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Advanced technology delivers low-cost ENT care : Madan Krishnan

Deafness and hearing loss are two of the most common health issues faced by patients in the developing world.
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Imagine living with an undiagnosed ear injury or infection. Deafness and hearing loss are two of the most common health issues faced by patients in the developing world. Lack of public awareness coupled with underdeveloped healthcare infrastructure can turn what should be a relatively routine diagnosis and treatment plan into years of pain, frustration, and possible permanent hearing loss for children and adults. Around 75 million people in India are estimated to be suffering from hearing impairment which often leads to adversities like loss of productivity, academic underachievement, unemployment, social stigma, and societal isolation. Diagnosing common ear health issues is mostly dependent on access to timely and affordable specialist care. 

Globally, more than 360 million people live with disabling hearing loss, which is almost 5.3% of the world’s population.Around the world, there are several factors that lead to hearing problems but in India one of the main reasons is the barrier that exists between the patient and point of care. It has been noted by the WHO that half the causes of deafness are preventable and about 30%, though not preventable, are treatable or can be managed with assistive devices. Thus, about 80% of all deafness can be said to be avoidable.

Beyond the upper and upper middle-class segments, lies most of the rest of the country’s population, the truly underserved – those who have no access to healthcare today. The Shruti program in India is a social business initiative that harnesses the power of partners and technology to address the critical need for affordable and accessible treatment of chronic ear infections. Launched in 2013 with a philosophy to create sustainable program of low-cost ear care including awareness, screening, diagnosis, and treatment to the underserved, particularly in densely populated, low-income urban settlements and rural areas by leveraging medical technology, telecommunication, and frugal innovation. It is a hallmark example of health system innovation, serving dual objectives of social impact and business viability simultaneously. 

The development of this program required a new way of thinking and broader forms of innovation. Patients are screened by community healthcare workers, using a diagnostic kit and smartphone based oto-endoscope, which wirelessly transmits the data to a partner hospital/cloud server. This information determines the best treatment path for each patient. 

Shruti program is currently operational in 51 hospitals across 42 cities in India. Through, community health workers, the program has screened more than 600,000 people. Approximately 22,000 people have received life-improving treatment at a significantly reduced cost through the Shruti program so far.

With an ENT doctor as the central point of care, the program is operationalized through trained community health workers (CHW), working for the ENT doctor and equipped with an “Ear Screening Kit.” Shruti community workers include people who are high school/metric passed and graduates, generally unemployed who are willing to enhance their skill for improving employability. They are trained by field coordinators for over a week followed by field supervision using specially developed curriculum based on ENT Surgeons’ and WHO recommendations. They also receive practical experience by working closely with ENT surgeons and paramedical teams coupled with use of the Shruti kit. 

Trained community health workers are equipped with ENTraview and deployed in low income urban communities and rural areas, where they conduct door-to-door screenings as well as in camps. The ENTraview enables these health workers to gather relevant details from the patients including, complaints and along with an image of the ear canal. A WHO based field evaluation helps them to identify population with several kinds of ear disorders, from minor to major, and enables them to make a provisional diagnosis of the patient’s problem. The field audiometry application also allows them to assess patient’s hearing loss, and if required, program and give trial of a state-of-the-art hearing aid also in the field itself, saving time and effort of taking a day off work to go to an audiology center which may be far away.

The program aligns with the government’s vision of ‘Make in India’, as the ear screening kit is made completely in India, being designed and manufactured in Bengaluru and Chennai, respectively. The Shruti program drives ‘Digital India,’ by ensuring the use of information technology to drive down the costs and expand last mile access to quality healthcare. Lastly, the Shruti program also supports ‘Skill India’ through our training programs for community health workers, which has resulted in upskilling and creation of jobs.

In December 2017, a case study on the patient impact of the Shruti program was published by BCtA (Business Call to Action) – a United Nations Development Program (UNDP) initiative. Recently, BCtA studied the impact of the Shruti program on a sample of over 400 patients to measure people’s awareness of hearing impairments and ear care; the prevalence and age distribution of disease; patients’ income levels; post-treatment rehabilitation and satisfaction levels.

Shruti continues to address the critical need for affordable and accessible treatment of chronic ear infections and hearing loss in parts of the country where many people suffer from preventable partial or complete deafness by building new partnerships which enable increased access and maximized impact. This is a ground-breaking program for Medtronic. When fully scaled, it has the potential to provide a level of access to comprehensive care for the underserved, which is unprecedented in our history. 

Source:ET

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