in Indian states
An efficient work mechanism with path breaking speed has been endorsed by various government functionaries, bureaucrats and political class.
2. Private Partner GVK EMRI:
GVK EMRI is a not for profit organisation having collaborations with globally renowned institutes like Stanford University of USA, Geo-Med, Singapore Health, NENA USA, etc with technology partner M/s Tech Mahindra to create and maintain the latest software application to run 24X7 Emergency Response Services in the state with global standards, processes and protocols.
3. People:
108 has impacted more than 60 million people of Gujarat with fleet of 525 ambulances. >2600 employees in GVK EMRI team identify themselves with mission of saving lives. As on 8th Dec 2013 has responded to 4,092,035 Medical,58,471 Police & 5,389 Fire emergencies and has saved 296,407 lives in critical condition. In >3% of all pregnancy related transports, emergency deliveries assisted on scene and while en-route in ambulance have brought smiles to families of the mother and child.
Popularity and mass appeal of 108 is a reflection of the benefit reaped by multitudes.
4. Medical Fraternity:
Extending the “window of survival” for victims with effective pre hospital care ensures arrival at hospital in a salvageable condition. Seamlessly linking emergency care from scene to hospital, the medical community has expressed solidarity for 108 in the best interest of Saving people’s lives.
GVK EMRI has been termed “Gandhian Innovation” by Management expert Dr. C. K. Prahalad in Harvard Business Review Jul 2010 Issue.
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| 6. How was the strategy implemented and what resources were mobilized?
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108 Emergency Response Service is a project under Public-Private- Partnership (PPP) between Government of Gujarat & GVK Emergency Management & Research Institute.
100% funding for state pertaining Operational and Capital expenditure is provided by Government of Gujarat and the Technology, Leadership, Global standard EMS protocols and processes are born and brought to the state by GVK group. All the assets are bought for and in the name of the Government of Gujarat including the ERC infrastructure to all the moving ambulances and their equipments for the whole project.
After attaining the sufficient number of ambulances, the strengthening of services is a continuous process by adding, relocating and replacing the fleet for health operations.
108 Service is free of cost to any citizen (end user). Burden of less than One Rupee / Citizen / Month, if correlated, is lesser than any state or national budget on health. Comparing with advanced countries like the USA, one ambulance trip of GVK EMRI ambulance amounts to 13$ - 16$ as against one ambulance trip in US relating to 600$ to 700$. Poor, under privileged truly benefit from the 108 service.
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| 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
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1. Reduction in Maternal Mortality Rate to 148 (per ‘00,000) from 160 (per ’00,000) in first year of launch (2007).
2. The project has proved to be most helpful in critical pregnancy cases and neonatal cases attended in Gujarat state. The provision of emergency services was a great challenge in rural area where the hospital reaching time is high. So EMT available in the 108 Ambulances help getting the job done even before patient reaches hospital (Total 41,949 cases).
o Deliveries assisted by EMT - On Scene – 12, 827
o Deliveries assisted by EMT team – In Ambulance – 29,122
3. Contribution in reduction of Maternal and infant deaths in Gujarat by expeditious transport of pregnant ladies and safe assisted delivery option while enroute in impending delivery situations. GVK EMRI has thus safeguarded lives of young mothers and babies. Maternal mortality remains one of the most daunting public health problems and reduction in maternal mortality has been identified as a prominent component in the millennium developmental goal. A pragmatic strategy of maximizing institutional deliveries GVK EMRI has enabled the public healthcare system to reduce the MMR & IMR. “Three delays” of delay in deciding to seek care, delay in reaching care, and delay in receiving adequate treatments is significantly reduced through GVK EMRI innovative approaches. GVK EMRI has been instrumental in improving overall health system through utilization of healthcare facility.
4. 108 has impacted more than 60 million people of Gujarat with fleet of 525 ambulances. >2600 associates in GVK EMRI team identify themselves with mission of saving lives. As on 8th Dec 2013 has responded to 4,092,035 Medical,58,471 Police & 5,389 Fire emergencies and has saved 296,407 lives in critical condition. In >3% of all pregnancy related transports, emergency deliveries assisted on scene and while en-route in ambulance have brought smiles to families of the mother and child. Major killer emergencies such as Pregnancy related maternal and child emergencies, Trauma, Cardiac, Respiratory, Poisoning and other EMs are dealt with care, passion, professionalism and patience.
5. Popularity of 108 and mass appeal across all sections of society has made 108 a lifeline for people. GVK EMRI’s 108 Service is a boon to the people. An efficient work mechanism with path breaking speed which has benefited multitudes and is creating value for the society has been appreciated by all sectors of society including Media and public at large. The bureaucratic network has endorsed GVK EMRI’s innovation, recognizing the potential of these services. Diverse entities, International Agencies, Senior Government officials and opinion leaders with independent view of thought have expressed their appreciation for the 108 project. Medical experts have commended the pre hospital care innovation and heralded the advent of revolutionary Emergency Response Services, in Gujarat.
6. Notable appreciation by late Dr. C. K. Prahalad terming GVK EMRI “Gandhian Innovation” in the Harvard Business Review (Issue Jul –Aug 2010) for synthesizing technologies (telecom, computing, medical and transportation) with commitment to serve the unserved has been a feather in cap of GVK EMRI.
7. Receiving accolades from various quarters, Gujarat 108 ERS was recognized in 2011 with E India Award for best Healthcare initiative.
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| 8. What were the most successful outputs and why was the initiative effective?
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a. Partnership with government, domain experts and allied key functionaries to bring in innovations of futuristic value.
b. Structured review mechanisms are followed at various levels and periodicity for monitoring the progress and for taking the policy inputs for overall functioning of system. Various reports and bulletins are published and shared with the stake holders to keep them aware about the progress made.
c. Research and analytics wing to monitor, forecast and strategize for impending emergencies. Evidence based understanding shared with stakeholders to eventually prevent and control emergencies.
d. Distinguished efforts on training and developmental activities to take overall healthcare to next level with capacity building.
e. Surging past barriers of cultures, religions, caste, economics and genders GVK EMRI has demonstrated and equitable service model for all.
f. Robustly linked Sense Reach and Care model involving technology in all aspects.
g. The collaboration and sharing of best practices for knowledge and technology are:
o Stanford University USA
o Carnegie Mellon University, USA
o GEOMED Research
o SingHealth (Singapore health services)
o American Academy for Emergency Medicine in India
o American Asso of Physicians of Indian Origin (AAPI)
o Public Health Foundation of India
o Shock Trauma Centre, USA
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| 9. What were the main obstacles encountered and how were they overcome?
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a. Integration and active Involvement all sections of government machinery including Police and Fire wings with regular interface and mutual understanding for knowledge sharing.
b. Challenge of prompt and even response time for Urban and Rural areas confronted with strategic ambulance placement based on population, load and trend of emergencies in particular area, analyzing time variation and external factors of demands.
c. Availability to telecom networks especially the mobile networks and local health infrastructure was a challenge and was met with planned actions with prioritization with concerned stake holders in identified segments.
d. Community participation in leveraging the installed resources for their optimum use in case of genuine need without hesitation.
e. To develop and maintain the service level and faith of the beneficiaries in health system of the state.
f. Creating capabilities in terms of trained manpower for Emergency response centre (ERC) & ambulances with essential knowledge and skills to provide care at par with global standards.
g. Public sensitization of 108 number for emergencies was overcome by regular local community awareness demonstrations, activities for information in schools and villages, regular communication at gram panchayat and taluka levels.
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