PROPOSAL FOR IMPROVING PRIMARY HEALTH CARE AND

HEALTH EDUCATION IN RURAL INDIA

OBJECTIVES
The objective is to improve and enhance the services offered by Primary Health Centers
(PHCs) in the rural communities of India. We propose to do this by applying novel
solutions that take advantage of developments in harnessing solar power, computers, and
information technology. Our strategy is to use technology to provide effective early
medical intervention, deliver expert health care, and minimize the inconvenience caused
to patients and health-workers from poor logistics and long travel time. An equally
important role of PHCs is to provide health education emphasizing family planning,
hygiene, sanitation, and prevention of communicable diseases. A final step in this process
will happen through video consulting and examination, a technology we anticipate
becoming available in rural areas by year 2010.
OVERVIEW
The long-term goal of the Indian government and international funding agencies has been
to provide health care to rural communities through PHCs. However, even with large
funding, these centers have not been successful for a variety of reasons that include lack
of decent facilities, equipment for performing even simple laboratory tests, etc. Even
more important is a social reality: there just are not enough trained and qualified doctors
to adequately serve the entire urban and rural populations of India even if we could
provide financial incentives for them to work in rural areas. Since we believe that the
dearth of doctors willing to practice in rural areas and their reluctance to travel to, let
alone live in, remote areas will continue to exist for a long time to come, we have
incorporated this reality into our planning from the start as described in this proposal. Our
plan, therefore, is to increase the effectiveness of doctors who are willing to work in rural
areas by a large factor. This can be accomplished by reducing the need for doctors in the
initial screening of patients, and by allocating one physician for every five PHCs.
Simultaneously; we plan to make working at PHCs more attractive and satisfying.
The result of non-functioning PHCs has been that, in many cases, diseases are not
diagnosed in their early stages nor treated. The rural population has to often travel to
urban areas when they can no longer bear the suffering caused by the disease, thus
increasing the load on hospitals in urban areas and ending up with serious complications
that, in many cases, could have easily been treated at their early stages. The need to
rectify this problem has become critical especially given the fact that over 650 million
people live in rural areas across the country with poor awareness of health issues. This
ignorance, coupled with the increased mobility between rural and urban areas, has led to
an explosive increase in the spread of diseases like HIV/AIDS and Hepatitis B and C.

We envisage PHCs functioning as the first level in a hierarchical system of health care
facilities. At this primary level, PHCs will play two equally important roles: First,
diagnosis of diseases based on symptoms and simple laboratory tests, and their treatment
either at the centers or through referral. Second, health education leading to family
planning, better hygiene and sanitation, and prevention of communicable diseases,
especially sexually transmitted diseases.
The government has shown keen interest in finding private partners to revitalize the
PHCs. To this end The George Foundation, in collaboration with the Government of
Tamil Nadu, has initiated a pilot project involving one PHC covering some 79,000 people
in the Dharamapuri District. Five more PHCs will soon be included in the pilot project.
The goal is to build on the existing infrastructure at these PHCs, make them functional
and enhance their capability. The George Foundation will coordinate and manage this
proposed project.
STEPS IN THE PROCESS OF ENHANCING THE CAPABILITIES OF THE PHC
The first step is to furbish the existing PHCs (land, building, equipment, and supplies)
already set up by the government. We anticipate each PHC to consist of an initial
screening room with a computer, an examination room for the doctor, a laboratory for
medical tests and supplies, and toilets. The furnishing will be simple, comfortable, and
durable.
The most critical infrastructure element is electricity. We propose to use either solar
panels or diesel generators (depending on a cost-benefit analysis) connected to batteries
for uninterrupted electric power for computers and laboratory equipment. Such units have
already been field tested by The George Foundation at its boarding school for
economically disadvantaged children, Shanti Bhawan, and will assure the operation of
equipment for much of the day even when conventional electric power is unavailable.
Each PHC will have a full time staff consisting of a paramedic individual to perform
initial screening with the computer, a trained nurse or physicians assistant, and a
laboratory technician. We anticipate that a qualified medical doctor will be shared
between 3-5 PHCs in a given area. Training of this staff in the novel technology and in
the holistic approach we are proposing will be extensive and continuous, and their
performance will be monitored constantly as described in Appendices B and C.
In addition to the testing capability of the on-site medical laboratory, a crucial tool for
diagnosis will be the computer. A software program called EDPS2000 shall assist the
technician in maintaining, in a protected and confidential manner, the medical history of
all patients, in suggesting tests to perform, and to evaluate possible causes based on the
symptoms displayed or the description given by the patient. It will also incorporate the
medical history in making the probable diagnosis. In addition, based on this diagnosis, it
will also prescribe medicines for minor illnesses, which will be sold at cost by the PHC.
In cases of probable major illnesses or when the diagnosis is not clear, the computer
output will propose a future course of actionfurther tests and possibly a visit to a
specialist. In the latter case, the computer will print out the patients relevant/essential
history that can be taken to the specialist. We anticipate that the majority of cases will be
2

