As the country is reeling under Covid-19 pandemic, the state of Andhra Pradesh is putting up a noteworthy fight against it. A.P. which has a population of around 53 million has reported over 1.2 million Covid-19 cases till now. Since the last week of April, state is witnessing over 20,000 cases every day. Right from the beginning of the pandemic, the political leadership in the state has shown strong commitment, resulting in a multi-pronged strategy to deal with it. The government has been relentless on testing, identifying, isolating and contact tracing. It is ensuring door-to-door delivery of important amenities like medicine kits, rations, and other essential health services. The government is also fully committed to providing free of cost healthcare for Covid 19 patients through government and Arogyashri empaneled hospitals. As the part of the multi-pronged strategy, the state has redesigned 104 help line for meeting the needs of the crises.
104 emergency services were conceived initially to dispatch Mobile Medical Units (MMUs) to provide quality primary health care services through medical officers at the village level. However, with the outbreak of the pandemic and exponential increase in the number of cases, a dedicated call center was setup to act as an Integrated Command and Control center, with the goal to act as one-stop solution for all Covid-19 related issues.
104-call center is presently running from an HCL facility on the outskirts of Vijayawada and is headed by a seasoned IAS officer, Babu Ahmed. The call center is functioning round the clock in 3 shifts. It is manned with 60 executives in morning and afternoon session each and 30 in the night shift.
The calls to the center are primarily for three types of inquiries: firstly, seeking information related to Covid like nearby covid hospital, covid care center, vaccination point, bed availability, contact of local ANM, medical officer etc., secondly, for consulting a medical professional and thirdly, for some action-oriented inquiry like asking for hospitalization, testing etc. In addition to this Integrated Command and Control center, there is a District Command and control center (DCC) manned by at least 10-10-5 individuals on a shift basis. Each shift also consists of at least one medical professional to steer them through emergencies. DCC is functioning through Collectorate and is commanded by a young IAS officer in most districts.
It is the responsibility of the DCC to close the tickets arising from 104 within a stipulated time. For example, any issue for hospitalization has to be redressed within 1 hour and for testing, swab collection and sample id generation has to happen within 3 hours of the call. Further, they are responsible for maintaining an updated database of their district which is used by the call center executives for info-services related inquiries. They also make regular outbound calls to the people under home isolation and home quarantine to review their health condition and address their psychological needs.
During the first wave of Covid 19, YSR Telemedicine facility (dial 14410) was widely used, and it helped reduce the burden on hospitals for out-patient care. In order to expand its scale and operationality, a remote teleconsultation facility has been linked to 104. Under this, almost 3700 doctors of all specializations have voluntarily come ahead to participate. During registration, they have indicated their ideal time and day. Accordingly, the calls from the patients are routed to them and they are compensated on hourly basis. Those suffering from any symptoms of Covid-19 can access medical advice on a phone call. This facility is proving very useful for those under home isolation and reducing hospitalization.
Smooth roll-out of remote teleconsultation and training doctors in using the software was possible through determined effort of another young IAS officer, Dr. Vinod Kumar who is also a member of Expert Committee of the state on Covid management.
The call center is now receiving over 17,000 calls per day with less than 800 abandoned calls, providing connection ratio of over 95%. A fortnight ago, even though the call volumes were significantly less, abandoned calls comprised over half of them leading to poor connection ratio.
Enormous amount of hard work had gone into setting up of the system. First, a hard bargain was driven with HCL service providers to increase the number of systems and executives in each shift, in a short span of time. Second, emphasis was laid on simplifying the workflow for each service that was delivered. Third, high attrition rate among the workforce was also a major issue. All the new executives, had to be trained for 2-3 days before they were ready to take calls. It was observed that most of them came from Vijayawada city and had to travel almost 15 km to reach the call center. Thus, pick and drop buses were arranged at 6 am and 10 pm every day. This not only arrested the drop-out rate but also attracted many young women to come and work. Fourth, to build confidence among them and prevent drop-out due to Covid-19 illness, all of them were vaccinated under the front-line worker category.
It would be wrong to say to say that system has been perfected. Healthcare infrastructure is under great stress, often leading to delays in arrival of ambulance or allocation of bed. However, the manner in which 104 help line has evolved as a one-stop command and control center for Covid-19 is remarkable. The credit for this goes to Katamneni Bhaskar, Commissioner Health and Family Welfare for setting up this system and to Babu Ahmed for making it what it is today. They have always emphasized that every single incoming call should be attended diligently, and timely help must be provided to all the distress calls. This is key to building people’s trust in the effectiveness of 104 system.
Officers like Babu Ahmed, Katamneni Bhaskar, Vinod Kumar and their committed teams have demonstrated that technology can be used to manage unprecedented crisis like COVID and to handle the fallout of a pandemic like this. This is an outcome of their vision, commitment, meticulous planning and leadership qualitites.
Anil Swarup has served as the head of the Project Monitoring Group, which is currently under the Prime Minister’s Offic. He has also served as Secretary, Ministry of Coal and Secretary, Ministry of School Education.