The ambitious plans of another charity of the Satyam [Get Quote] founder, the Health Management Research Institute, in partnership with the Andhra Pradesh government, are under scrutiny.

The Health Medicine and Research Foundation, floated by Satyam founder B Ramalinga Raju as part of his personal charity, is attracting the same questions that are being thrown at the Emergency Medicine and Research Institute Foundation as Health Management Research Institute is also getting 95 per cent of funds from the state government now and claims to be the world's largest tele-medical helpline. HMRI has an ambulance service that is touching 22,000 service points in rural Andhra Pradesh.

It is confined to 16 districts in the state but claims to get 60,000 calls daily on its 104 helpline, besides working closely with the health department in implementing immunisation programmes targeting women, infants and school children in 275 ambulances.

Also on the agenda is a tele-medicine programme or 'docs in a box' which is already being piloted on the outskirts of Hyderabad.

The idea is to get doctors from Hyderabad reach out to every village through technology put in a box that can be easily taken from place to place.

The HMRI is also linked to the National Rural Health Mission of the Ministry of Health as it has tied up with Accredited Social Health Activist workers who have been given Java-enabled mobile phones and have been trained to bring mothers and kids to the mobile van on fixed days. The vans are being upgraded with biometric facilities to ensure that visits of the patients are marked. ASHA also gets an incentive of Rs 400 a month.

Once the programme takes off, the mobile vans would also have scanning facilities to enable distant doctors to diagnose pregnancy-related problems at an early stage. This is an area which has the potential of abetting female foeticide in Andhra Pradesh.

The fact that public funds are being used to back a project that has not emanated from public health experts is an issue that worries many.

Health activist Sabu George says: "Technology cannot make us blind to other options. Andhra Pradesh does not face scarcity of doctors and hospitals as many states do. Private companies can only think in terms of pushing technology and for them it is expansion of their market. Besides, having ultrasound scanning facilities in privately-run vans is fraught with danger for the girl child."

Balaji Utla, chairman of the 104 helpline, recalls that it was a by-product of 108 helpline and intended to make health care accessible to the rural population. He said those who criticise the helpline or the vans are not the ones who die due to lack of health care.

The 400-seater call centre of HMRI has about 150-odd doctors, mostly retired. There are also life science graduates who take calls and give non-medical tips and pass on the calls to doctors on duty for medical prescriptions, if required.

The HMRI, like the EMRI, has an array of 275 ambulances and is planning to have 475 in all, each of which costs the exchequer Rs 25 lakh (Rs 2.5 million) annually.

Utla added that HMRI won't replace the primary health centre but complement it. As for criticism of its technology driven programme, he said, "the service spends ten paise on a patient and costs 10 per cent of the total health expenditure of the state." He does not rule out doctors in government primary health centres being out of work as doctors paid by the government will be available for consultation in every village once the tele-medicine project comes through.

May be the role of the primary health centres can then be redefined, he said. He added that it is a purely romantic notion to expect a doctor to be present in every village, sacrificing the needs of his family who need urban facilities. So why not have doctors stay in cities and take care of patients in the villages, he asks.

Utla says the tele-medicine project will take a doctor to the remotest village through satellite linked kits through Time Division Multiple Access which can be carried on horseback or cycles. About 8,000 boxes are needed to cover the entire state, he says.

The foundation is eyeing 80,000 registered medical practitioners in the state for this job and it has prepared a plan to train half of them.

He is trying to bring down the cost per kit from Rs 800,000 to Rs 100,000. It is the shampoo sachet model which will come to their rescue. "If you paid only for the hours used, then the price can be brought down," he says. The questions raised against EMRI's non-transparent memorandum of understanding are valid for the funds it gets from the Andhra Pradesh government, says Shaffi Mather, the lawyer who represents the petitioners in the case against EMRI.

Utla says that the MoU with the state has been very transparent and they have been charging Rs 25 lakh per ambulance taking into account the six workers, doctors and para-medical staff manning the call centres. As for the absence of competitive bidding, he says that it was not a commercial project. It was a service that was to be delivered for free in Hyderabad. The government liked it and wanted it for the state and invited HMRI to be the nodal agency.

"If others want to do it, how can I stop it. I wish there were more who would like to send doctors and medicine to remote villages," said Utla.

Besides he says every penny spent by the government can be audited. "There are millions to find fault with us now but when we started there were 200 ambulance providers in the state. Why didn't any of them come up with a model of health care delivery for remote villages? Is that my fault?" he asks.