handled at the level of PHCs, thus drastically cutting down the burden placed on hospitals
and doctors. A brief description of the EDPS2000 software is given later and in Appendix
D.
Patients visiting PHCs will also be provided health education by the staff through posters
and through audiovisual demonstrations. Providing information and help with family
planning, and awareness on communicable diseases, will be a key role of the staff.
Community programs for which we shall form collaborations with Non-Governmental
Agencies (NGOs) and social workers will supplement these activities.
At present we envisage each PHC to be an isolated unit. All software updates and sharing
of information would have to be uploaded/downloaded periodically by a person traveling
from center to center. We plan to connect each PHC to its assigned doctor through
wireless communications and a palm computer. Over a three-year time frame we propose
to connect the computers at different PHCs through standard telephone and/or cell phone
link to a central coordination/support center. The central facility will then be able to
collect and update the data from all PHCs within its jurisdiction, and perform pattern
detection and epidemiological analysis, thereby predicting epidemics and exposing
widespread health problems in their early stages. In addition to simplifying the
uploading/downloading of data onto the central computer, this enhancement will allow
on-line access to specialists via e-mail, further reducing patient's travel time and cost and
the load on urban health care facilities.
As a final step, we anticipate enhancing the diagnostic capability of PHCs through video
consultations wherein the patient (through the PHC) will access a physician (and even a
specialist) via a two-way video camera and screen. We anticipate that this technology and
the required transmission rate using cellular connections will become a reality in rural
India in 5-10 years.
HEALTH EDUCATION AND DISEASE PREVENTION
Rural India faces many very serious problems. Notable amongst them are potable water,
emerging pandemics, population control, good hygiene and sanitation practices, basic
education, and simple techniques for improving their crops and lives (see Appendix C).
One cannot expect to upgrade the peoples health without simultaneously making an
impact on these issues, and vice versa. We will, therefore, train and empower the staff at
the PHCs to spread awareness on some of these issues, build trust within the community,
and to take a holistic approach to health care.
Using the telephone link to the central facility, relevant training and educational material
and specific health instructions will be periodically transmitted to the computers at all
PHCs, and the status of various educational programs will be monitored.
COMMUNITY INVOLVEMENT
For the PHCs to be effective, people have to believe that the PHCs are there to serve
them and to provide value. To facilitate this we plan to involve the local population in
the operation and in the community outreach programs. We also plan to encourage
cultural activities, self-help programs, and health education through the PHCs. The

monitoring role of The George Foundation will be to evaluate the performance of PHCs
and to provide guidance. Evaluation will be based on one simple criterion whether the
PHCs have significantly improved the health and well being of the community.
DESCRIPTION OF EDPS2000
The Early Detection & Prevention System (EDPS2000) is a software system developed
by Dr. Abraham George, the founder of The George Foundation, a non-profit trust. It can
provide early diagnosis of patients health status. EDPS2000 screens patients and
identifies those who need prompt attention by qualified physicians, while recommending
treatment for others with minor illnesses.
It provides a probable diagnosis of disease conditions based on the complaints narrated
by the patient along with the results of a few relevant laboratory tests and the patients
medical history. It must be understood that this software does not aim to give a
confirmatory diagnosis in most cases, but only a probable diagnosis. Several conditions
are supported by laboratory tests, which in turn, may enable the user to make a
confirmatory diagnosis. It should, therefore, be seen only as a first line of intervention
whereby the patient, equipped with a probable diagnosis, can then go on to the next level,
like referral to a specialist, when required. Several minor or common illnesses will be
treated at this level on instructions given by the software.
As of now, the diseases covered by EDPS2000 are based on the common disease patterns
seen in South India. This list of approximately 300 diseases presently covered by the
software is given in Appendix E. A special team from both India and the United States
has designed this software over the past two years, and The George Foundation has
exclusive license to use in selected areas in rural India. The system is being maintained
and enhanced under license by eMedexOnline LLC, a U.S. based company. It has been
extensively tested with over 10,000 patients in three leading hospitals in Bangalore for
accuracy and acceptance by both the user and the patient. Appendix D summarizes the
results of the tests, and the comments from the hospitals.
Another aspect of the EDPS software is maintaining a database of doctors and
hospitals/clinics to whom referrals are made. By prior arrangements made by The George
Foundation with doctors and hospitals/clinics, we hope to cut down on the cost and
hardship incurred by the patients.
WHO CAN USE THE EDPS2000 SOFTWARE?
The EDPS2000 software has been designed to be extremely user friendly. Persons
involved in primary health care in remote, rural and backward areas will be able to use it
easily. The basic qualifications expected of a person who will use this software are
knowledge of English, a simple understanding of computers, and a strong motivation and
aptitude for primary health care. It does not require someone with a medical degree or
even formally trained health workers and nurses. Users will undergo specific training to
use the software, and will have extensive hands-on training before they are allowed to use
it in the field.

