Chakrajmal
village, in the Bijnor district in the North Indian state of Uttar Pradesh, got
its first doctor in 2008. He was not based in the village, though.
The villagers had access to the doctor via a telemedicine project
launched by World Health Partners (WHP) to provide health care services to
1,000 villages in Uttar Pradesh's Bijnor, Meerut and Muzaffarnagar districts.
Set up in 2008, WHP, a U.S.-headquartered international nonprofit,
provides basic health care and reproductive health services by harnessing local
market forces to work for the poor. According to Gopi Gopalakrishnan,
founder-president of WHP, the organization's model is to draw on private sector
capacity through social franchising, innovations in labor management, and
low-cost technologies to develop a scalable and sustainable health care service
delivery model.
WHP's Uttar Pradesh telemedicine network now comprises around 1,200
local individuals called Sky Care Providers and 120 entrepreneur-run centers
branded as Sky Health Centers. The Sky Care Providers are given training and
low-cost mobile solutions by WHP to perform diagnostics, symptom based
treatments, tele-consultations and, wherever needed, referrals to the Sky
Health Centers.
These centers use remote diagnostic devices for measurement of basic
parameters such as blood pressure, heart rate, electrical activity of the heart
and pulse rate. The patients are connected to doctors at WHP's central medical
facility in New Delhi via computers and webcams. The entrepreneurs have the
option of leasing the equipment from WHP. For the patients, consultation
charges vary from 20 U.S. cents for below poverty line households to US$1 (at
the exchange rate of Rs. 50 to a U.S. dollar).
Patients who require surgery, inpatient care or specialized procedures
that cannot be delivered via telemedicine are referred to the nearest WHP
franchised health care clinic. Currently WHP has 16 such clinics in Uttar
Pradesh. Since 2008, WHP has provided villagers in Uttar Pradesh with around
35,000 tele-consultations for common ailments such as fever, indigestion and
gynecological problems.
Gopalakrishnan is now replicating this model in Bihar. Currently there
are 104 telemedicine centers up and running in 13 districts of the state. He
hopes to expand to 400 centers across 25 districts (covering a population of 70
million) by end of 2012 and 1,250 centers over the next three years. Apart from
treating basic ailments, Gopalakrishnan now also wants to focus on detection
and treatment of tuberculosis, visceral leishmaniasis, childhood pneumonia and
diarrhea.
"There's a huge, unmet health care need in our rural hinterlands.
The challenge is to make health care affordable for the masses and attractive
to the providers at the same time," says Gopalakrishnan.
"Telemedicine is a good strategy to strengthen the existing human
resources available in health care. The scale, however, will come only through
effective government intervention."
According to Rana Mehta, executive director and leader of health care
practice at PricewaterhouseCoopers (PwC), access to health care in India
"gets limited by the affordability factor and hence telemedicine -- or the
remote diagnosis, monitoring and treatment of patients via videoconferencing or
the Internet -- has a very important role to play. It is at a fairly nascent
stage right now having started only about a decade back, but it is undoubtedly
a fast-emerging trend, led by growth in the country's information and
communications technology sector."
K. Ganapathy, president of the Apollo Telemedicine Networking
Foundation, past president of the Telemedicine Society of India and adjunct
professor at the Indian Institute of Technology, Chennai, is categorical that
telemedicine is the way ahead. "We can't go far with conventional
brick-and-mortal hospitals,' he says.
Vijay Govindarajan, professor of international business at the Tuck
School of Business at Dartmouth College, not only sees India as one of the
early adopters of telemedicine, he also notes that the country has the
potential to develop innovations that can be adopted in other parts of the
world, including developed nations like the U.S. "In the United States, we
are thinking of IT [information technology] as just electronic medical records,"
Govindarajan says. "This shortchanges IT's full potential. Driven by
extreme need, India is inventing new ways to use information technology to
improve health care."
Govindarajan lists the reasons why telemedicine will take off first in
India: A severe shortage of doctors, especially in rural areas; very high
patient volumes; widespread availability of mobile networks; rapid growth in
the availability of low-power, hand-held medical monitoring devices, and the
shift away from the proprietary, local area network-based medical image
archiving and communications systems to a networked tele-enabled system.
"Innovations in telemedicine will accelerate in India, where access and
cost are critical issues. These telemedicine innovations will be adopted in the
U.S., where cost and access are becoming increasingly talked about. This is a
classic reverse innovation story," he adds.
Potential for
Growth
A January 2012 report titled, "Global Telemedicine Market
Analysis," by RNCOS Industry Research Solutions, an India-based market
research and information analysis company, projects that the global
telemedicine market will grow at a compound annual growth rate (CAGR) of around
19% from 2010 to 2015. An earlier report in 2009, titled "Global
Telemedicine Market: 2008-2012" published by Infiniti Research, a
London-based market intelligence firm, pegged the size of the global
telemedicine market in 2008 at US$9 billion. According to this report, Asia is
the fastest growing region for the telemedicine market with India and China
leading the growth.
