Access to basic healthcare is a very big challenge in Rural India, and globally. 70% Indians live in villages, but 74% Doctors are in the urban areas. Attempts to take doctors to the rural areas have repeatedly failed. People are mostly treated by un/semi-qualified personnel. Those who can afford private healthcare have to spend much more than their urban counterparts. Diseases are detected late. Tens of millions of people get pushed below the poverty line annually because of healthcare expenditures alone!
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70% population lives in rural areas, yet 74% doctors, 75% dispensaries and 60% hospitals are in urban areas. 60-80% private practitioners are semi or un-qualified and absentee rate at government rural clinics is ~40%. For rural population, healthcare is 1.5 times costlier. Quality healthcare is sought very late in disease-cycle, resulting in huge expenses. ~80% of healthcare financing is out-of-pocket. Doctor to population is lower by 6 times, hospital beds to population ratio 15 times lower, per-capita public health expenditure 7 times lower.
There is a huge demand-supply gap for the Primary & Rural Healthcare. The largest provider is a completely fragmented set of unorganized, at best semi-qualified private practitioners. The Government channel lacks efficiency and equipment, NGO channel is heavily dependent on donor funds, lacks systemic scaling and is mostly verticals based, and the private sector is unorganized and lacks skills.
Hospitals like Glocal & Vaatsalya in the towns, NRHM support, RSBY are welcome initiatives, but still can't address rural primary care need, where ailments can be arrested much earlier in the disease cycle.
Earlier telemedicine initiatives could not operate with the limited infrastructure and skill-set available in villages. In addition, viable business model & healthcare continuum were missing.
In this context, ReMeDi™ has demonstrated appropriate technologies augmenting local skill-set as an effective method to address this need.
ReMeDi™ was designed and built to make available a remote healthcare solution that
•works on limited infrastructure and scarce human & material resources
•can be operated even by someone not trained in health
•is affordable to the rural poor
•supports each component of primary healthcare delivery
An indigenously developed, low-cost ReMeDi™ Medical Data Acquisition Unit and ReMeDi™ Software can measure basic physiological parameters like electrocardiogram, temperature, blood-pressure, oxygen saturation, and heart & lung sounds in real-time, and provide patient’s vital information to a remote doctor for preliminary diagnosis. The video conferencing between doctors and patients works at bandwidths as low as 32 Kbps. With images taken using a normal web camera, doctors can provide eye care, dermatology and ENT services.
The system has inbuilt redundancies to deal with disruptions inevitable in low resource settings.
A person with basic literacy - typically a high school graduate - can operate ReMeDi™ technology with minimal training. Training processes are also considered a part of technology itself.
The ReMeDi™ solution captures delivery processes, and has evolved to provide a seamless platform for multiple providers in the ecosystem to come together to provide efficient & meaningful healthcare delivery – the village telemedicine centers, mobile health workers, diagnostic centers, clinics, pharmacies, secondary/tertiary care units and a Central Medical Facility
There are presently three models that ReMeDi™ is deployed on, and all have been identified as replicable and scalable:
• NGO centric
• Healthcare Outreach centric
• Government centric
In all models, existing infrastructure and local capacity are leveraged to ensure long term sustainability. ReMeDi™ integrates end-to-end healthcare delivery processes.
NGO model – a social franchising structure which is made operational by harnessing efficiency of the private sector, economy of scale to drive down costs, and linkages with the public sector. Telemedicine serves as a value-added service to providers (rural tele-clinics, diagnostic labs & peri-urban clinics) who subscribe to the system. Central Medical Facility (CMF) employs doctors for consultations.
Healthcare Outreach model – includes a few factors of the NGO model with a hub and spoke architecture: paramedics providing services in villages are connected to a CMF. A small fee charged to the patients generates sufficient revenue for operational profitability.
Government model – the ReMeDi™ platform makes the existing system efficient.
Last year alone, there have been more than 85,000 paid rural tele-consultations. 75% of the patients visiting telemedicine centers avoided further travel. Patients exhibit high level of confidence with 40% patients being repeat visitors for different episode of illness. The access to quality healthcare is much nearer and quicker for a villager.
CHMI report has identified telemedicine as one of the five innovative approaches to watch-out for, highlighting WHP-Neurosynaptic model.
Rural Healthcare is an estimated USD 30 Bn market in India. However, it is difficult to access, due to lack of established delivery channels. Several approaches have been taken towards addressing this market:
•Semi-urban Hospital chains, e.g. Glocal, Vaatsalya: hospitals for primary & secondary care. Use of HMIS, and a few mobile solutions.
•Social Franchising, e.g. Janani: link private sector resources and public sector infrastructure for efficient program delivery.
•Earlier Telemedicine attempts, eg. VRCs: Expensive infrastructure, rely on high skill-set, absence of viable business model.
•Vertical based Initiatives, e.g. cardiology, eye-care services: technology based, some sustainability.
•WHP and e-Healthpoint Services: use ICT for tele-consultations, operate with different population aggregation, operators, models
•Medical helpline, e.g. 104
•Mobile based information collection & diagnostics initiatives elsewhere in the world, e.g. Dimagi
In telemedicine, there are a few Medical Devices, Software as well as Healthcare Service Providers as players. Neurosynaptic differentiates itself as the largest channel & an end-to-end platform provider, seamlessly integrating components of healthcare delivery at the ground level, with a reach in rural areas. It takes a collaborative approach and operates through Integration, Distribution and Implementation partners. It presently has a revenue model of sale and support of hardware and software, and customization services
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