There are two main persons involved in the use of this software: the patient and the
interviewer (computer user). The software will prompt the interviewer with the questions
to ask. The software will keep on evaluating the answers and posing new questions until
it has narrowed the list of possibilities down to a probable diagnosis or a future course of
action. The interviewer is, therefore, passive in this process. This feature has been
incorporated by design to minimize the medical knowledge expected of the interviewer.
For cases referred to specialists or hospitals, the interviewer is responsible for following
up and making sure that the paperwork, diagnosis, and results of lab tests are entered into
the computer to maintain the full and up to date medical history.
COST BREAKDOWN
The following 3 types of costs are associated with the project:
(1) EDPS2000 Development Cost: The George Foundation has already invested Rs.90
Million ($2.2 Million) in the design, development, and enhancement of EDPS2000.
Further development/enhancement costs are also likely to be substantial. We are not
including these development costs in our estimates and in the funding request.
(2) Pre-operating costs per PHC:
a. Improvement of PHCs

: Rs. 250,000

b. Solar Panels and batteries:

c. Computers and Printers
d. Lab for urine, blood and stool tests
e. Medical Supplies, Stationery, etc
f. Furniture and fixtures
Total

:
:
:
:
:
:

Rs. 300,000
Rs. 50,000
Rs. 50,000
Rs. 50,000
Rs. 20,000
Rs. 720,000 ($14,800)

(3) Operating Costs per annum per PHC:

a. Project Coordinator (1/5 time Physician)
b. Paramedic/Computer Operator
c. Nurse/medical assistant
d. Lab Technician
e. Transportation
f. Consumables
g. Other
Total operating cost per annum

: Rs. 60000
: Rs. 72000
: Rs. 84000
: Rs. 72000
: Rs. 30000
: Rs. 32000
: Rs. 50000
: Rs. 400,000 ($8,200)

TOTAL COSTS
We propose to amortize the pre-operating costs over five years. Based on this, we expect
an expenditure of Rs 544,000 per annum ($11,200) per PHC in the initial year. To our
above estimates we add a 8% per annum increase in cost due to inflation, and a 20% for
expenses towards a) maintaining Support and Training Centers (see Appendix B), b)
coordination and monitoring of PHCs, c) enhancement of EDPS2000 (see Appendix D),
d) development and distribution of health education materials, and e) administration and
fiscal management of the project (see Appendix A). The total then amounts to Rs.
4,880,000 (about $100,000) per PHC over a five-year period.
PROJECT GOAL
Our goal is to incorporate 1000 PHCs into the program in the first phase spanning 5
years: 2001-2005. Initially, PHCs will be selected in the southern states of Andhra
Pradesh, Karnataka, and Tamil Nadu; subsequently, additional PHCs will be selected
throughout India. While the entire 1000 PHCs will become operational within the initial
24 months, they will require another 2-3 years to achieve their desired full and effective
capabilities. This will be accomplished in coordination with State agencies and NGOs.
Based on the calculations presented above, we anticipate a total outlay of Rs 4,880
Million (about $100 Million) toward this. Since each PHC reaches between 20,00060,000 people, this modest start will address issues of primary health care and health
education for about 40 million Indians (6% of the total) in rural areas. It is hard to believe
that investing Rs 24.00 ($0.50) per person per year will make such a BIG difference in
the lives of so many. We feel confident that it will.
COST RECOVERY FOR SUSTAINABLE OPERATION IN THE FUTURE
In the first phase, while we build trust in the PHCs, patients will be asked to pay a good
faith fee of Rs. 10 - 15 per visit to the PHC, and the community will be asked to provide
volunteer labor for upkeep and upgrades on the building. We anticipate using the money
collected by the PHCs from the patients for community services and for future
development. The idea being that anything we collect from them, we reinvest in the
project and for their immediate welfare.
We anticipate that by the second phase, 2006-2010, the community served by a given
PHC would have learned its value to them. We anticipate that they will be willing to pay
Rs. 20 per visit by then. Assuming that on average 30 patients visit a given
PHC per day, this fee would aggregate to over Rs. 200,000 per year (about 50% of its
annual operating cost).
MANAGEMENT OF OPERATIONS
A Steering Committee consisting of representatives from the donors, The George
Foundation, government officials, and local communities will oversee the project. An
International Advisory Board will assist this committee in setting priorities and policies.
Day-to-day operations will be carried out by a management team under the supervision of

The George Foundation. Funds received will be credited to a Trust account in a bank(s),
and will be operated by The George Foundation. The George Foundation will have the
overall responsibility for executing the project, and will coordinate its activities with
government agencies and other NGOs participating in the program.
CONTACTS
This proposal is being submitted by The George Foundation for funding toward US$100
million required for the project over a five-year period. Since the project involves the
participation of non-governmental organizations, central and state governments,
international institutions and private citizens, it is anticipated that several donors will
contribute toward the necessary funds. For further information, please contact Abraham
George or Rajan Gupta at addresses noted below.

___________________________

__________________________

Abraham George
Founder, The George Foundation
2 Penny lane, Boonton Township
New Jersey, 07005
Tel.: 973-575-8333 Ext. 3521

Rajan Gupta
Sr. Advisor, The George Foundation
231 Maple Drive
Los Alamos, NM 87544
Tel.: 505-667-7664

[email protected]

[email protected]

Foundation Address:
The George Foundation
1155, 6th Main Road
4th Block, 1st Stage, HBR Layout
Bangalore, India 560 084
Tel.: 011-91-80-5440164
Email: [email protected]
Web-sites: www.tgfworld.org
www.leadpoison.net