There are no clear numbers, though, on the current size of the
telemedicine market in India. Murali Rao, associate vice president for health
care at the New Delhi–based research and consultancy firm Technopak Advisors,
estimates the current size of the Indian telemedicine market to be around
US$7.5 million. "This is expected to grow at a [compound annual growth
rate] of 20% over the next five years," he says. That would take it to
around US$18.7 million by 2017. Mehta of PwC on the other hand notes:
"Studies indicate that the size of India's telemedicine market is expected
to be US$500 million by 2015." (This is a nascent area and estimates vary
widely.)
Ganapathy of Apollo points out that 80% of India's population has no
direct, physical access to specialist health care and gives some
back-of-the-envelope calculations: "Estimates suggest that the
telemedicine market is at least for 800 million Indians. Even if half of these
800 million need to consult a specialist once a year, [that still amounts to]
400 million specialist consultations per year. Even if 10% of these are enabled
through telemedicine we are talking about 40 million consultations per year
from rural India alone…. The market potential for telemedicine is obviously
enormous."
While the numbers may vary, what is undisputed is the potential that
telemedicine holds. A major driver of telemedicine in India is the dismal state
of health care in the country. India's government spending on health as a
proportion of the GDP – currently at around 1% of the GDP - is among the lowest
in the world. Even in other Asian countries, it is higher. The corresponding
amount is 1.8% in Sri Lanka, 2.3% in China and 3.3% in Thailand. Despite the
launch of the National Rural Health Mission in 2005, India continues to grapple
with a 33% shortage of rural hospitals, which are called Community Health
Centers (CHCs). Even in the ones present, there is an acute shortage of staff.
According to the Ministry of Health and Family Welfare, there is a shortage of
50-70% of physicians, specialists, lab technicians and radiographers at the
CHCs. And around 10-15% of them lack even basic amenities such as water supply
and electricity.
Experts have time and again suggested that if the vision of
"Health for All" is to be achieved by 2020, India will have to pump
in 6% of its GDP in the health care sector. At the same time,
technology-enabled health care networks can play a huge role by bridging the
distance between doctors and patients through Internet and other
telecommunication technologies.
Ground Realities
Some of the major players in telemedicine in India at present include
Narayana Hrudayalaya, Apollo Telemedicine Enterprises, Asia Heart Foundation,
Escorts Heart Institute and Aravind Eye Care. Devi Prasad Shetty, a leading
cardiac surgeon based in Bangalore and founder of Narayana Hrudayalaya
Hospitals, predicts that it is only a matter of time before we see a huge spurt
in the use of telemedicine. "In the early days, satellite was the only
means of managing the telemedicine program and keeping satellite connectivity
was not very easy," he notes."However, now with Skype and other ways
of videoconferencing there are many options available. With the stabilizing of
technology platforms, technical problems are extremely rare."
Shetty is at the helm of one of India's earliest and largest
telemedicine programs. Launched around 10 years ago, the initiative is managed
through satellite connectivity provided free of cost by the Indian Space
Research Organization (ISRO). Presently, the Narayana Hrudayalaya telemedicine
network is connected with about 100 telemedicine centers across India. Outside
India, as part of the PAN African satellite network, it is connected to 55
cities in Africa. The connectivity also extends to some other places like Iraq,
Malaysia and Mauritius. Since its launch, it has conducted around 53,000
tele-consultations in the areas of cardiology, neurology, urology and cancer.
Narayana Hrudayalaya also has an electrocardiogram (ECG) network wherein
general practitioners in remote locations are given a trans-telephonic ECG
machine that helps transmit ECGs. Narayana Hrudayalaya gets about 200-300 ECGs
daily. These are interpreted by its doctors and then communicated to the local
doctors at the remote locations.
Shetty points out that telemedicine is not just about connecting remote
locations. Six years ago, when Narayana Hrudayalaya started performing liver
transplants on babies, its cardiac anesthetists did not have adequate
experience for this procedure. So Shetty turned to telemedicine. Narayana
Hrudayalaya's operating room in Bangalore was connected to the Children's
Hospital of Philadelphia and the anesthetists there. "After hand-holding
for about five to seven liver transplants, our anesthetists acquired the knowledge,"
says Shetty. He goes on to add: "In the coming years, most of the medical
treatment will be through telemedicine either in the same city or in other
countries. There will be enough gadgets available at home to check blood
pressure, blood sugar, ECG, oxygen saturation, even ultrasound. Patients will
consult the doctors through mobile phones or videoconference through
cellphones."
Some of this is already happening. Recently, leading telecom player
Airtel tied-up with Healthfore (a division of Religare Technologies) and Fortis
Healthcare (a Religare group company) as the knowledge partner to offer
Mediphone services to its customers. This service allows subscribers to access
basic medical guidance on non-emergency health problems over the phone. The
service is available around-the-clock at less than US$1 for each consultation.
