Study of disease care initiative in India supported by Gates Foundation



A large-scale evaluation of an innovative health care program in the Indian state of Bihar has been awarded a $3 million grant by the Bill & Melinda Gates Foundation.

The Bihar Evaluation of Social Franchising and Telemedicine (BEST) study will be led by Manoj Mohanan, an assistant professor of public policy and global health at Duke University.

Mohanan and his co-principal investigators at COHESIVE-India, a multi-institution research collaboration, will assess the impact of the World Health Partners (WHP) telemedicine and social franchising program. Specifically, they will assess the program’s impact on health outcomes associated with four priority diseases in 12 districts in Bihar: childhood diarrhea, childhood pneumonia, tuberculosis and visceral leishmaniasis, the second-largest parasitic killer in the world after malaria. Their study will assess program results based on data collected from more than 100,000 households over the next four years.

In addition to the grant from the Gates Foundation, Mohanan anticipates receiving supplemental funding of $1.3 million for the BEST study from other organizations.

The goals of the WHP program, which is also funded by Gates Foundation, are to improve the quality and sustainability of rural health care services delivered by the private sector and to standardize service delivery through the creation of affordable local franchisee networks. These networks of private-sector practitioners treat and refer cases, but because they may have minimal medical training, they are able to consult with formally trained physicians through the use of cell phones and telemedicine facilities.

A telemedicine facility allows a practitioner to use Internet-connected computers to share patient data such as blood pressure or heart rate with a consulting physician. The physician also can be consulted via webcam on the diagnosis and treatment of a patient. Patients often can purchase prescribed medicines on site.

The study also will estimate the costs associated with the target diseases and the benefits from the program intervention. It will address specific policy-relevant questions about the program’s sustainability, affordability, scalability and future government support.

“Social franchising has received a lot of attention as a potential service delivery mechanism in the health sector,” Mohanan said. “However, due to factors such as challenges with design issues and funding limitations, there have been no large-scale experimental evaluations of these programs.

“We plan to collect information from more than 100,000 households during three waves of data collection. In addition, we plan to undertake research on households’ choice of providers to estimate the demand for higher quality of care and to study how provider incentives could help to improve quality of care.”

The evaluation research will be implemented by collaborators in India: Sambodhi, a leading evaluation research consulting firm in Delhi, and Institute for Social and Economic Research on Development and Democracy, or ISERDD, which has extensive experience with implementing provider quality assessment studies in various states in India.

COHESIVE-India, based at the Duke Global Health Institute, was established in response to the need for rigorous impact evaluation studies in India’s health sector that can help guide policymakers. The collaboration was established by Mohanan along with Grant Miller of Stanford University, Marcos Vera-Hernandez of University College London and Jerry La Forgia of the World Bank.

Other researchers involved in the BEST study are Jeremy Goldhaber-Fiebert (Stanford), Manish Kakkar (Public Health Foundation of India), Sunil Raj (Public Health Foundation of India), and Veena Das (ISERDD and Johns Hopkins) in addition to experts from Duke, Yale, the University of Edinburgh and the World Health Organization.