Date: April 15, 2000

Appendix A: Management of the Project

Overall project management is the responsibility of The George Foundation (see
attachment). An international advisory board (see Appendix I) will assist in continued
development of the concept and strategy. The steering committee for this project will
consist of Abraham George (see Appendix F), Rajan Gupta (see Appendix G), Jude
Devdas (Chief Operating Officer, The George Foundation), nominees of major donors,
representatives of local, state, and central governments, and prominent local physicians.
We anticipate the total strength of this committee to be up to 20 individuals. They will be
responsible for overall planning, setting of priorities, budgeting, and monitoring of the
project, and for developing new opportunities. To facilitate the development and
operation of this project, both Abraham George and Rajan Gupta will spend between four
to five months per year in India.
The Head Office will be adequately staffed to perform overall management and
administration of the project. It will include a Project Manager, several Assistant
Managers/Coordinators, accountants, software engineers, and consultants, as required.
Development of training and educational material, on-line communication with PHCs,
and other centralized functions will be carried out by this Head Office.
For every 50 PHCs, there will be a Support and Training Center. It will be staffed with a
project administrator, 5 field coordinators (social/health workers), 3 computer
technicians, and 2 staff members for training PHC staff under the supervision of a
physician. These Centers will be responsible for responding to the needs of their
respective PHCs (repair of hardware, updating of software, allocation of medicine and
supplies, training, coordination, etc.), and for monitoring their activities. These centers
will be established within their respective communities, and will store and handle
supplies and medicine needed by the PHCs. The project administrator is responsible for
keeping the Head Office informed of the progress, and for executing its directives.
While each PHC operates independently, one physician will be assigned to every 3-5
PHCs, and will be responsible for ensuring the quality of health care delivered by them.
Field coordinators will oversee the activities of PHCs. We anticipate the involvement of
local NGOs in the smooth running of PHCs, and for providing assistance in delivering
health education and for social activities. Social/health workers will be empowered to
develop peer groups. These individuals will be selected from within the community to act
as teachers and role models. To facilitate dissemination of information and for building
trust within the community, we shall provide financial incentives to the peer groups to
partially compensate their efforts.
Project progress will be evaluated at monthly meetings with senior administrators, and
by field inspections. The steering committee will meet at least once every six months.
Annual status reports will be circulated to all concerned parties, including the major
donors, at the end of each year and within 60 days following the end of the fiscal year.
Adjustments to the program will be made as and when necessary, and new and/or
innovative ideas for improving the service will be field-tested when deemed appropriate.

Appendix B: Support and Training Centers

Ongoing Support and Training of PHC personnel are the responsibility of the Support and
Training Centers established for every 50 PHCs. Support activities consist of recruiting
PHC staff, set-up of facilities, supply of medicine, maintenance/repair of hardware,
coordination of transportation, interaction with local community, etc. Field coordinators
and computer technicians carry out most of these activities. Arrangements with doctors
and hospitals/clinics in the nearby areas will be made for handling referrals from PHCs.
Involvement of local NGOs will be encouraged.
Support activities will be coordinated and made efficient through on-line
communications, tracking procedures/systems, pre-maintenance, periodic status review
meetings, and other techniques. The goal is to ensure that PHCs are fully operational at
all times to serve the community.
Training of PHC staff covers the following areas: a) administration of PHCs, b) use of
EDPS2000 system, c) conducting laboratory tests, d) proper understanding of the cultural
and social norms of the area, and e) how to carry out health education. Comprehensive
training for the above will be conducted at the Support and Training Centers, which will
be followed by on-site training at the PHCs under the supervision of physicians and field
coordinators. Training materials and User Guides will be supplied.
The EDPS2000 operator is expected to have basic understanding of English, enough to
input information into the computer and read and translate the questions posed by the
computer from English into the vernacular. We believe that individuals with good high
school graduation results or with higher education can be trained to carry out this task.
The complete training course material for the lab technician and the EDPS2000 operator
will also be made available at each PHC as an interactive software package on a CD. One
of the most important aspects of the training will be the communication skill of the staff.
In additional to English, they will need to be fluent in the language of the community
they serve. Since gaining the trust of the community is the foundation stone of our
approach, we feel that communication skills are very important. Using the feedback we
receive from the PHCs, illustrative examples of good communication with patients and
the community will be developed in an audiovisual format, and will be included in the
training.
Training to provide health education will be an integral part of the program. The initial
scope of this program and the current status in the development of the material are
described in Appendix C. We will supplement this by initiating an active program to
attract visiting physicians, social scientists, and public health officials. Their
recommendations will be incorporated where appropriate, and additional training and
educational materials will be developed with their assistance.