Other telecom players like Aircel and Idea have launched similar
services in collaboration with HealthNet Global, a Hyderabad-based emergency
and health care management services firm. The subscribers who call to seek
health advice are visited by paramedics who come with a laptop and medical
diagnostic equipment and conduct consultations via video conferencing. This is
also gaining traction among insurance companies. "We have already conducted
1,000 sessions since our launch in September 2011. We are currently present in
Chennai, Mumbai, Delhi and Hyderabad. We plan to expand our services to all the
metros," notes Rahul Thapan, global head of marketing & sales for
HealthNet Global.
In December of last year, microfinance firm Equitas also launched
tele-health care delivery centers in association with HealthNet Global. The
project is funded by Fem Sustainable Social Solutions (FemS3), a nonprofit
company operating in the social business space. Equitas' Consult 4 Health and
Call 4 Health products, developed exclusively for the firm by the Centre for
Insurance and Risk Management at the Chennai-based Institute for Financial
Management and Research, allow its members to consult physicians from Apollo
Hospital over video for a charge of US$1 a consultation. The patient's data is
also stored for any further diagnosis and treatment in the future.
"It is our endeavor to improve the quality of lives of our members
and their families," says P.N. Vasudevan, managing director of Equitas.
"Health care is a source of significant financial stress for this segment.
The initiative with HealthNet Global using physicians from Apollo Hospital will
bring a revolution by providing health care to the doorstep of our members and
the best medical care anytime, anywhere. We will roll out our services from
Chennai and gradually go pan-India." Currently, Equitas has three
tele-health care centers operational in Chennai.
Other new models are also emerging. Take Mumbai-based MeraDoctor (My
Doctor) founded in 2010 by Gautam Ivatury, who was earlier working in the area
of mobile phone-based services, and Ajay Nair, a medical doctor with a master's
degree in public health management from Harvard. A phone-based medical advice
service, MeraDoctor works on a membership model. The company offers family
membership plans for three months and six months; during this period, members
are entitled to unlimited phone consultations with MeraDoctor's team of
doctors. Members can also avail of discounts at select diagnostic centers that
MeraDoctor has tied up with.
There are new products, too. Dartmouth's Govindarajan points to General
Electric's innovative low-cost ECG machines, which were developed in India and
can take digital images that can be emailed to cardiologists in the U.S.
"[This gives] poor patients in remote rural areas access to world-class
care," he says.
Another example is 3nethra from Bangalore-based Forus Health. Developed
with the aim of enabling mass pre-screening outside the hospital environment,
3nethra is a portable, non-invasive device that helps in early detection of eye
diseases like cataract, diabetic retina, glaucoma and cornea related issues.
The digital information taken by 3nethra can be easily transmitted electronically.
The device won the Samsung Innovation Quotient award in 2011. "At 3nethra,
we wanted to work with the system and its limitations," notes K.
Chandrasekhar, founder and CEO of Forus Health. "Even a minimally trained
technician can operate it. The idea was to develop a solution that was cost
effective. The device that we have developed is available for one-sixth the
cost of present diagnostic devices. Also, it uses only 10 watts of power. It
can run for four hours on a UPS, making it ideal for rural areas [which face
enormous shortage of power]."
Challenges Remain
But even as the telemedicine scenario in India is seeing significant
developments, challenges still remain. According to Narayana Hrudayalaya's
Shetty: "The greatest challenge is getting enough medical specialists to
see patients in remote locations and also to get the patients to trust the
opinion by the doctors, virtually."
Healthnet Global's Thapan points out that India will soon have a
billion phone connections and the network will not be a problem. "It's now
about finding the right linkages," he says. Thapan notes that ASHA
(Accredited Social Health Activists) workers, for instance, can be trained to
aid the doctors. "It will help spread the network," he adds.
Apollo's Ganapathy suggests that the potential of telemedicine in India
is still under-realized because of lack of awareness among the masses and lack
of a business model that caters to all the stakeholders. "Telemedicine
will never reach the critical mass for take-off until doctors are excited about
it and unless people clamor for it as a cost-effective method. We need
public-private-partnerships to drive telemedicine [in India]."
Mehta of PwC says the entire ecosystem needs to be strengthened.
"Ten years ago, there was the technological barrier," he notes.
"That has gone away. However, the economic barrier stays. The ecosystem,
in terms of incentives for the hospitals, the broadband service providers and
the patients, needs to be defined. That is the tipping point of the
telemedicine market in India."
India Knowledge@Wharton
Business & Investment Opportunities
YourVietnamExpert is a division of Saigon Business Corporation Pte Ltd, Incorporated in Singapore since 1994. As Your Business Companion, we propose a range of services in Consulting, Investment and Management, focusing three main economic sectors: International PR; Healthcare & Wellness;and Tourism & Hospitality. We also propose Higher Education, as a bridge between educational structures and industries, by supporting international programs. Sign up with twitter to get news updates with @SaigonBusinessC. Thanks.
No comments:
Post a Comment