ITU Workshop on
“E-health services in low-resource settings:
Requirements and ITU role”
(Tokyo, Japan, 4-5 February 2013)
Challenges in developing Countries
& E-Health
Rajendra Pratap Gupta,
Member , World Economic Forum’s
Global Agenda Council – Digital
Health 2012-14
Office.rajendra@gmail.com
Tokyo, Japan, 4-5 February 2013
eHealth was born out of the challenges
of - constrained financial resources,
Clinical resources, infrastructure,
increasing need of healthcare in rural /
remote settings and advancements in
ICT
Rajendra Pratap Gupta
Tokyo, Japan, 4-5 February 2013
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eHealth is no more an innovation now.
It is a basic necessity of every
healthcare system
Rajendra Pratap Gupta
Tokyo, Japan, 4-5 February 2013
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eHealth – Push & Pull
MCH – IMR – MMR
Rural Health
Health Screenings
Secondary prevention
amongst affluent class
– NCDs
Second opinion or
referrals & teleradiology
Geriatric Care
Medical tourism
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Priorities for the Developing World
MDGs 4 & 5 – MCH
Healthcare delivery in rural areas
NCDs
Training of *HCWs
* HCW – Healthcare Workers
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MDGs 4 & 5
In India , MMR is 212 / 100,000 live
births . 1 death every 10 minutes.
Target is to get MMR down to 109 /
100,000 live births by 2015
IMR is 48 / 1000 live births & needs
to be brought to 42 / 1000 by 2015
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Jeevandainee Project - Maharashtra
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Sample report – High risk patients
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Tracking high risk pregnant women
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Outcome
Cost of intervention per village < $ 100
In a year and half of being in
operation;
Maternal mortality dropped from 91
/100,000 to 51 / 100,000
A drop of 43.95 % in MMR
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Healthcare Delivery in Rural areas
70 %( about 830 million ) of India’s
population lives in rural areas
India has about 6,40,000 villages
Absenteeism of doctors is 40 % in
rural settings
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eHealth delivering in low resource settings
•
•
•
Service is operational in several
regions in India
– More than 677 village centers
in UP, Bihar, Tamil Nadu, AP,
Maharashtra, Tripura, MP &
Karnataka.
More than 200,000 consultations,
Rs. 20-200 fee, sustainable village
centers
Covering 40 Mn population. To
increase to 70 Mn by end of 2013.
Equipment
•Stethoscope
•Temperature
•
30-40% traffic of patients who
have earlier visited for a different
ailment
•Blood Pressure
•ECG
•SPO2 (opt)
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Rural Health Centre
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NCDs
53 % of all deaths in India due to
NCDs ( WHO ). This is set to increase
by 18 % in the next 10 years ( WHO).
* Raised blood pressure prevalence is
32.5 % ( approx. 396 million )
* Raised blood glucose prevalence is
10 % ( Approx. 122 million )
*
Tokyo, Japan, 4-5 February 2013
estimates as per WHO. http://www.who.int/nmh/countries/ind_en.pdf
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NCDs
Government has already started a
mass screening program
Crossed 14 million screenings
India needs a mass secondary
prevention program for NCDs, using
mHealth / eHealth.
Tokyo, Japan, 4-5 February 2013
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eHealth has the solution for RPM*
• Biometric Screening
–SpO2
–Blood Pressure
–Blood Sugar
–Spirometry
–Total Cholesterol
–ECG
–Triglyceride
–Body Composition
–HBA1C
–Ultra-sound
–X-Ray
– Doctor consultation
* Remote Patient Monitoring
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Training of *HCWs
India has approx. 866000 *ASHAs
No. of ASHAs to increase in future
A new 3 year course for HCWs (Rural)
Training , capacity building & retraining - a big challenge !
*
Tokyo, Japan, 4-5 February 2013
HCW – Healthcare Workers. ASHA- Accredited Social Health Activist
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mHealth – addressing the challenge
•
Trained 40,000 workers
•
1 million minutes of talk time
used by Health workers
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360 degree approach to
communication
•
Launched 4 months ago
•
Covers 29 million
population / 8 districts
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Challenges for eHealth
Lack of data in support of eHealth
Successful & scalable eHealth
projects
Technical competence amongst
policy makers to understand eHealth
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Challenges for eHealth
VOI ( Value On Investment ) should be
considered for eHealth and not just
financial ROI ( Return On Investment ).
BOO ( Build , Own & Operate model )
or BOOT ( Build , Own , Operate &
Transfer model ) under PPP ( Private
Public Partnership model ).
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Conclusions and Recommendations
When it comes to eHealth , we have achieved
‘technical maturity’ , but the lack of
‘organizational maturity’ is proving to be a big
bottleneck in unlocking the potential of eHealth
Rajendra Pratap Gupta
Tokyo, Japan, 4-5 February 2013
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