Telemedicine: Future of Universal Healthcare

By: Shobhit Rastogi,

      MHA-Health, (2011-13)

According to a recent data, 71% of Indian population resides in rural areas whereas only 2-3% of specialists are present in those areas to take care of their health. The condition of ambulance transportation of patients, connectivity of roads and referral coordination between hospitals is still very bad. Ultimately, it’s the poor patient who is still suffering the brunt of inefficiency of governance and planning.

Telemedicine:

Telemedicine mainly focuses on two aspects of connectivity: physician to physician (primary care to speciality care) and physician to patient (homecare). Other than the real time patient care, another aspect is pre-recorded data collection and data transfer. Electronic Health Record (EHR) and Cloud Computing along with Telepathology and Teleradiology can prove to be revolutionary concepts for fulfilling the indigenous requirements of our healthcare system. Cloud Computing is used to put EHR and other relevant database on a common platform so as to be accessed as and when required anywhere in the world. Telepathology and Teleradiology virtually brings Pathology lab to the patient’s doorstep, thereby reducing the burden of visiting the lab again and again for submission and collection of reports and also revolutionising the way in which these reports are processed by physicians and specialists.

Stage is set for TeleMedicine to flourish:

Department of Information Technology has announced the establishment of 100,000 Telecentres across the nation as part of it’s E-Governance initiative, which will be connected with fast internet and will be a resource centre for all governmental activities, Telemedicine would also be an integral part of this initiative. In the next five year plan, government plans to spend Rs 20,000 Crores for creating a Optical Fibre network across the country and they also have a proposal to give ‘Right to Broadband’ as a basic right in coming future.

Another very important boon to growth of telemedicine in India is the very high penetration of mobile usage in the country. According to a recent estimate, there are more than 900 million working mobile numbers in our country right now, which is an  enormous resource with more reach and more potential than any other means of communication. We can use this huge network of mobile telephony for betterment of health services, management of chronic diseases, increasing health awareness and to provide follow up care along with various newer and more innovative models of interventions. 

Barriers for TeleMedicine

The biggest barrier is the mindset of both physicians and patients. Physicians have their own reservation about different legalities associated with Telemedicine, about Consumer Protection Act and about how to administer care without actually meeting and touching the patients. In more than 80% of cases encountered in primary health care settings, actually touching the patients is not required and with all the available high end technical devices for real time auscultation, ECG, Fundoscopy, skin examinations, autoscopy and pulse oximetry; they can make even better diagnosis than the physicians in the field with the traditional equipments.

As far as patients are concerned it has been seen that the ease of usage and quality of care has been instrumental in winning the confidence of the people world over and the initiatives have picked up speed through mouth publicity only. Similar response has also been observed in different pilot projects of telemedicine carried out in various parts of the country.

Another very important barrier is lack of connectivity and proper network of internet services, that is why any organisation who wants to render services through Telemedicine has to first create their  own network, than by using that network they provide their telehealth services, which leads to sky rocketing of costs and makes the entire project commercially non viable. The required model is where a service provider (has to be the government) creates a network for telemedicine and opens it for usage by different organisation and charge them on the basis of amount of usage by each of them. With the recent announcement of DoT & IT of ‘right to broadband’ and nationwide optical fibre network, this model is very soon going to be a reality. 

'Health for All': means to social justice

By: Dr.Vanita Singh, 

      MHA-Health (2011-13)

'Justice implies something which is not only right to do and wrong not to do, but which some individual person can claim as his moral right' (A.M. Sarma, 1991). Social justice is an integral part of justice. Though it is not like legal justice where you can be imprisoned for wrong doings, but it is based on the moral principles of equal distribution of  benefits and burdens throughout the society. When ALMA ATA declaration took place for HEALTH FOR ALL, it was perhaps based on the same principle of social justice.

Today, looking at the growing differences in health indices between developing & developed countries and between rich & poor states within the same country, no doubt that social justice is nowhere to claim. Looking at the health indicators especially infant and child mortality, the poor sections of the society are in grave situation. Various factors identified for these disparities include inaccessibility of services for poor either geographic inaccessibility or financial barriers.

One of the important components of social justice is redistribution of wealth fairly among the population. However, the data in India shows that 20% of the richest have about 75% of the wealth of the country while 80% of the poor have only around 25% of the wealth of the country. Thus, the principle of social justice is blindly violated. The policy makers are rich and affluent; their policies are also biased towards richer section. The name-sake policies for poor people are for writing on papers only.

Right to health is a fundamental right and it’s the state responsibility to ensure access to health care for all without any discrimination on the grounds of caste, sex or ability to pay. Is this really happening???

A poor man can’t even think of going to a corporate hospital. Even their entry system is so technical that a poor and illiterate person would hesitate to enter a corporate hospital. When he reaches a government hospital, that too after travelling a long distance and paying huge some of money as travel-fare, to his surprise, doctor is unavailable or some unskilled person is there to treat him. 

Many schemes have come forward for BPL families. And to avail that service they need a yellow card for which they keep on running from post to pillar and that too sometimes of no use. Is this the social justice? On one hand governments slab for deciding poor people are not less than a joke and on the other hand a poor has to run here and there to prove that he is poor. With all these flaws in our system the dream of health for all seems distant. 

The rural urban differences in health indicators are huge, still government approves opening of new hospitals in urban area/s. Why not drive a policy to set up hospitals in rural areas..! The profit has become the only motive for providing health services; perhaps because of this, the health care has become an industry now from a philanthropic service area.

Let the social justice govern all schemes and policies and in all sectors, only than universal health coverage is possible. Social justice, not for the name sake rather for implementation. This is the only answer to prevailing inequalities in health sector. For holistic growth, each part is required to grow; If only a section of the society will keep on growing, the society may perish..!