PARTAP CHAUHAN

India,

Dr. Chauhan, an Ayurvedic physician by qualification, combines the ancient Indian traditional practice of Ayurveda with modern technology to both increase access to healthcare and build a strong eco-system for Ayurvedic practitioners.

This profile below was prepared when Partap Chauhan was elected to the Ashoka Fellowship in 2012.

INTRODUCTION

Dr. Chauhan, an Ayurvedic physician by qualification, combines the ancient Indian traditional practice of Ayurveda with modern technology to both increase access to healthcare and build a strong eco-system for Ayurvedic practitioners.




THE NEW IDEA

By using his background in Ayurveda, an ancient medical practice that doesn’t require in-person physical examinations to diagnose patients, Dr. Chauhan has designed India’s first Ayurvedic telemedicine service, broadening access to healthcare services for many patients who would otherwise go untreated. Dr. Chauhan saw the opportunity to increase access to healthcare, particularly care for chronic and incurable diseases such as diabetes, rheumatoid arthritis, and asthma.

Jiva, a private company founded by Dr. Chauhan, spreads awareness about Ayurveda and reaches out to patients through multiple platforms such as internet and television. Patients seeking medical advice have access to over 120 professional Ayurvedic doctors. Calls are routed to doctors through a systematic process designed by Partap where each patient’s medical history and information is carefully documented. Each patient’s recovery is tracked and their progress is monitored by doctors and support staff, creating a complete treatment process that follows patients from initial diagnosis to treatment options and follow-up wellness consultation. For the first time, Ayurvedic doctors are also benefitting from a mentoring system where they can draw on a strong database of knowledge and case histories. Most consultations address ailments with a holistic approach focused on wellness, where the doctors advise patients on diet and lifestyle changes that will improve their condition, along with traditional Ayurvedic home remedies. In case the patient requires Ayurvedic medication, Jiva provides a prescription, and provides the patient with other remedies to aid in recovery. All consultations are free of cost, Jiva only charges the patients for medication and currently, only 20% of patients actually need to purchase the medication.

Over 5,000 patients receive consultation from Jiva daily, both from in and outside of India. Looking forward, Dr. Chauhan is planning to leverage the data and knowledge collected on the effectiveness of their treatments to build support mechanisms for Ayurvedic physicians in the future.




THE PROBLEM

A large part of the Indian population continues to suffer from limited access to appropriate health information, advice, and care. The health care sector in India is plagued by inadequate infrastructure, manpower, and medicines that adversely affect the provision and quality of health services, especially in tier 2 (population between 1 million-5 million) and tier 3 (population below 1 million) cities, towns, and remote villages.

Due to inadequate health care infrastructure in rural and semi-urban areas, people must travel for several hours to see a doctor if they seek medical attention. On average, there are only 0.6 doctors per 1,000 people in India. Even in cities, the lack of adequately trained doctors, results in an extremely low doctor to patient ratio. As a result, patients often tend to ignore symptoms until their condition becomes an emergency situation.

Given the lack of doctors and infrastructure in remote areas, telemedicine is increasingly seen as an opportunity to reach the scores of patients who have limited access to medical facilities. Ayurveda is uniquely suited to provide efficient and quality care in this context. Unlike allopathic medicine, Ayurvedic treatments do not rely exclusively on physical examinations, technology, or expensive equipment for diagnosis. Instead, Ayurvedic doctors rely on a process of inquiry for investigation and diagnosis. This is because the tradition of Ayurveda focuses on addressing the root causes of disease and not only symptoms of the problem. The Ayurvedic tradition does not look at health as only a physical problem that afflicts the body of the patient, but also accounts for the social and emotional conditions that have a bearing on the patient’s well-being. Ayurvedic medicine practiced in this holistic manner has great potential to provide positive healthcare outcomes for patients who suffer from chronic and incurable life-long disease. However, in order to achieve this, patients are required to be empowered and proactive with adequate access to health advice and information and not just remain recipients of health care services. In order to achieve broad and long-lasting success, Ayurvedic patients must be empowered with heath care information and enabled with the tools needed to have ownership of their well-being, as opposed to only being recipients of health care services.

