Of battles won and lost: telemedicine in India

In India, tele-medicine has finally opened up the prospect of medical documentation for vast swathes of the uneducated population. 

Medha Uniyal
23 July 2015

People wade through the receding flood waters in Lal Chowck. Shahid Tantray. All rights reserved.

 September 2014 saw Kashmir swept by the worst flood it had seen in a century, with 2,000 villages severely hit and over a million people left displaced. For over a month, the Indian government deployed its army and air force along with their medics and paramedics, to bring respite to the region. Soon, roads were cleared and external support was pulled out, even as a ‘red alert’ threat of epidemic outbreak was declared in the region.

Despite widespread knowledge of the post-deluge period being prone to deadly water-borne pandemics, preventive measures are an oft-ignored step in the disaster management checklist. Yet, this time was different. An independent group of Kashmiris in the USA – the Kashmir Overseas Association – provided free medical Skype-support. The immensely effective initiative, which started receiving about 200 calls a day soon after, highlighted two things: one, the actual potential of tele-medicine, if brewed together with innovation, and two, the weakness of the government in fully embracing the technology that it had ushered in with great enthusiasm 13 years ago.


Launch of Meenakshi Telecare project. Direct Relief/Flickr. Some rights reserved.

Since the official inclusion of tele-medicine in Indian policy in 2001, the government has been grappling with advancing the field. Yet their initiatives have remained limited to creating medical transcription, conducting health awareness drives and providing customer service through tele-portals and hospital management systems. While smaller government initiatives have indeed tasted success, they are still not focused on delivering rural healthcare in a sustained manner. The highly subsidized, state-led efforts still haven’t reached scale and even the Indian Space Research Organization (ISRO), which has been in the news for it's successful maiden Mars Mission, has halted several tele-medicine expansion plans since 2012.

Meanwhile, the late-on-the-block, for-profit sector, has learnt to extract high returns on investment from the welfare space and the resultant innovation has been mutually beneficial – to the new ‘social entrepreneur’ and to the communities that they cater to. A tele-medicine centre that cost about 2,000 dollars to set up can provide a profit of about 25 percent by the end of the first year itself. This investment-light, profit-heavy model is weaving together the loopholes left by the existing public health system. Tele-medicine set-ups now act as conduits between private medical facilities, which were hitherto too expensive, and the governmental amenities, which have never been adequate.


Telemedicine in Meenakshi. Direct Relief/Flickr. Some rights reserved.

Healthpoint Services, for instance, started providing online medical consultations in northern Punjab at a rate of 80 cents, and conducted diagnostic tests for 1 dollar. In a short space of time, the tele-medicine kiosks began receiving a large influx of visitors. As the initiative gained traction and the footfall increased, they were further able to both bring down costs and expand the scope of their activities. Now, Healthpoint Services have started equipping villages in what they call ‘preventive medicine,’ another term for ‘providing clean water’. As they realised a major proportion of diseases can be averted by the mere provision of safe drinking water, they began water subscriptions at a monthly fee of 1.50 dollars. 

It isn’t just Healthpoint Services alone; practices across the board are becoming increasingly sophisticated, and have progressively moved away from the traditional connotations of ‘tele-medicine’. With more than 1,000 phone calls a day, Mediphone Services – an initiative run by tele-operator ‘Airtel’ – has saved lives through tele-operations (with specialist help from urban centres) to tele-operators (who explain the CPR procedure to people in remote villages). Specialized services in urban centres are being matched to meet specific needs in rural regions.


Providing telemedical assistance. Direct Relief/Flickr. Some rights reserved.

These independent players aren’t just utilizing the ubiquity of telecommunication lines, but are also tapping into the existing infrastructure created by the government. Semi-professional support staff and auxiliary nurse-midwives trained by the government have been inducted into numerous projects to enhance efficiency. HMRI Asara, an Andhra Pradesh initiative now called Primal Swasthya, has trained midwives – who have culturally grounded knowledge – and equipped them with medically validated health information to help with complicated procedures in tribal regions. Following a tele-training course, their presence during all deliveries in the region supplemented by virtual access to physicians through video-conferencing has dramatically brought down maternal mortality and morbidity, increased institutional deliveries by 50 percent and has even led to a rise in the number of registrations from 11 percent to 30 percent in the first trimester and from 36 percent to 48 percent in the second trimester.

In India, like several developing nations, diseases are rife; doctors are sparse and medical history records are non-existent. Here, tele-medicine has finally opened up the prospects of medical documentation for vast swathes of the uneducated population. The tracking of patient history in regions covered by tele-medicine is not only improving, but is also evolving to cater to specific community needs. From tracking graphs that illustrate malnutrition, to tracing patterns of malaria, innovation has come a long way. ZMQ Software Systems – an organization that also produces console games – has been helping 13 high-risk districts to track polio vaccination while Medic Mobile – an Africa-based non-profit – has been utilizing the prevalence of regional languages on cell phones to create an SMS vaccination reminder system.


TA Kashmiri man collects reusable materials from his flood damaged house. Shahid Tantray/Demotix. All rights reserved.

The barriers of broken roads and poor transport are being overcome by tele-medicine. For rural India – where 80 percent of the population lives with only 30 percent of the country’s doctors and where healthcare access is determined by geographical location and income levels – the success of healthcare, at the moment, hinges on innovation.

But akin to the early manifestations of tele-medicine – like smoke-signals used in Africa to warn neighbouring villages of epidemic outbreaks, or two-way radios used to contact the Royal Flying Doctor Service of Australia – these projects have prospered in isolation. They are not scalable, and worse, they are not sustainable. While they have tasted phenomenal success due to tailored technological efforts, specialized financial models and focused implementation strategies, the entire mechanism is only a halfway house for integration with physical infrastructure and primary medicine management. Remote regions still await hospitals and dispensaries, even though tele-medicine has changed the face of rural medicine.

Tele-medicine isn’t here to replace, but it’s bridging the chasm.


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