Appendix C: Health Education and Community Activities

Initially we shall concentrate on the following community health education related
activities:
1. Training of local women as midwives to reduce risks during childbirth.
2. Instruct women on pre and post-natal care and early childhood development.
3. Provide information on family planning and birth control.
4. Give instructions on simple practices that improve hygiene and sanitation.
5. Provide instructions on how to make drinking water safe.
6. Provide information on how to reduce the risk of communicable diseases.
An educational course on health and hygiene, emerging pandemics (TB, malaria,
Hepatitis B, Hepatitis C, sexually transmitted diseases, and HIV), addictions (alcohol,
tobacco, drugs), abuses (emotional, physical, sexual), and environmental concerns (air
and water pollution) has already been developed in Microsoft PowerPoint 97. At present
this material is information rich and in the form of brief summary statements -- an
information resource organized by topics. Over time we propose to convert this into a
modular multimedia format. The modularity aspect is crucial as we envisage maintaining
a central backbone that is relatively stable and examples illustrating the points to be
drawn using local people and situations. Offering health education, and learning how to
communicate the message in a simple manner will be an integral part of the training for
the entire staff. It will be available at each PHC so that the staff can refresh their
understanding as needed.
A second important way in which we propose to deliver these instructions is to develop
homegrown video demonstrations. These will be recorded using local people who hold
the respect of the communities, and using local situations to provide better identification
with the problems and the solutions. These videos will be duplicated for distribution and
the local PHC staff will be trained to further explain and demonstrate the procedures so as
to make their adoption easier.
Instructions will also be offered to the community at the time of visit to the PHCs. We
plan to use the computer at the PHCs and possibly a television with a video player to
continually provide this information while patients/families wait for their checkup.
Local community centers and village meetings are other forums for presenting the
information. NGOs and social workers will be provided the necessary tools, like the
homegrown videos, to enable them to educate the rural population on health issues. The
field coordinators will organize the above activities with the assistance of local NGOs
and community leaders.

10

Appendix D: Results of Field Testing of EDPS2000

The first field test of the EDPS2000 software was conducted at 3 major hospitals in
Bangalore, India, during October 1999 to January 2000. It was based on a study of
10,000 patients at the KIMS Hospital, Victoria Hospital, and Vani Vilas Hospital; the first
is a private hospital, while the other two are government hospitals. Outpatients were
screened at these hospitals using both the EDPS2000 system and by medical examination
by a doctor. In some cases, when required, laboratory tests were conducted either at the
EDPS2000 clinic or at the hospital laboratory. Subsequently, the two sets of evaluations
were compared and analyzed. The results of this first pilot test are shown in the
following table. Overall, the EDPS2000 software performed exceedingly well. Further
testimonials from physicians/administrators at these hospitals are also attached.
The data presented in the table are based on the entire set of 10,000 tests conducted over
the 4-month period. Based on the ongoing analysis performed during the test period, the
diagnostic logic within EDPS2000 system was continually improved. As a result, the
data obtained during the last two months of the pilot project were better than the overall
results presented in the following table. We shall continue to further enhance the
capability and reliability of the EDPS2000 software.
EDPS2000 system will be implemented at PHCs only with government approval. The use
of the system and its benefits will be explained to local officials, community leaders, and
the general population at village meetings. It must be noted that the system is only the
first line of intervention, and all serious cases will be referred to doctors and/or hospitals.
The data entered into the computers will be regarded as sensitive and highly confidential
as it will contain the patient's and possibly their family's medical and social history. It is
therefore essential that we address the issue of confidentiality properly. To guarantee this
the EDPS2000 software will incorporate the same degree of checks and security
procedures that are employed in today's financial world.

11

EDPS2000 Pilot Test Results

(October 1999 January 2000)
SL NO.

TYPE OF DISEASE

MALNUTRITION

CORRECT
DIAGNOSIS

BLANK
DIAGNOSIS

WRONG
DIAGNOSIS

TOTAL
CASE
S

611(90.3%)

24(3.5)

42(6.2)

677

199(76.53)

34(13.1)

27(10.4)

260

ANEMIA
VITAMIN DEFICIENCY
MUSCULOSKELETAL
PROBLEMS
VIRAL FEVER
COMMON COLD
MALARIA
OTHER INFECTIOUS
DISEASES

1106(85.88)

54(4.19)

128(9.94)

1288

SORE THROAT

105(80.77)

9(6.92)

16(12.30)

130

PREGNANCY

277(92.95)

13(4.36)

8(2.68)

298

CHEST PAIN

220(81.48)

20(7.47)

30(11.01)

270

STOMACH PROBLEMS
GASTROENTERITIS
ACID PEPTIC DISEASE

1025(87.08)

72(6.12)

80(6.80)

1177

BACK PROBLEM
CERVICAL SPONDYLOSIS

199(89.64)

5(2.52)

18(8.11)

222

GENITAL PROBLEM

221(96.51)

4(1.75)

4(1.75)

229

10

EYE PROBLEM

193(94.15)

2(.98)

10(4.88)

205

11

WOUND
FRACTURE
DOG BITE

447(92.74)

14(2.90)

21(4.36)

482

12

EAR PROBLEM

183(93.37)

3(1.53)

10(5.10)

196

13

HYPERTENSION
DIABETES

256(100)

256

14

PROBLEMS WITH THE

NERVOUS SYSTEM

105(90.52)

5(4.31)

6(5.17)

116

15

JAUNDICE

51(100)

51

16

BLEEDING FROM ANY SITE:

NOSE BLEEDS,
HEMORRHOIDS, INJURIES

96(88.07)

4(3.67)

9(8.26)

109

17

URINARY PROBLEM

209(85.65)

15(6.15)

20(9.08)

244

18

TOOTH PROBLEM

21(95.45)

1(4.54)

22

19

HEADACHE

295(84.29)

28(8.0)

27(7.71)

350

20

RESPIRATORY PROBLEMS
ASTHMA
BRONCHITIS
PULMONARY KOCHS
SKIN DISEASES

1949(97.55)

2(0.1)

47(2.35)

1998

1202(84.64)

90(6. 34

128(9.O1)

1420

TOTAL

8970(89.7)

398 (3.98)

632(6.32)

10000

21

12

Notes:
1.
2.
3.
4.
5.