Ayurveda as a practice is in an advantageous position because it has minimal infrastructure needs, however as a result, the system is unable to reach significant scale.  Although India has over 250 medical colleges that offer the five-and-a-half year Bachelor of Ayurveda and Medical Surgery (BAMS) degree, Ayurvedic treatment has customarily been an individual practice set up by individual physicians. The lack of large Ayurvedic hospitals results in hordes of recent graduates that are forced to either set up their own independent practices or join hospitals that practice Allopathic medicine. Also, unlike the study of conventional medicine, new graduates often do not have senior practitioners that can mentor or advise them through their first few years of practice.  Every doctor that practices Ayurdevic medicine must register with the State’s Ayurvedic Board and must obtain a license for making and disbursing pharmaceuticals. All of these requirements contribute to a lack of institutional framework for Ayurvedic medicine that has also resulted in limited access to data and documentation for practitioners and researchers in the field. As a result, the Ayurvedic community of practioners is unable to build strong case histories that can be used to demonstrate efficacy of their treatments and build credibility.




THE STRATEGY

Dr. Chauhan seeks to ensure that anyone with access to a phone can receive free consultation and get medicines delivered to their doorstep. He has pioneered Ayurveda telemedicine service by actively communicating the principles behind Ayurveda and building a strong professional environment for Ayurvedic doctors to practice. 

Dr. Chauhan uses every platform available to expand his outreach. He hosts a television program on several Hindi-language television channels where he discusses the philosophy and principles behind Ayurveda, root causes of diseases and solutions to address them by focusing on diet and lifestyle changes. Over the years, these shows have a consolidated viewership of more than 50 million people. To supplement his television programs, he reaches patients using the Internet and regular newsletters.

Jiva has pioneered the development and use of an information technology platform to effectively deliver care to more individuals. Patients reach out to Jiva through the phone or the Internet. When a patient calls into the telemedicine center, the call is first routed to a ‘call agent’. The call agent inputs the patient’s basic background information and health condition of the patient into the system. He then routes the call to the appropriate physician and flags it for them. This allows each doctor to see how many outstanding calls he or she has on real-time basis. Jiva’s doctors receive and respond to a total of approximately 5,000 calls a day from patients across India and, despite this call volume, their system ensures that all calls are returned within 24 hours.

In addition, Jiva has created strong prompting mechanisms and formats for doctors to use while making enquiries to make a diagnosis under Ayurveda. An aspect of this mechanism is a robust protocol for initial diagnoses that saves time and results in better and more precise treatment. While consulting, every doctor captures essential information about the patient including his or her detailed profile, medical history, and symptoms. Depending on the nature of the query, the patient is either given a home remedy or prescribed medicines. During this period, if a patient calls back to give an update on their condition or register a new ailment, they are referred to the same doctor to ensure consistency in advice. In some cases, second opinions are also sought out or cases are referred to another doctor.

Jiva employs approximately 125 full-time doctors. The roles and responsibilities of each doctor are dependent on their experience and expertise. They are also trained and mentored to build their own professional skills and knowledge. Doctors are ranked on a three tier basis: junior doctors, hybrid doctors, and senior doctors. In the first three months, a mentor trains the junior doctors and every consultation by a junior doctor has to go through their mentor. The mentor also listens in on patient conversations to ensure that the quality of the consultation is high and the advice provided is scientific and medically sound. Hybrid doctors in this system are mid-level doctors, who handle new cases and referrals from the junior doctors. Finally, senior doctors typically only look into follow-up or referral cases that other doctor’s find challenging to answer.

Physicians recommend diet and lifestyle changes or herbal remedies in approximately 80% of cases. In the remaining cases, Jiva facilitates doorstep delivery of medication prescribed at approximately $18 dollars (Rs. 1,000) per month, including the cost of medication. Over the next 2 years, Jiva is exploring a video-based consultation model that will enable patients to consult their doctor live over a video-link and Partap is planning to expand it to 200 cities within India. Where possible, Jiva doctors also draw from conventional medicine diagnoses and reports to understand the case history of the patient.

