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

ITU Workshop on “E-health services in low-resource settings:

Requirements and ITU role”

(Tokyo, Japan, 4-5 February 2013)

Tokyo, Japan, 4-5 February 2013 2

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

ICTRajendra Pratap Gupta

Tokyo, Japan, 4-5 February 2013 3

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 4

eHealth – Push & Pull

MCH – IMR – MMR

Rural Health

Health Screenings

Secondary prevention amongst affluent class – NCDs

Second opinion or referrals & tele-radiology

Geriatric Care

Medical tourism

Tokyo, Japan, 4-5 February 2013 5

Priorities for the Developing World

MDGs 4 & 5 – MCH

Healthcare delivery in rural areas

NCDs

Training of *HCWs

* HCW – Healthcare Workers

Tokyo, Japan, 4-5 February 2013 6

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

Jeevandainee Project - Maharashtra

Tokyo, Japan, 4-5 February 2013 7

Sample report – High risk patients

Tokyo, Japan, 4-5 February 2013 8

Tracking high risk pregnant women

Tokyo, Japan, 4-5 February 2013 9

Tokyo, Japan, 4-5 February 2013 10

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

Tokyo, Japan, 4-5 February 2013 11

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

eHealth delivering in low resource settings

Tokyo, Japan, 4-5 February 2013 12

• 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.

• 30-40% traffic of patients who have earlier visited for a different ailment

Equipment•Stethoscope

•Temperature

•Blood Pressure

•ECG

•SPO2 (opt)

Rural Health Centre

Tokyo, Japan, 4-5 February 2013 13

Tokyo, Japan, 4-5 February 2013 14

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 )

*estimates as per WHO. http://www.who.int/nmh/countries/ind_en.pdf

Tokyo, Japan, 4-5 February 2013 15

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.

eHealth has the solution for RPM*

Tokyo, Japan, 4-5 February 2013 16

• Biometric Screening–SpO2

–Blood Pressure–Blood Sugar–Spirometry–Total Cholesterol–ECG–Triglyceride–Body Composition–HBA1C–Ultra-sound–X-Ray– Doctor consultation

* Remote Patient Monitoring

Tokyo, Japan, 4-5 February 2013 17

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 & re-training - a big challenge !

* HCW – Healthcare Workers. ASHA- Accredited Social Health Activist

mHealth – addressing the challenge

Tokyo, Japan, 4-5 February 2013 1818

• 360 degree approach to communication

• Launched 4 months ago

• Covers 29 million population / 8 districts

• Trained 40,000 workers

• 1 million minutes of talk time used by Health workers

Tokyo, Japan, 4-5 February 2013 19

Challenges for eHealth

Lack of data in support of eHealth

Successful & scalable eHealth projects

Technical competence amongst policy makers to understand eHealth

Tokyo, Japan, 4-5 February 2013 20

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 ).

Conclusions and Recommendations

Tokyo, Japan, 4-5 February 2013 21

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