The Swasthya Slate: Changing Healthcare Access for the Poor

On an apartment rooftop in a working class neighborhood in South Delhi, India, a group of about a dozen men gather around a new piece of medical technology that has the potential to change the way they access healthcare. The men are urban migrant workers and range in age from their mid-20s to perhaps mid-60s. All speak of their experiences in an overburdened healthcare system.

"When I went for an ECG test, first I had to wait in a queue at a government hospital. Finally my ECG happened but the reports came out after 4 days! I don't understand the reason for such a delay," says one man. Another man adds, "At a private hospital you can get all the reports in one day but their charges are high."

All are fascinated and delighted by the device that performs basic medical tests and displays results as soon as each test is completed, free of cost. The device is the Swasthya Slate and its developer, Dr. Kanav Kahol, is demonstrating it to the group.

Dr. Kahol, an adjunct and affiliated faculty member with the Biodesign Institute's Center for Sustainable Health, is an expert in the field of human computer interaction and has had the chance to work with several ASU faculty during his tenure, first as a Masters and PhD student and then as a faculty member.  At ASU, he worked on affordable medical simulation to allow widespread use of technology to improve patient safety.  His core focus on biomedical engineering, computer science and electronics engineering, all of which he learned in ASU, have been instrumental in his getting deeply inspired by the power of technology and its ability to support revolutionary new paradigms.

Additional inspiration came from collaborations with Nobel Laureate Lee Hartwell, PhD and Michael Birt, PhD, the director of the Center for Sustainable Health. The Center focuses on improving healthcare outcomes and lowering cost by establishing worldwide partnerships with organizations and individuals to sustain health through the integration of molecular and behavioral metrics. His collaborations with Drs. Hartwell and Birt ultimately steered his career in an entirely new direction.

"ASU gave me a strong foundation as an institution to focus on problems rather than technology," said Kahol. "In my work as a professor in ASU, I was focusing on problems that were addressing a small piece of the puzzle. My stint at the Center for Sustainable Health and working with Michael Birt and Lee Hartwell allowed me to understand the big picture and study global health as a function of multiple complex interactions.  This excited me as a researcher, and when I got a chance to contribute to Indian efforts in enabling the vision of universal health care coverage though judicious and appropriate use of technology, I jumped at the opportunity."

That opportunity came when Dr. Kahol became the Director of the Division of Affordable Health Technologies in the Public Health Foundation of India (PHFI). The position, combined with his technological expertise, allowed him to develop the Swasthya Slate to improve the delivery of health care to underserved populations.

According to statistics from the PHFI, there is one physician for every 1,666 patients in India. For this reason, untrained health workers are often called upon to provide routine healthcare services. In rural areas, 42 percent of healthcare is provided by these untrained workers, as compared to 15 percent in urban areas. They are limited in their ability to provide care because they have no method to diagnose conditions and over half of their time is spent in maintaining paperwork and reporting.

"Ultimately, the people who are there at the front lines are very few," said Dr. K. Srinath Reddy, President, Public Health Foundation of India. "If you could get onto the front lines an instrument, into which multiple functions can be integrated, then you can deal with multiple health problems of the same family, together, through one health worker."

Although the number of health care workers is few, 99.8 percent of India has data connectivity via mobile phones. Because of this, India is ripe for technological solutions that can provide basic screenings for common but frequently undiagnosed conditions such as heart disease, hypertension or diabetes. This is the need that Dr. Kahol is trying to meet with the Swasthya Slate.

In Hindi, Swasthya means "health" and a slate tablet is still frequently used in schools around the world. The Swasthya Slate is a diagnostics lab in a shoulder bag, capable of performing diagnostic tests such as blood pressure, blood sugar, blood hemoglobin, heart rate, electrocardiogram (ECG), body temperature, urine protein, urine sugar, and even water quality (total suspended particles in water). The tests can be performed anywhere and the results can be stored locally on the tablet as electronic health records or uploaded via Bluetooth to any Android-enabled device for storage in the Cloud. Physicians and other healthcare providers download the results at any location simply by accessing the Internet.

The Swasthya Slate also includes decision support tools that walk a healthcare worker through a protocol and, in the end, generates a recommendation to the healthcare worker to either refer the patient immediately to the doctor or assure the patient that they are okay. This makes the Swasthya Slate powerful because it can be run by healthcare workers at all skill levels or even general users to deliver quality recommendations for achieving better health.

Although initial rollouts of the Swasthya Slate have focused on frontline health workers, the men on the Delhi rooftop were thrilled by the simplicity of use and affordability of the device. "We can get all the test results while sitting at home!" says one. "People use expensive mobile phones all the time. Why not buy this instrument for our family if we can?" says another. And finally, "If we can take care of our own health, nothing can be better than this."