Over 85% of the patients who visited iKure clinics experienced, for the first time, easy access to formal healthcare with qualified doctor within a distance of 500 m to 1 km from their place of stay compared to a travel of 10 km or more in the usual scenario. When compared to equivalent health care services in the nearest location they saved at least USD 2.7 per visit when they visited iKure for consultation. The turnaround time taken to access iKure clinics is usually 60 minutes compared to 4 -7 hours they have to spend otherwise going to the nearest town, representing further savings in time and money.
The biggest share of social impact is being created for the patients by iKure. The key drivers of this impact are savings in man days lost to common and chronic illness and reduction in health care costs. The verification on number of man days and wage loss saved (one day of wage loss in this case) was done based on the patient surveys and a longitudinal sample study was set up to monitor these impacts.
The present survey provides qualitative and quantitative assessment of the sustainability of iKure’s impact in its area of operation. Data were collected through focused discussions, interviews, and visits to local residents in villages.
The impact assessment exercise has established that iKure has provided patients with better access to healthcare relative to public sector facilities and improved healthcare coverage at points of service. Key performance indicators from IRIS also demonstrated iKure’s achievement towards greater gender outreach in the communities served as well as towards employee gender diversity.
Impact is analyzed in terms of changes to the stakeholder
All impact is quantified in terms of how many beneficiaries experience each type of change affected by iKure. Impact on economic and human capital is quantified in terms of its monetary value. The value of the economic and human capital is determined using either market prices of the actual change or close proxies.
The table below summarizes the effectiveness of iKure’s healthcare delivery model based on feedback from semi-annual patient surveys conducted.
Theory of Change : What iKure does and how it leads to social impact
Activities (What iKure does) Provides easy access to quality, affordable healthcare to underserved population in rural areas.
Leverage technology for patient records, follow up care and escalation to network hospitals.
Training of community health workers, community based employees on healthcare and health awareness.
iKure’s hub and spoke primary healthcare in the rural areas of West Bengal and Orissa, India, is a model that provides social impact to four groups of stakeholders:
iKure patients account for major part of the social benefits provided by the social enterprise.
|Stakeholder Group||Relations to iKure, type of social impact derived|
|iKure Voluntary Health workers||
|iKure community Based Health workers||
PATIENT IMPACT 1 : INCREASED ACCESS TO FORMAL HEALTHCARE : UPTO 65 % OF THE iKURE PATIENTS EXPERIENCE INCREASE IN ACCESS TO FORMAL HEALTHCARE
65% or more of the patients experience increase in access to formal healthcare, because most of iKure’s patient footfall comes from its spoke clinics located in rural, remote areas. Even in Hub clinic a number of patients come from neighboring villages with no access to formal healthcare in close proximity.
We are defining formal healthcare as the presence of a certified MBBS (Bachelor in Medicine, Bachelor in Surgery) doctor, able to provide consultation services and write prescriptions, basic diagnostics, and presence of paramedic / pharmacist for dispensing medicines.
With the aim to bring quality healthcare through its hub and spoke model in rural villages where till now the first point of contact for patients has been informal medical practitioners (quacks) or local pharmacy shops, iKure’s Hub and Spoke model has been rolled out into more locations thereby providing access to affordable primary healthcare up to last mile rural population. As of 2015, iKure is actively implementing plans to scale up its operations in remote villages of northern Karnataka, Odisha, Assam, Tamil Nadu, Uttar Pradesh and other states with partnerships and collaborations with other companies, both governmental and non-governmental and the government.
PATIENT IMPACT 2: SAVINGS ON MEDICAL EXPENDITURE : 90 % OF THE PATIENTS COMING TO THE iKURE CLINICS EXPERIENCE MEDICAL COST SAVINGS OF USD 4.9 OR MORE
The average cost savings for a patient who visits iKure clinic is between USD 2-8 when compared to similar services elsewhere. The above data includes patient who visit quacks for healthcare issues. Patients who prefer only formal healthcare are saving on an average USD 6.1.
The following table gives an indication of typical cost savings which iKure offers. Note that for various disease types, patient condition and length of treatment the costs will vary and the following is just indicative.
