Rose Weeks

Advancing Healthcare With the BoP Series: Dial 104 for Health

Editor’s Note (Correction): An earlier version of this blog incorrectly stated the terms of a memorandum of understanding between the state and HMRI. According to HMRI, the MOU signed in February 2009 stipulated that the data generated in the implementation of the HMRI scheme is the property of Andhra Pradesh. HMRI could not and has not shared the data with any other entity.

Editor’s Note: This post is part of the NextBillion series, Advancing Healthcare With the BoP. The Center for Health Market Innovations and Ashoka are both contributors to the series.

A housewife in rural Andhra Pradesh (AP), India has persistent lower back pain. Like 86 percent of other villages in AP, hers lies more than 3 kilometers from the nearest hospital and she has no vehicle or time to travel by bus. Before 2007, she would, like most rural residents, be resigned to seeing a local, untrained doctor when her pain worsened. Today, she simply dials 104 from her mobile phone. 104 Advice, run by the Health Management Research Institute (HMRI), is a 24×7 toll-free health helpline providing standardized medical information, advice and counseling that receives about 50,000 calls each day. Paid for by her state government, the service uses a database with 400 algorithms and 165 disease summaries to answer her questions about the pain and, if necessary, recommend a nearby specialist to help resolve her condition.

HMRI is one of nearly 700 health programs documented on the Center for Health Market Innovations (CHMI)’s interactive web platform at Through a global network of partners, CHMI collects information on innovative programs in more than 100 countries. Using this information, CHMI identifies and analyzes emerging, innovative models that could be scaled-up or adapted in other countries. CHMI works to better understand which emerging program models truly have the potential to improve health and financial protection for the poor.

In this focus on call centers, I asked Vijay Reddy, a government contracting specialist who has been following the developments at HMRI since its incubation at ACCESS Health International, CHMI’s hub in India, to explain why many believe the model for 104 Advice is so promising.

Rose Reis: Why do you feel this program is innovative?

Vijay Reddy: HMRI applies new technology and operational processes to improve access to care for 80 million people across the state. About 50 percetn of the calls come from small villages with no permanent medical facilities or staff.

Reis: How did the 104 for Advice start out? Was it always intended to be so large?

Reddy: It took about four years to reach this stage in which HMRI receives up to 50,000 calls per day. After a pilot, government launched 104 across AP in 2007.

Reis: How was HMRI selected?

Reddy: Satyam Computer Services Ltd has been technology partner for Emergency Management & Research Institute (EMRI), which the people in AP came to trust in a lot. Similarly, HMRI was established with Satyam Computer providing technology. Now that a model exists, most other states are taking up this model to launch through a competitive, transparent bidding process. This can be controversial. Some feel the lowest bidder might not be the right bidder. In Bhutan, government selected not the lowest bidder but a bidder who can transition management of the call center system to locals. Bhutan was looking at developing competency within the country, so very specifically they put out a call for an organization to take up the initiative, continue it for several months and hand it over to an organization internal to Bhutan. [Hyderabad-based tech company] Procreate has contracted to start up the model in Bhutan and it will be implemented any day.

Reis: What is the financing model for this model? Does it differ from state to state?

Reddy: Government of Andhra Pradesh pays 95 percent of costs and the present private partner, Piramal Health Group, covers the remaining 5 percent. I think there is a strong case that the model could only scale so quickly and be sustained in a public-private partnership with technology enabling things to become very simple to implement. If you look at the Piramal initiative in Rajasthan, sustainability has been a big challenge. This is operating as a CSR in only a few villages.

Do some states charge a user fee? [SA1] Delhi’s government is considering setting a user fee for the service, but the cost of collecting the fee may be more than the fee itself. You spend around 30-40 rupees [less than $1 USD] to collect a user fee and you hardly take in 5 rupees per transaction.

Reis: How does this health advice line benefit people’s lives?

Reddy: Many people in rural areas have no access to trained health providers. They have no way of judging if their vague health complaint is something serious. They call 104, give their complaint, and trained counselors classify their condition into critical, serious or stable. They provide medical advice as well as counseling on a wide span of issues, from depression to HIV.

104 provides ready information about healthcare facilities in the government sector and enables easy access. In Delhi, patients will be able to make appointments at public and private facilities by calling 104. Hospitals paying for part of the implementation will be able list their availability to get more patients.

Reis: Health advice lines. Flash in the pan trend, or lasting model?

Reddy: With more governments initiating such programs in India through public private partnership they can be scaled up to most parts of the country to reach people in a scattered geography where there is significant shortage of healthcare professionals in a very short time.

I expect these initiatives to create tremendous impact and lessons for the future. It is essential to have transparency and accountability in contract management to achieve an expected outcome.

This partnership attempts to combine the capabilities of public sector with those of the private sector-and overcome weaknesses in both sectors. Governments’ robust and dynamic structure sets them as an enabler with high ownership, safeguarding consumer and public interests apart from commercial interests with a transparent and well-conceived contract.

Read more about HMRI, then check out more than 120 other programs using ICT to make health processes more efficient (thus affordable) for the poor.

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