The second wave of Covid is ravaging India, especially the urban cities. Apart from being deadlier another distinct feature of the second wave has been — it is spreading to the rural parts of India as well. During the first wave, people in rural parts used to ask us ‘if it is true or a myth’. However this time it’s very different and people are getting affected in every village we are working in. It is heartening to see every group on social media turning into a support group for Covid and collectively working to get us through such unprecedented times. Urban cities are the focus of much of these efforts. How are we going to solve this problem for the massive population residing in rural India? The fact that 70% of the population is in rural areas whereas only 30% of doctors serve this population is a sobering one. We believe Telemedicine is the solution to the rural healthcare problem. The regulatory approval for Telemedicine last year from the Government of India could not have come at a better time. However, the regulatory approval of Telemedicine is just one piece of the puzzle — execution on the ground would be the key and that requires a fundamental shift in thinking and problem-solving. Let us first look at the current approach to addressing the problem of rural healthcare.
There are 6.5 lakh villages in India where almost 70% of the Indian population resides. To provide healthcare in these villages the government of India built a huge infrastructure of 23,391 primary health centers and 145,894 sub-centers. Crores of rupee are pumped into building this infra, however, access at the grassroots level remains abysmal with most of the centers remaining closed or open infrequently. As a consequence people in rural parts have to go to cities to get health services because quality healthcare service providers are in big towns and people have limited access to them. They have to spend money on transport which increases the cost of treatment. Getting the right treatment and avoiding overspending is also a big concern. Treatment for chronic ailments needs regular check-ups, is costly and resource-intensive. For rural women & girls getting advice on female issues is difficult and costs a lot. Because of all these quacks rule the rural part of India and people prefer them to save money and due to lack of awareness. Mostly rural people are served by nurses & quacks, who are mainly male via a small clinic. They operate without any medical qualification/license, hence they don’t invest in any infrastructure and are not able to provide reliable healthcare. According to MCI data, there are 10,00,000+ quacks operating in India. Healthcare is broken to the core in India.
We believe Technology is the lynchpin for weeding out these systemic inefficiencies. Telemedicine is a natural choice to improve access to good quality consultation. But rural people face certain problems that can’t be addressed by the now ubiquitous mobile-only solutions. In fact, with this second wave, most of us used Telemedicine to get regular healthcare and realized that we can get advice but to get quality advice, doctors need data of patients without which it’s just like shooting in the dark. I think we need to fundamentally rethink how we are going to solve this problem. While working on this problem for the past few years to provide primary care remotely in a village, we found seven key insights which we need to keep in mind to solve this problem from the root.
- Local Dialect: A doctor sitting in another city will not be able to understand the dialect of the rural person. It’s because in India the dialect of people changes every 10 km. So overcoming the dialect problem requires a local person on the ground to bridge the gap between the doctor and patient.
- Vital measurement:- For any kind of diagnosis you need to measure the patient’s vitals and that facility is not available in the majority of rural India. The problem is so acute that people in rural parts don’t even keep a thermometer to measure temperature which is the most common vitals to look at.
- Behavior change:- Expecting a behavior change in people in rural India which is harder than anywhere else. People are used to going to the nearest clinic, get advice, buy medicine, get any test done then and there and come back. This is also one of the reasons why quacks are successful in rural India. Expecting these people to book online and make payment online is a far-fetched idea right now.
- Demand all services at one place:- Rural people demand all the services at one place. The reason why quacks can operate in rural India is that they provide complete treatment at their place. Expecting people to buy medicine from somewhere else and getting tests done from different places is not going to work.
- Time and cost:- Given how far the health centers are, the time to go there, lost wages due to that and the cost of traveling is so high that people choose not to go there until the problem becomes critical. Once the problem becomes critical they end up paying more for the same treatment.
- Geographical spread:- India got 6.5 lakh villages and out of these only 99,000 villages are with a population of greater than 2,000 rest all are small villages or satellite villages. Opening a health center in each village will not be feasible and economically viable even for the government. Generally, in rural India, there is a village with >2000 population and some 10–15 small villages in the near vicinity of 10kms. The solution needs to take care of the geographical spread of villages.
- Patient Education:- educating rural people about the right treatment is key in solving this problem. They are used to the treatment of quacks and look for similar treatment, so educating them about the disease, diagnosis and treatment is necessary.
At Aaspatal we realized these are fundamental problems that are there with rural people in India and a simple solution can solve this problem.
Telemedicine + a local health-worker on the ground + Mobile Clinic + Connected Diagnostics + Cloud hospital
This is what we have built at Aaspatal in the last 1 year to provide quality healthcare services to the remotest part of India. We started our journey with one motto “ Build end to end solution for delivery of primary healthcare to the next billion using mobile & IoT technology”. At Aaspatal we are developing a network of ‘semi-automated, intelligent, reliable, and connected’ micro-clinics that would solve the problem of non-accessibility and affordability of healthcare to the underserved population of India. These micro-clinics will serve as economical healthcare centers with diagnostics, medicine dispensing, and consultation platforms. ‘Intelligence’ in the micro-clinics should enable easy training to the low-skilled resources in the rural areas as well as assist remote physicians to diagnose effectively and efficiently. ‘Connectivity” should help the patients to access the experts in Tier 1 & Tier 2 cities. It will be a one-stop solution for rural and remote areas of India to get basic healthcare in one place at a very low cost and with minimum human intervention.
- Telemedicine:- People in rural India would like to see a doctor on a large screen and this also helps us build trust with rural people easily. So built “TeleDev” our low-cost Teleconsultation device which runs on a raspberry pi OS with a large screen with an endoscopic camera for ENT care and thermal printer for prescription printing.
- A local health worker:- a qualified nurse who knows the local language is the key in the model and this person should be from the village only to build trust and provide proper home care as well.
- Micro clinic with a satellite clinic:- A fixed micro clinic in main villages with a population greater than 2000 and a mobile clinic to serve the nearby villages and cover a larger population to make the whole machinery economically viable. This has to be an electric vehicle which will help save the fuel cost and provide the necessary power to run the small diagnostic and Teleconsultation setup.
- Connected diagnostics: “Athena” is a critical piece in the entire setup as you need to provide the complete vitals data to the doctor, that too without any human error in a short time so that people can get quality advice from doctors.
- Cloud hospital:- Supply of specialist doctors as per the need of the patient via cloud hospitals or partner hospitals.
through this model, we were able to provide primary care to 6,000+ patients and reach the remotest villages in Rajasthan with no access to healthcare.
India stands at 145 out of 190 countries in terms of healthcare access and quality index (Global Burden of Disease study published in Lancet) despite being the 3rd largest economy in the world. If we put the efforts in the right direction and implement this solution we can definitely improve our ranking among the top 10 countries in the next 10 years. With a network of 3,00,000 health micro-entrepreneurs, we can solve this problem to the core of India and Aaspatal is moving forward with this mission.
We are looking for partners and micro-entrepreneurs who want to solve this problem in their villages. We are more than happy to share our learning and share our technology with anyone willing to solve this. Do reach out to us at abhay@aaspatal.com
