Technology may be able to bridge the health service delivery gap between India’s urban and rural populations. With the spread of 3G technology, allowing for significantly faster connection speeds and therefore more varied and rich media sharing, experts are pointing to this technology as having the potential to provide telemedicine services to millions.
Chennai-based eye care institute Sankara Nethralaya operates a handful of vans fitted with advanced medical equipment that tour rural areas, stopping at locations where small groups of villagers wait for an eye check-up.
One by one, the residents have their eyes examined with a slit lamp, an optical instrument that scans the front and back of the eye, and a fundus camera that captures images of the interior surface.
The results are transmitted using the multimedia messaging service and very small aperture terminals (VSATs) to a central hub in Chennai where they are analysed by an eye specialist stationed there. The ophthalmologist then interacts with the patients and onsite paramedical staff on the telephone or through a video link-up and diagnoses the condition of the eye.
From 60 to 120 patients are examined on a daily basis, says Manavalan M.K., deputy general manager (information technology), at Sankara Nethralaya.
“Each trip involves about Rs.15,000 per camp, per van for about 100 patients,” says Manavalan, whose organization started its teleophthalmology project in 2003 and runs five mobile medical units that tour villages in Tamil Nadu, Karnataka, West Bengal and Maharashtra to attend to poor rural residents.
The operational cost is something that deters most healthcare providers engaged in telemedicine from expanding in a country where the doctor-patient ratio stands at 1:1,700 and where technology could aid delivery of medical services at the patient’s doorstep in remote rural areas.
Still, Manavalan is upbeat. He sees the promise of cost cuts in the advent of third-generation (3G) mobile-phone technology that enables high-speed data streaming and videoconferencing.
“Right now we have it (3G service) only in some cities. We are waiting for 3G to come across the state. It becomes easy for us to do VC (videoconferencing),” Manavalan says.
“We could have one or two persons visit a village on bus or a bike. They could carry the medical equipment in a suitcase, and we can conduct videoconferencing over smart phones. See the cost difference?” he says, without hazarding a guess on the extent of savings that 3G mobile technology would result in.
Sankara Nethralaya is working with some leading institutes including an Indian Institute of Technology (IIT) to produce smaller and more mobile medical equipment, he said, without identifying the IIT by city.
The growth of telemedicine and its ability to bridge the urban-rural divide in healthcare delivery has been hampered by the high cost of information and communication technologies, according to K. Ganapathy, president of the Telemedicine Society of India.
Setting up fibre optic connections to remote locations entails heavy capital expenditure and the return on investment is low, discouraging private companies from venturing into the space.
3G technology, experts say, has the potential to provide the next leap in telemedicine. For instance, HealthNet Global Pvt. Ltd (HNG), a healthcare information technology solutions provider, has already designed a solution to enable 3G medical consultations over smart phones.
It will introduce the application in the market soon in collaboration with Aircel Ltd, which currently runs a mobile healthcare service in collaboration with HNG in which callers can dial a number and get voice-based medical advice at a price.
HNG provides backend support in the form of technology and operates two medical response centres in Chennai and Hyderabad that have trained doctors, nurses and paramedics.
3G videoconferencing takes telemedicine a step further from voice-based consultation as it allows a doctor to see the patient, says Charles Antony, chief executive officer of HNG.
Sensing the potential for smart phone penetration, HNG has also developed about 500 mobile phone applications across different mobile platforms including Google Inc.’s Android, Nokia Oyj’s Symbian and Microsoft Corp.’s Windows Phone 7.
To be sure, the 3G solution is not a replacement for a doctor, Antony says. It can only be used to provide a health advisory service or for medical consultations on ailments such as cough, cold, eye irritation and fever or when a baby starts crying inexplicably during the night, for instance.
Nearly 12 million smartphones are expected to be sold in India in 2011, a near doubling of sales from last year, according to CyberMedia Research. India had a mobile-phone subscriber base of 825 million at the end of February, according to the Telecom Regulatory Authority of India.
However, mobile-phone penetration in rural areas is still limited although growing. From 100 million in March 2010, rural teledensity is projected to reach 200 million at the end of 2012, said Ganapathy, also the president of Apollo Telemedicine Networking Foundation, a part of Apollo Hospitals Enterprise Ltd.
Apollo Hospitals embarked on a pilot mobile health (m-health) project in August 2007 in collaboration with Ericsson AB. The Gramjyoti Project was conducted across 18 villages and 15 towns and included medical tasks such as clinical examination, monitoring of blood pressure and heart beats. The so-called proof of concept validation project lasted three months.
“India is a paradox,” says Ganapathy. About 60 million customers are using m-banking (mobile banking) in India, he says, but there are few takers for m-health services so far, he says,
One of the groups to have pioneered telemedicine in India, Apollo currently has 103 centres under its telemedicine network, including nine abroad. Recently, the group embarked on a mission to set up 1,000 telemedicine centres in 1,000 days in India and abroad.
The country has about 650 telemedicine centres; some 800,000 tele-consultations have been performed so far in India.
Around 80% of India’s medical specialists cater to 20% of the population. Some 750 million Indians in semi-urban and rural India do not have direct access to specialist care, says Ganapathy.
“For a country like India where you will never have enough onsite staff of doctors or paramedics, you need something like telemedicine to take it forward,” says Sangeeta Gupta, senior vice-president, National Association of Software and Service Companies (Nasscom). “Creating independent network is very expensive and…it has to be a government-supported initiative and how we can ride on the ICT investments the government is already making.”
Principal scientific advisor to the government of India R. Chidambaram recently said the National Knowledge Network (NKN ) was open to the idea of private players using the powerful nationwide network for delivering services such as telemedicine.
Connecting 1,500 knowledge institutions (educational and research) across the country, NKN would be riding on an ultra-speed network and participating institutions can seamlessly connect to it at speeds of 1 Gbps or higher.
“If the government allows us to use NKN, why not, we will definitely use the network,” says Sangita Reddy, executive director, operations, Apollo Hospitals.
But the smartphone may be the best bet to serve rural India’s healthcare needs.
“I think that the smartphone is a revolutionary tool,” Muir Gray, chief knowledge officer, National Health Service, United Kingdom, and the brain behind creating the National Library for Health, said. “The public is ahead of doctors. Doctors better wake up.”