If the country has the dubious distinction of having one doctor for every 15,000 people, low-cost telemedicine model Remote Healthcare Delivery Solutions is set to bridge the great Indian healthcare divide.
The rural healthcare scenario is a complex interplay of various parameters that include affordability, availability of healthcare personnel and medicine, infrastructure, social security/insurance and viable, sustainable and scalable business models. With a population of more than 1 billion, of which nearly 72.2 per cent reside in rural areas, the Indian healthcare industry is faced with many challenges while extending its services, particularly to those living in rural and suburban areas of the country.
In India, the bias in healthcare delivery is evident from the fact that nearly 80 per cent of physicians reside in urban areas, leaving the 72.2 per cent rural population with limited access to healthcare services. Even as primary healthcare centres and makeshift dispensaries are being constructed at remote areas, the country experiences a perennial shortage of trained doctors and nurses. For instance, India has just one doctor for every 15,000 people, and specialists are even rarer. In the absence of qualified doctors, predominant healthcare personnel in rural areas are unqualified practitioners, who have either limited or no training.
In most cases, people in the rural areas have to travel long distances to reach a doctor for basic healthcare services. This is also a reason why not many people attend to their medical needs in the early stage of the disease cycle. They visit the doctor only when their condition turns serious. This also increases medical expenses, sometimes dragging the rural folk back into dispair. It is estimated that about 20 million families get pushed below the poverty line every year because of healthcare expenditures alone. As a result, medical debts are the biggest non-productive source of debt in rural India.
Another area of concern is the inadequate availability and unaffordable application of technology. Unless there is bandwidth or internet connectivity available, unless there is equipment and devices available that are cost-effective, it wouldn’t be possible to provide services at an affordable price.
Against this backdrop, two enterprising engineers with the vision of leveraging technology to improve healthcare delivery in rural India developed a low-cost telemedicine model that connects rural patients with urban doctors via the web. Neurosynaptic Communications Private Ltd, founded by Sameer Sawarkar and Rajeev Kumar in 2002, in collaboration with the TeNeT group of IIT Madras, developed ReMeDi or Remote Healthcare Delivery Solutions.
This technology facilitates remote diagnosis of the patient by capturing various basic physiological parameters, thereby providing an extremely affordable method for remote healthcare delivery. The technology has been clinically validated at reputed medical institutions for accuracy and quality of medical data.
The solution allows transmission of various vital parameters about the patient to a doctor for preliminary diagnosis, either real time or in a store-and-forward mode. This allows telemedicine to bridge the healthcare divide for rural areas effectively and affordably. No wonder, Ventureast-TeNeT and APIDC-Biotech funds have invested in Neurosynaptic right from the inception stages.
Neurosynaptic incorporated the following key features in its diagnostic solution:
Service at doorstep: ReMeDi sets up kiosks in villages. A kiosk essentially is a place where the necessary equipment exists and there is a knowledgeable person to operate it. The patient only has to walk to the nearest IT kiosk and have the diagnostic parameters taken and then consult the doctor.
Minimal training for operators: To address the lack of availability of trained medical professionals in the villages, the solution has been developed such that it can be operated after a minimal amount of training. The ReMeDi range of products provide complete electronic medical records, images, various health parameters like blood pressure, body temperature, blood oxygenation, ECG and heart sounds, as well as audio-video conferencing at low bandwidth, making it a viable platform for rural and remote healthcare delivery in villages that lack infrastructure and medical expertise.
Low power usage: ReMeDi uses a device integrated with video conferencing software. The device runs on two watts of power and the video conferencing runs at 32 kilobits per second. It also runs over reliable telephone lines or normal modems. An integrated patient-record centre helps doctors in recording all health-related issues of a patient.
In case there is no connectivity, a store-and-forward option allows the capturing of all parameters, which are transferred when connectivity is established. When real time bandwidth is more than 32 kilobits per second, then one can connect and transfer all the parameters real time — so the stethoscope sound is heard real time, while the chest piece is put to the patient. The doctor guides the operator to put the stethoscope chest piece at a particular place on the chest. Apart from charts at the kiosks, the operators are also trained in using a stethoscope.
Cost-effective: The model offers a platform that is cost-effective for remote healthcare delivery. It is based on the premise that cost-effectiveness does in no way mean a compromise on quality. The solution is best deployed in a cluster, and various partners are required to offer a complete healthcare solution. It is possible to provide consultation at a village clinic at a price-point of Rs 30 - 50 and in a sustainable way.
End-to-end healthcare delivery: ReMeDi has built in a viable business model for multiple parties, such as the healthcare providers, technology providers, operators, pharmacists etc. It was important to understand the complete experience of healthcare to build an end-to-end healthcare delivery solution, including drug delivery.
Acceptablity: The acceptability rate or ReMeDi’s return patient rate is about 40 per cent. More importantly, about 75 per cent of ReMeDi’s patients did not have to travel to another town to meet their healthcare needs. There is a great amount of affordability, because this model allows patients to get access to healthcare for less than a dollar.
ReMeDi has also been successfully validated at many reputed hospitals, and it is also in the process of acquiring various certifications. Neurosynaptic has started providing samples and supporting various entities worldwide that work in the area of remote healthcare delivery. Various models are being experimented with in countries like Tunisia, Mexico, Brazil, and other African and Asian countries. In India, it is so far deployed in the states of Maharashtra and Tamil Nadu, which are run with various partners and are slated for a scale-up.
Neurosynaptic received its recognition when the World Economic Forum chose it as one of the 39 technology pioneers from a list of 273 nominees. Technology pioneers are companies that have been identified as developing and applying highly transformational and innovative technologies in the areas of energy, biotechnology and health and information technology.
Beyond healthcare delivery: If that is not all, Neurosynaptic has also developed a low-cost automatic weather monitoring station to enable weather data collection at the village level thereby allowing breakthrough solution in agricultural advisory, insurance, resource planning and allocation.
Moving on, ReMeDi is now getting into large scale experimentations with its findings. It is partnering with various agencies that have expertise in the healthcare delivery and working with them to set up larger networks. With the commitment to building technologies to make quality healthcare available to each and every individual equitably, ReMeDi is poised to revolutionise healthcare delivery.
Technology is going to be a game changer. If people are provided with high innovation at low cost, they will become more productive and their earning potential will increase. Technology can go a long way in improving lives in a country like ours, if we can make it affordable and accessible.
(Series concluded)
The author is Director, CII-ITC Centre of Excellence for Sustainable Development.
The case studies have been adapted from a report titled Sustainable and Inclusive Innovation: Strategies for Tomorrow’s World, published by the CII-ITC Centre of Excellence for Sustainable Development