6.

7.
8.

Figures in parentheses are percentages.

Results over a four-month period covering three major hospitals outpatient departments.
30% of the cases were children aged 0-14 years.
Software was being modified throughout the pilot testing. Hence, more recent results are better
than overall results shown.
Blank and wrong diagnoses were primarily due to: Incorrect entries
Incomplete information from doctors
Lab. test results that did not return
Complicated cases
Incorrect entries, incomplete information from doctors, and lab related problems could be reduced
at the PHCs. Complicated cases will be referred to physicians/hospitals.
Wrong diagnosis implies EDPS results different from doctors diagnosis.
Non-medical personnel manned 2 of the three sites; medical interns conducted the 3rd site testing.
Disease wise break up within each of the 21 categories is in the process of being analyzed.

13

Appendix E: List of Diseases Evaluated by EDPS2000

1.

NUTRITION RELATED

2.

Malnutrition
Kwashiorkor
Marasmus
Vitamin A deficiency
Vit.B Complex deficiency
Scurvy (Vit. C def)
Rickets (Vitamin D Deficiency)
Iron deficiency anemia
Iodine deficiency thyroid problem

INFECTIOUS DISEASES

Viral

HIV
*
Viral Encephalitis
Measles
*
Dengue fever
Mumps
*
Poliomyelitis
Rubella
*
Hepatitis A
Chicken pox
*
Hepatitis B
Influenza (Flu) *
Gastroenteritis
Rabies
*
Herpes Zoster
Rubella (German Measles)

Bacterial

Diphtheria
Anthrax
Whooping Cough
Strep. Throat
Staph. Skin
Typhoid/paratyphoid

*
*
*
*
*
*

Tuberculosis
Food poisoning
Tetanus
Leprosy
Dysentery
Cholera

*
*

Malaria
Filaria

Protozoal

Amebiasis
Giardiasis
Worm infestations

STDs

Syphilis
Gonorrhea
Trichomonas
Chlamydia

14

Fungal

Candiadiasis

15

3.

HEART DISEASES

Myocardial infarction (heart attack)

Angina

Cardiac failure

Rheumatic fever

Valve heart diseases

Hypertension

Pericarditis

Congenital heart diseases

Deep vein thrombosis

TAO

4.

RESPIRATORY DISEASES

Common cold
*

Laryngitis
*

Sore Throat
*

Allergic Rhinitis
*

Tuberculosis
*

Emphysema
*

Laryngotracheo bronchitis *

Cystic Fibrosis

4.

GASTRO-INTESTINAL DISEASES

Hiatus hernia
*

Appendicitis
*

Cirrhosis
*

Hernia
*

Dyspepsia
*

Alcoholic liver disease

*

5.

RENAL SYSTEM

Acute Glomerular nephritis

Nephrotic syndrome

Urinary Tract infection

Renal stones

Prostrate hypertrophy

6.

TEETH

Caries

Gum problems

Impaction of wisdom tooth

7.

EYE

Flu/influenza
Sinusitis
Bronchitis
Pneumonia
Asthma
Pleural effusion
Bronchiectasis

Acid peptic disease

Hepatitis
Bile stones/gall bladder
Cancer esophagus/stomach
Lactose intolerance
Irritable bowel syndrome

Cataract
Conjunctivitis
Refractive errors
Glaucoma
Blindness
Squinr

16

8.

EAR/NOSE/THROAT

Deafness

Acute Otitis Media

Chronic Otitis Media

Wax in ears

Earache

Nose Bleeds

Tonsillitis

9.

ENDOCRINE

Thyroid problems hyper/hypo

Diabetes Mellitus

10.

BLOOD

Anemia

Aplastic anemia

Thallasemia

Leukemia

Sickle cell disease

Hemophilia

11.

12.

13.

*
*
*
*
*

Neutropenia
Lymphomas
Bleeding disorders
Megaloblastic anemia
Idiopathic thrombocytopenic purpura

MUSCULO-SKELETAL SYSTEM

Rheumatoid arthritis
*

Ankylosing spondylitis
*

Osteoarthritis
*

Cervical spondylosis
*

Sciatica
*

Carpel tunnel syndrome *

Costochondritis-ribs

Osteoporosis
Gout
Osteomyelitis
Lumbar disc herniation
Muscle sprain
Frozen shoulder

CENTRAL NERVOUS SYSTEM

Meningitis bacterial/ tuberculosis

Cranial nerve damage

Epilepsy

Parkinsons

Brain tumors

Febrile convulsions
SKIN

Eczema
*
Urticaria
*
Scabies
*
Fungal infections *
Moles
*
Acne vulgaris
*
Vitiligo
*
Sebaceous cyst *

*
*
*
*
*
*

Psoriasis
Rash
Burns
Warts
Molluscum contagiosum
Neurofibromatosis
Milaria Rubra
Corns

17

Encephalitis
Migraine
Stroke
Herpes Zoster
Bells Palsy
Cerebral palsy

14.

