Feature story

Tech-tonic boost to lift a lifeline

Technology is being employed in a variety of ways to help enhance India’s public health system

An overview of India’s healthcare system reveals a skewed distribution of resources, with only around a quarter of it devoted to rural areas that are home to over 70% of the population. Look deeper and a host of other ills plaguing India’s public health system are revealed: shortages of staff and medicine, inadequate — and often crumbling — infrastructure, low quality of treatment and care, and a general sense of despair about the whole edifice.

Studies have shown that 25-30% of people who get pushed below the poverty line every year are those forced to cope with unbearable medical expenses. Rural folks have it worse since they have to travel long distances to access hospitals. A mitigation solution to tackle the twin challenges of scarce facilities and limited resources is technology, and this is being employed to a greater extent across the country.

“Technology is an essential for a large-scale, disruptive transformation in India’s healthcare setup,” says HSD Srinivas, project director, health systems, at the Tata Trusts. “The health infrastructure in rural areas remains unutilised because of resource constraints and rural patients often land up in tertiary hospitals. This increases the pressure on the system and frequently leads to long waits for admission. Technology can help in this regard.”

Reach and impact

The Trusts have over the last few years been increasingly using technology to improve the reach and impact of multiple programmes in the health sector. For example, tele-health services have been woven into a range of the Trusts’ healthcare initiatives. And technology is the enabler in projects looking to strengthen the country’s public health systems — connecting diagnostic devices to decision-support systems, riding on advances in information and communications, and even restructuring processes to provide solutions for public health issues.

The Trusts have been running telemedicine programmes in Telangana, Uttar Pradesh and Andhra Pradesh for a number of years. These programmes became more important than ever during the pandemic. In the ‘Telangana care coordination centre’ initiative, a pilot programme has enabled nurses and technical staff based at a central facility to set up virtual consultations with specialists in district hospitals and direct patients to relevant hospitals.

Electronic health records have been a part of the programme. A customised application was developed for the telemedicine centre, which captures health records against unique IDs. These centralised records can be accessed when patients visit any inter-linked facilities.

The Telangana centre functioned in tandem with a group of doctors from government hospitals and routed virtual consultations. Despite the challenges of the lockdown, the Trusts managed to set up a call centre to monitor Covid-positive patients who were under home quarantine. These patients had access to the telemedicine centre’s doctors.

In Andhra Pradesh, the Trusts’ hub-and-spoke telemedicine network has been making primary healthcare more accessible and cost effective. The project has sited the hub in Vijayawada and set up 20 clinics run by the Trusts in underserved rural zones as the spokes. Public health centres have been equipped with connected medical devices and high-speed internet.

Remote but not restricted

The tech infrastructure enables a handful of doctors located at the hub to treat patients from 365 villages. Set up in 2017, the telemedicine network not only promotes a proactive approach towards health and wellness, but also facilitates the creation of a scalable, affordable and commercially viable healthcare ecosystem.

A similar model has been operating since 2018 at the Ramakrishna Mission Sevashrama in Vrindavan in Uttar Pradesh. Here a network of nine telemedicine units help villagers in the state’s rural areas to access primary healthcare.

Initiatives such as these demonstrate the power of telemedicine to provide a much-needed helping hand to public health systems. As Mr Srinivas explains: “A country with a population of 1.4 billion people can’t be serviced by only two million doctors. You need to utilise our doctors’ expertise intelligently through technology in order to ensure that it reaches out exponentially to a larger base of patients.”

The Trusts have built in other technology solutions into their health portfolio. The team has electronically connected health facilities in various states in order to extend clinical services. It closely works with hospital administrators to restructure processes. And it has set up a toll-free number to make it easier for patients to seek appointments and get information about hospital services available nearby.

Apart from state-level initiatives, the Trusts have also been offering support to the central government to bring extra doses of technology into the public health system. One example is the pan-India noncommunicable diseases (NCD) programme, where an app has been developed to screen patients at the public health centre (PHC) level.

In the NCD initiative, the Trusts have partnered the central government’s Ministry of Health and Family Welfare and Dell Technologies to develop software that contains an electronic patient record system, which enables screening for early detection of these diseases and also automates referral management. The application, linked to the Ayushman Bharat National Health Protection Mission, has been used to screen around 82 million beneficiaries for NCDs in some 500 districts in 28 states and union territories.

The other important tech solution helping save lives is the application used by the Alliance for Saving Mothers and Newborns, an initiative that aims to reduce maternal, neonatal and infant mortality rates in the country.

Similarly, real-time data is at the heart of the SEHAT (systematic enabler for health action and transformation) mobile app, a collaboration with the Madhya Pradesh government. The app provides real-time information about the gaps at PHCs with respect to human resources, logistics, training and practices.

Such real-time monitoring of data has helped the state address local needs, and it has had a cascading effect. Says Mr Srinivas: “Mapping data can help put together a comprehensive picture of how resources can be allotted: which hospitals in a district can receive pregnant women for deliveries, which ones can be utilised for immunisation, etc.”

A health camp conducted through a mobile medical unit in Andhra Pradesh’s Chittoor district

Healthcare on wheels

Mobile medical units (MMUs) tend to be white vans. Which is why the eye-catching pink bus draws attention. This colourful bus offers mobile medical services in Chittoor district and is attached to the Sri Venkateswara Institute of Cancer Care & Advanced Research in Tirupati, Andhra Pradesh.

The pink MMU has been designed to meet the needs of people living in remote areas and it serves many purposes: screening for breast, cervical and oral cancers, tests for noncommunicable diseases such as hypertension and diabetes, and even examinations with mammography machines.

Camps are organised six days a month in collaboration with public health functionaries to ensure maximum attendance (not less than 70 beneficiaries per camp). And there’s a call centre to provide support and conduct follow-up with patients.

The MMU was launched by the Tata Trusts through its associate organisation, the Alamelu Charitable Foundation (ACF), set up in 2017 in partnership with the Tirumala Tirupati Devasthanams to implement a joint cancer care initiative.

More in the offing

Technology is expected to get further entrenched in the healthcare sector in the post-pandemic era. The National Digital Health Mission (NDHM), launched in August 2020, will give a further boost to tele-health services as also the adoption of artificial intelligence to provide personalised care, especially to patients who need monitoring.

Preventive healthcare is yet another area where technology is playing a vital role, be it with wearable technologies or using technology to promote therapies and lifestyle changes. “Today, most of the money spent by the government on insurance goes towards end-stage disease corrections,” explains Mr Srinivas. “Primary healthcare can help us diagnose ailments at an early stage, manage patients who will require chronic disease management and ensure more planned hospitalisations.”

There are challenges for sure, not least with internet connectivity and the need to upskill the first-level cadre in rural healthcare systems: nurses, doctors and technicians. Additionally, there’s the need to treat people in the PHCs itself so that only critical cases are referred to tertiary hospitals. Technology will be central to these and other efforts to enhance healthcare outcomes in India.