How the rise of telemedicine can reform the healthcare sector in India

Telemedicine gained prominence during the lockdown by making treatment easily accessible and holds great promise of changing the healthcare landscape of the country by bridging the gap between urban and rural India.
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As a country that shared its copious knowledge of Ayurveda with the world, the contemporary healthcare system in India has raised some eyebrows for its vast disparities of world-class to abysmal. While the deadly virus has impacted life for millions worldwide, in India its effects have been more far reaching and often crippling.

Health and medical facilities in India are divided into two ends of a rather broad spectrum. At one end there are corporate hospitals offering state-of-the-art medical facilities in sparkling high-rise buildings, whereas at the other end are public hospitals and primary health centres which lack the basic infrastructure.

The lack of access is even more stark in our rural and tribal areas where the corporate hospitals have not yet spread their wings and there is larger dependence on the government-managed infrastructure.

In this predicament, investing in healthcare infrastructure and ensuring timely medical attention is the need of the hour. To my mind, telemedicine has risen as a worthy contender to bridge the gap between the demand and supply of this resource.

In fact, before the pandemic raised its head, the country did not have any guidelines for telemedicine, and remote consulting and diagnosis were by and large frowned upon. However, recently the government has swung into action with sweeping reforms in this sector, giving a much needed boost to tele-consultation.

Challenges for healthcare in India

Public health and sanitation form a part of the state list in the seventh schedule of the Constitution of India. In other words, decisions regarding public health and infrastructure come under the purview of the state government and are to be dealt with accordingly.

While some states are doing a brilliant job in ensuring that basic medical facilities are available to all – they are often limited by constraints like fiscal budgets and trained manpower. Moreover, lack of awareness, locational access constraints, absenteeism of health staff and poor affordability continue to remain some of the unfortunate realities of the medical system in India.

In the past few years the country has taken great strides in transforming the medical landscape of the country. From eradicating polio completely to successfully controlling the spread of various epidemics and communicable diseases to developing affordable drugs for others, the country has progressed in leaps and bounds.

Awareness, access, absence and affordability

According to the last census, more than half of India’s 1.1 billion population lives in villages and rural areas. Further, as the United Nations has suggested, by 2025 India is going to surpass China as the most populous country in the world. In a country, where the doctor-population ratio is 1:1456 against the WHO recommended of 1:1000, we are staring at a severe deficit of qualified healthcare providers. To make matters worse, doctors and healthcare facilities are disproportionately concentrated in the cities and the metros.

Telemedicine – the bridge between India of the cities and India of the villages

Aligning with Prime Minister Modi’s Digital India mission, during the pandemic, telemedicine has played a phenomenal role in bridging some of the pain of the lockdown. Due to doctors being able to consult, write prescriptions and spread awareness over a phone call, the load on hospitals had considerably reduced. Especially so when a huge chunk of the healthcare infrastructure was focused on catering to the Covid-19 pandemic.

Till online shopping and grocery became a reality, nobody could gauge that scale of the ecommerce possibility. Similarly, till the pandemic struck us, there was still a chunk of the population that believed that online education and work-from-home was a myth. With the digital penetration that the new normal has brought about in India, the rise of telemedicine as an antidote to the public health lacunae is probably one of the key discoveries of the pandemic.

Answering the ‘Four A’s’

While telemedicine has a number of advantages, the most palpable ones are to respond to the ‘Four A’s’ of India’s public health system – absence, access, affordability, awareness.

Doctors and healthcare experts available on-call or at the click of a button can provide immediate medical assistance or information that can serve as the first stage of medical attention as well as potentially help in saving the life of a patient or control the spread of an infectious disease.

Telemedicine can also be accessible irrespective of the location of the patient, thus helping an individual get state-of-the-art advice for his ailment regardless of the city or town he is based in. This is a corollary of the significant breakthrough in India of mobile phone and teleservices penetration and easier access to the internet.

Through the help of telemedicine, patients in the most remote parts of the country can access help from qualified professionals/super-specialists in the city. The greater penetration of smart phones and last mile bandwidth availability will only help promote digital/online consultation.

This is also more affordable for patients, since they will end up saving a substantial amount of money in the form of monthly trips to cities and other hospital-related expenses. A win-win for all.

Last but not least, awareness. In India, even if the other three issues are addressed satisfactorily, awareness is still a major concern. Aggressive circulation of fake news, age-old customs and lack of access to information often results in victims succumbing to misinformation.

With telemedicine becoming a part of local culture, it will thus be easier for medical professionals to spread awareness about deadly diseases and infections. This will also help the health ministry in accessing better health data and support more robust policy making.

The growth of telemedicine in India

According to an EY-IPA study, the telemedicine market in India is expected to reach USD $5.5 billion by 2025. This includes all sorts of virtual and remote care like e-pharmacy, tele-consult, tele-pathology and tele-radiology. During the pandemic, this was one of the immediate disaster management tools resorted to by the government.

The ministry of health even formulated guidelines to regulate the different facets of telemedicine and ensure no medical malpractices occur. Further, even the IRDAI has prescribed insurers to administer telemedicine charges as a component in claims. Going forward, the reliance on technology to provide first stage medical care is just going to increase.

The lockdown period has drastically changed individual behaviours and highlighted the need for safety and comfort. Telemedicine, which comes directly to the doorstep of an individual, thus plays an important role in ensuring that much required social distancing.

There is an interesting case study of Animal Husbandry and Telemedicine. BFIL an associate of Indusind Bank set up a tele-consultation facility for cattle via a call center in Hyderabad serving the rural populations of Jharkhand under the brand Bharat Sanjeevani. With a network of GPS-enabled vets, a call from a farmer raised a ticket which was also sent to the nearest available doctor. The standard was that the vet would connect on the phone within the hour and physically attend to the problem within 6-12 hours, based on severity.

The service works beautifully and has been replicated in other states. The beneficial fallout and probably the greatest gain is with Artificial Intelligence and Machine Learning a significant part of the first response can be automated in terms of diagnosis, categorisation, severity and the likely treatment which can be adopted and all this within very robust margins of error. It is not to say that we blindly replicate such models but the possibilities that it throws up especially for first line of response is immense and must be explored with the necessary regulatory caveats.

Battle half won?

Though the benefits of telemedicine and its potential to transform the healthcare sector in India is far-reaching and holds out much hope, the battle is only half won here. Telemedicine, even in its most advanced form currently, can only help in the early diagnosis of a disease, and spread awareness about the same. It can help quick assessments and support by immediate prescription for drugs.

Though the lifesaving capability of telemedicine should not be underestimated, it cannot serve as a replacement for physical public health infrastructure.

Advance treatments, more complex assessments and administering of lifesaving drugs would need access to a hospital or physical medical center, which is what the healthcare sector needs to work on creating for the citizens of the country.

Having said that though, it cannot be denied that technology has the immense likelihood of surprising us and maybe in the future telemedicine can be developed enough to perform complex procedures virtually. But for now, the need for a medical set-up that can cater to every nerve of the expansive population of India should be the chief priority of the health ministry and policy makers. Telemedicine could be the frontline to a more nuanced medical delivery system and has certainly got a much deserved leg up because of the pandemic.

(Disclaimer: The views and opinions expressed in this article are those of the author and do not necessarily reflect the views of YourStory.)

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