PSYCHIATRIC

Depression

Schizophrenia

Hysteria

15.

SURGICAL CONDITIONS

Wounds/ Injuries

Head injuries

Abscess

Lipoma

Lumps in different organs

Ulcers

Fractures

Piles (Hemorrhoids)

Anal fissure

Fistulas and sinuses

Pilonidal sinus

Varicose veins

Breast lump

Cleft lip/palate

Mass abdomen

Acute abdomen

16.

GENITAL

Pregnancy related:

Normal pregnancy
Anemia in pregnancy
Toxemia of pregnancy
Diabetes in pregnancy
Short stature
Bleeding in pregnancy
Abortions

Cancer cervix
Menstrual disorders
Dysmenorrhea
Uterine prolapse
Polycystic ovarian disease
Vaginal discharge
Genital warts
Infertility
Hydrocele
Phimosis
Hernia
Penile ulcers
Penile swelling

18

17.

POISONING/BITES/STINGS

18.

Organophosphorus poisoning
Iron poisoning
Kerosene
Sleeping pills
Lead poisoning
Snake bite
Insect bites
Dog bite
Rat bite

OTHERS

Downs syndrome
Gynecomastia
Heat stroke

19

Appendix F: Dr. Abraham George

Abraham George is currently a Vice-Chairman at SunGard, a company traded in the
NYSE, which develops and markets financial software solutions for financial institutions
and corporations. Previously, he was the CEO of MCM, a company he founded over 20
years ago, which was recently acquired by SunGard. His professional career included
nearly five years with CS First Boston, a global investment bank, as a Managing Director
of a subsidiary in the international finance area. He holds an MBA, MS and Ph.D. from
Stern School of Business, New York University, and is the author of four books and
several articles in finance and economics.
As a graduate of the National Defense Academy in India, Dr. George served as an officer
in an artillery regiment on the Indo-Chinese border for two years before coming to the
US. Five years ago he started a charitable foundation, The George Foundation, to find
innovative ways to deal with poverty and environmental health issues. Two major
projects were soon initiated: a world-class boarding school (Shanti Bhavan) in South
India for children from socially and economically deprived backgrounds, and a study to
recommend implementation strategies for developing countries to deal with lead
poisoning (Project Lead-Free).
Shanti Bhavan is unique in its objective in that it is aims at realizing the full potential of
children from the poorest backgrounds; to make them professionals and leaders of the
society. It is our expectation that Shanti Bhavan will one day become a model for the
type of quality education and care that should be offered to poor children so that they can
have an opportunity to break out of their historic low economic and social status.
Project Lead-Free was the largest lead poisoning blood sample study conducted anywhere
in the world. Over 20,000 children and adults from 7 major Indian cities were tested over
a two-year period, with the involvement of 15 hospitals and several doctors and health
care workers. Following the study, an international conference was organized by The
George Foundation in Bangalore with the sponsorship of the World Bank, World Health
Organization, US Centers for Disease Control and Prevention, US Environmental
Protection Agency, and the Government of India. Over 400 scientists and public health
officials from 25 countries attended the conference, which led to a Call for Action
document co-signed by all the sponsors. The recommendations contained in this
document was circulated to over 50 developing countries at the end of 1999, and to-date
several countries including India, Sri Lanka and Bangladesh have expressed their
willingness to implement them.
Dr. George has initiated many other innovative projects to deal with poverty and to
encourage talent among the poor. EDPS2000 is one of his major efforts to change the
way health care is delivered to rural areas in India and most other developing countries.
For further information, visit: www.tgfworld.org and www.leadpoison.net

20

Appendix G: Dr. Rajan Gupta

Rajan Gupta obtained his Ph.D. from the California Institute of Technology in 1982 and
is now a senior staff scientist at Los Alamos National Laboratory in the United States. His
research aims are to understand the interactions between quarks and gluons, the
elementary particles that make up hadronic matter -- protons, neutrons, and a host of
other short lived particles seen in experiments at the international high energy physics
laboratories. He is an elected Fellow of the American Physical Society and has over
hundred refereed publications in the areas of high energy physics, computational physics,
statistical mechanics, and biology. He has received the Department of Energy's Grand
Challenges Award in High Performance Computing four times since 1988, each for a
three year term. Using his expertise as a computational physicist he will lead the effort to
develop the software to analyze epidemiological data using statistical methods.
Two years ago he decided to devote part of his time to help alleviate societal problems in
India. He began by learning about HIV/AIDS, developing a series of lectures, and
travelling to India to work with the people. He has traveled regularly to India, giving
lectures to over 10,000 students from about 100 schools in North India. Depending on
the community, these lectures were given in English, Hindi, or Punjabi. He has also given
lectures on HIV/AIDS to industrial workers, medical hospitals and colleges. He is
certified by New Mexico's Department of Health as a counselor for pre and post HIV
testing, and volunteers his time at the Los Alamos Medical Center. A summary of his
work in India is available at http://t8web.lanl.gov/people/rajan/AIDS-india/mywork.html. He has
also written a number of articles concerning HIV and describing his experiences in India.
These can be found at http://t8web.lanl.gov/people/rajan/AIDS-india/myarticles.html .
In the process of interacting with schools and school going students, Dr. Gupta
recognized the need for a holistic approach. His belief is that societal problems arise due
to a number of factors occurring simultaneously in society. To effect changes one has to
examine all these various factors, isolate the most important, and develop ways of
providing information that motivates people to make rational and safe choices.
Consequently, he developed a teacher training course that covers health and hygiene,
exploding pandemics (TB, malaria, HIV/AID, Hepatitis B, Hepatitis C), addictions
(alcohol, drugs, tobacco), abuses (emotional, physical, sexual), and environmental
concerns. The goal is to train and empower school teachers to form a partnership between
them, the school management, students and their parents and to generate the environment
in which children gain the knowledge and the confidence to make right decisions in life.
He carried out the first of these five day program in February 2000 in Chandigarh, India,
involving teachers from eight schools. The next one is scheduled for October 2000.
His quest for implementing a similar program for rural communities bore fruit when he
met Dr. Abraham George in 1999. Together, they designed the project proposed here to
implement rural health care and health education by significantly enhancing the
capabilities of primary health care centers and to implement simple life-style changes that
will uplift the lives of the rural population.