Non-iKure patients experience, on average, 4 times more in terms of the total cost, that includes medical consultation, cost of medicine and cost of travel, compared to that experienced by the average iKure patient.
97% of non-iKure patients incurred higher medical expenditure compared to iKure patients and over 25% incur 4 times or more in total medical expenses. With an average daily wage of INR 104 among the patients surveyed, iKure patients saved a minimum of 2.5 day’s earnings on account of lower medical cost of iKure treatment.
PATIENT IMPACT 3 : REDUCED TIME COST OF ACCESS IN FORMAL HEALTH CARE : 100 % OF THE PATIENTS SAVED TIME AND MONEY TO REACH FORMAL CARE
More than 60% of the patients for all iKure clinics live in and around areas for which the time to access the iKure clinic is the same as that taken to access alternative formal healthcare options. However more than 60% of the patients can access iKure clinics’ services within 2 to 20 minutes (when living in the same village), and beyond 20 minutes (when arriving from a nearby village on a bicycle) thus representing a significant decrease in time compared to alternatives.
Given the current footfalls of patients per iKure spoke clinic, the survey reported that the patients do not have to wait more than 5 to 10 minutes. Based on feedback received from respondents who have visited private healthcare clinics previously, an estimated average waiting time is 30 minutes and more in any other several private clinics.
PATIENT IMPACT 4 : REDUCED TIME AND WAGE LOSS : 24 % OF PATIENTS TREATED AT IKURE WILL EXPERIENCE SAVING OF UP TO 2 DAYS AT WORK
We could conclude from the field verification that at least 24% of the patients experienced a time saving of 2 days when they visited iKure clinics when compared to nearest available equivalent healthcare option.
For people belonging to villages where the spoke clinics are located, accessing the services of a formal healthcare centre involves travelling 10 to 12 km. This was observed in nearly all the villages that were visited during the patient surveys. Traveling to the nearest clinics is done through buses which have scheduled timings, usually in the morning. Thus, the patients in these remote villages end up spending approximately 5 to 7 hours of their day, usually taking time between 8 am and 1 pm/3 pm. Furthermore, the travel and consultation time is usually in conflict with the peak working hours for daily wage workers.
Many respondents mentioned that when using the bus, they leave at 8 am and come back between 1 pm to 3 pm, indicating a time loss of 5 to 7 hours, during the peak activity hours. Traveling each way takes an hour.
HEALTH-WORKER IMPACT 1 : INCREASE IN PER MONTH SALARY : HEALTH-WORKERS EXPERIENCE A WAGE INCREASE OF USD 30 PER MONTH
HEALTH-WORKER IMPACT 2 : EXPERIENCES INCREASED KNOWLEDGE AND SKILLS IN RELEVANT FIELD
47.47 % OF THE PEOPLE PARTICIPATING IN IKURE SPOT AND HEALTH CAMPS FROM THE LOCAL COMMUNITIES BENEFIT FROM EARLY DETECTION OF DISEASES/ AILMENTS
The report concludes that at least 47% of the people participating in iKure spot camps and health camps benefit from early detection of diseases and ailments.
iKure’s frequent spot camps and health camps ensure early detection of ailments for patients visiting the health camps. The rural patients in such camps when diagnosed with some or the other form of ailments, doctors prescribe for further consultation and diagnostics to at least 90% of the patients. Currently there is no system in place to track the number of patients who actually go for the next round of consultation and diagnostics.
iKure healthcare delivery system enabled through Hub and Spoke model continues to serve patients effectively across all age groups.
EARLY DETECTION OF DISEASES SAVES AT LEAST 1 DAY OF WORK
Early detection of diseases saves at least 1day of work for the patients visiting the centers. The impact assessment team has been unable to verify this data from the field exploratory study.
Women as a percent of total clients provide a snapshot of iKure’s outreach to women clients. Proportion of Repeat Women clients indicate the effectiveness of iKure in serving women and their endorsement of the service that iKure provides. iKure’s commitment towards staff diversity is shown with percentage of women represented in, staff, management level and within healthcare workers.
|Gender Performance Indicator|
|% of Patients :Female||44%|
|% of Repeat Patient: Female||87%|
|% of Employees : Female||41%|
|% of Management Employees: Female||28%|
|% of Health Workers :Female||33%|