A strong emphasis on quality service is demonstrated by the presence of over 200 support staff that monitor quality. For instance, Jiva has a team of support staff that is dedicated to making follow-up calls with patients. Jiva has also created Saraswati, a knowledge portal that contains critical information and tools to assist doctors in making diagnoses and expanding their knowledge base. It also allows doctors to add to and draw from other doctors’ experiences. The portal captures data to analyze the nature of cases they receive, and study the most effective solutions, thereby filling the critical gap that remains of recording precedence and case histories in Ayurveda. Dr. Chauhan is keen on exploring ways to open this platform to Ayurvedic physicians across India. Towards this end, Jiva has recently created a partnership with the Indian Institute of Ayurvedic Medicine and Research, Bangalore that aims to draw from the clinical protocols and continued medical education processes designed by Jiva to influence the sector.

Most cases that Jiva responds to are for chronic illnesses like diabetes, migraines, chronic joint pains, to name a few. When patients have chronic problems like back and neck pains and other situations that require physical examinations, they are advised to visit Jiva’s clinic. To date, Jiva has seven clinics (three in Delhi, and facilities in Gurgaon, Noida, Surat and Vrindavan). Each clinic receives close to 50-60 patients a day. While most of these clinics offer only out-patient services, one clinic has in-patient care facilities. Jiva has successfully treated thousands of patients with chronic ailments, especially from smaller towns such as Banki (Orissa), Jhunjhunu (Rajasthan), Ratlam (Maharashtra), Satna (Madhya Pradesh) and Balia (Uttar Pradesh).

Apart from increasing the number of doctors at Jiva to over 250 in the next 18 months, Dr. Chauhan is looking at influencing the way students are taught Ayurveda. He is keenly exploring the opportunity to design stronger educational content for Ayurvedic colleges across India and eventually open his own university.




THE PERSON

Dr. Chauhan grew up in Faridabad, near Delhi, where his father was a farmer who wanted to ensure that Partap and his three brothers were well-educated.

It wasn’t until Partap’s oldest brother came back from the United States and decided to redirect his life and career goals that Partap began to reflect on the path he wanted his own life to take.

Dr. Chauhan deeply valued the strength of Ayurveda in enabling individuals to take charge of their health and he was committed to spreading this knowledge - not to simply lecture, but to inspire people to practice. He decided to pursue the study of Ayurveda. While Partap studied Ayurveda at the University of Delhi he had the opportunity to be mentored by his teacher for over five years who instilled the importance of making healthcare as easily accessible and affordable for India’s population. He started his own practice in 1992. In 1994, he got the opportunity to give a few lectures on Ayurveda in Europe. This experience made Dr. Chauhan realize that chronic diseases were on the rise in Western countries and people around the world were not empowered with basic information about how their body works and the impact of diet and lifestyle choices on their overall health.

Dr. Chauhan began to explore different ways to reach citizens. Partap created the first website for Ayurveda in 1995, just as the internet was emerging as a platform for mass outreach. The website posted some basic information about Ayurveda and its prescriptions for a healthy diet and lifestyle. This was well-received by people outside India (since Internet had not yet reached the majority of the Indian population). Partap used the internet to create the opportunity for online consulting. Dr. Chauhan would send questionnaires to patients and would stay connected through email correspondence. During the day, he consulted with patients in his clinic and by the evening and night he consulted online, primarily to his patients outside India. In 1996, responding to the increasing demand, he launched short online courses for Ayurveda. Partap’s goal for these courses were less about training individuals in Ayurvedic practice, but rather for them to better understand their own health. In 1997, Dr. Chauhan started doing the first video conferencing on Ayurveda. He partnered with a university in Sweden to reach out to students in classrooms. These initiatives captured media attention and Dr. Chauhan visited over 50 countries to increase awareness on the principles and effectiveness of Ayurveda.

This experience convinced Dr. Chauhan that appropriately utilized technology could serve as a powerful tool to increase access to health. He started to believe in his ability to develop mechanisms to spread Ayurveda. He hired the first doctor for his clinic in 2000. At the same time, he partnered with the IT Ministry and Massachusetts Institute of Technology (MIT) on a project called “media lab.” He used the technology provided by MIT to increase access to health in villages. While this pilot program stopped in a year due to change in political will, Dr. Chauhan recognized the need to continue reaching rural citizenry. He began using mobile technology (which was just becoming popular in India) to consult with patients.