21

Appendix H: Reasons for Our Optimism

This is an ambitious proposal, yet, we are very confident of success. In fact, failure is not
an option for us. We list here the most important reasons for our optimism.
1. The timing is right. India is undergoing a tremendous transformation to open markets,
and has leveraged its development on the boom in Information Technology. The
potential for India to emerge as a modern technological giant, however, depends on
its ability to close the economic and literacy gap between its rural and urban
populations, manage health pandemics, and control the population. For this to
happen, a long-term sustained investment in rural development, with health care and
health education as the foundation stone of this initiative, is essential.
2. Central and State governments are key partners in our proposed activities. They have
long-term vested interest in seeing this project succeed. We are proposing to build on
the infrastructure (land, building for the PHC, and concept) already developed by
them and supported by international agencies like UNDP, World Bank, and WHO.
Therefore, a significant start has already been made.
3. We bring together new paradigms that fully exploit modern technology and
incorporate anticipated developments in both human and material resources.
4. The approach is holistic. It is designed to be sustainable and yield long-term changes
in rural health care and welfare. The basis measure of success will be winning the
trust of the local populations, making significant behavioral changes in their daily
lives, and improving their understanding of, and involvement in, a modern
technological society. Population control is expected to be a major result of this
strategy.
5. The people involved in the development of the concepts and for providing the overall
vision are also going to be intimately involved in its execution and monitoring. We
shall bring to bear all the tools and strategies that make businesses succeed.
Accountability and business like efficiency will be incorporated at every level.
6. We believe proper training of the PHC staff is the key to success. To achieve this we
shall develop material in audiovisual format with simple examples that people can
identify with. We shall involve the best minds worldwide to act as advisors to help in
the continuous development and refinement of the training program. We shall
establish collaborations with local hospitals to facilitate the next higher level of health
care for the rural population and involve NGOs and schools of social work to help us
implement life-style changes.
7. The George Foundation and its senior management have previously demonstrated
their ability to organize and manage major projects, and coordinate their activities on
an international scale. In particular, for many years Dr. George has been the chief
executive of a company that has hundreds of multinational corporate clients in nearly
30 countries.

22

Appendix I: International Advisory Board

1. Dr Sanjeev Arora, President of University Physicians Association and Vice Chairman
of Clinical Affairs, Department of Medicine, University Hospital, 2211 Lomas Blvd
NE, Albuquerque, NM 87131-5271. E-mail: [email protected]. Tel.: 505 272-2808.
2. Dr. Trevor Hawkins, Medical Director, Southwest C.A.R.E. Center, 230W.
Manhattan, Suite 300, Santa Fe, New Mexico 87501. E-mail: [email protected]. Tel.:
505 989-8200.
3. Dr Vinod Gupta, Cardiologist, Family Health Care Medical Group, 996 Vista Ridge
Lane, West Lake Village, CA 91362, E-mail: [email protected]. Fax: 805-373-6888,
Tel.: 805-496-5532.
4. Dr. Robert Hawkins, Professor of Economics and Dean, Graduate School of Business,
Georgia Tech University, Atlanta, Ga., Tel.: 404-894-2618.
5. Dr. Karim Ahmed, Director, Global Childrens Environmental Health Fund,
Washington, D.C., Tel.: 202-530-5810, Email: [email protected]
6. Mr. N. Vaghul, Chairman, ICICI Ltd., Mumbai, India. Email: [email protected]
7. Dr. Nelson H. Hendler, Assistant Professor of Neurosurgery in Psychiatry, The Johns
Hopkins Hospital, Baltimore, Maryland, Tel.: 410-653-2403.
8. Dr. Marti Subrahmanyam, Professor of Finance, Stern School of Business, New York
University, NY. Tel. :212-998-0348.
9. Dr. M.S. Mahadeviah, Professor of Pediatrics, KIMS Hospital, Bangalore, India, and
Diplomate, American Board of Pediatrics, Tel.: 011-91-80-3348197.
10. Dr. Jeffrey Blander, Co-Director, Division of Health Sciences and Technology,
Harvard Medical School, Room 213, 260 Longwood Avenue, Boston MA 02115,
Email: [email protected]

23