Role of technology and innovation in rural healthcare in India
1. Role of Technology and Innovation in Rural
Healthcare in India
5
Anshul Pachouri
Senior Researcher
Institute for Competitiveness, India
E-Mail: anshul.pachouri@competitiveness.in
2. Rural India: A Snapshot
Definition of Rural India
s Monthly Per Capita Consumer Expenditure - 2009-
Series1,
Rural ( US $) 10, 21.18
The most standard and widely accepted definition is given by
Census of India in 2001 which define an area as rural area if it
fulfills the following conditions;
(1) Population density of less than 400 sq km Series1, 2004-
(2) Atleast 75% of the male population engaged in agriculture Series1, 1999- 05, 12.87
(3) No presence of Municipal Corporation or Board. 00, 10.80
Quick Facts Series1, 1993-
94, 6.36
Rural India – 70 % of the total Indian population
Total Rural Population :- 833 Million Individuals
Contribution to the National Savings – 33 %
Source: Data Extracted from Key Indicators of Household Consumer Expenditure in
India 2009-10, Ministry of Statistics, Government of India
Contribution to Total Consumption – 57%
Contribution to Total GDP – 45% • The monthly household per capita consumer expenditure (MPCE)
in rural areas has increased by more than thrice from 1993-
(Source: IBEF, NCAER and Census of India) 2010.
• Rural areas are going high on spending.
• But in the actual terms, they are spending half in comparison
to their urban counterparts.
3. Rural Healthcare : Opportunities
• India BoP healthcare market is estimated to be 26.5 Shortage of Series1, Radiogr Community Health Centers
Manpower at
billion 2005 International dollars at purchasing power aphers, 2724
parity dollars. In 2008 Series1, Genera
l Medical
• The average rural population meant to be served by each Officers, Total
Series1, 9933
health sub-center and primary health center is more than Specialist
6000 and 36000 respectively. Doctors, 11361
Series1, Paediat
ricians, 2991
• It is estimated that nearly 1.75 millions of beds will be
required to achieve the status of 2 beds per 1000 people, Series1, Physici
700,000 doctors to reach one doctor per 1000 population by Series1,ans, 2949
Obstetr
2025. (PWC) icians &
Gynaecologists,
•The total capital investment to reach the above targets is 2271
Series1, Surgeo
estimated to be US $ 80 billion approx. ns, 2583
• 8% of the total expenditure of rural people on health. Series1, With
Facilities at Primary Healthcare Centers
Telephone, 54.
Series1, With
3%
Computer, 47. Series1, Reach
0% able in all
weather
Series1, Witho conditions, 92.
ut Water 5%
Series1, Witho
supply, 12.4%
ut electric
supply, 14.2% Series1, With
4-6
Series1, Opera beds, 59.3%
tion
Theatre, 36.0%
Series1, Labou
r Room, 64.9%
4. Rural Healthcare: Challenges
Rural People Challenges Organizational Challenges
Distribution and Reach
Affordability
Recruiting skilled manpower
Accessibility
Tackling social issues and local beliefs (
Self medication)
Awareness
Creating awareness among the rural
consumers
Quality of Healthcare
Services
Changing the mindset of the rural
people
5. Emerging Business Models
Changing Times in Rural Healthcare
Tele-Medicine
With the advent of time, there has been significant change
Healthcare in the business models practiced in
Primary
Information rural healthcare and each type of healthcare is served by a
Healthcare
Systems particular type of business – model
and format.
Emerging Hospitals on
Traditional brick and mortar model can’t serve the
Trends Wheels
healthcare needs of rural people.
There is a need of sustainable and scalable business
Secondary models which can cater to this potential customer base.
Tele-Medicine
Healthcare
Healthcare Information Management Systems:
Telemedicine and BPO Model:
This model also uses the ICT technologies to guide its users
A new model which is emerging today is delivering healthcare about various good health practices.
with the help of information technology tools.
It teaches its subscribers about the different steps they should
Companies have discovered a notion to provide doctor’s advice on take which depend on the type of disease or health problem they
phone by using latest tele and video conferencing technologies. encounter.
6. Case 1.1: Apollo Tele-Medicine
Challenges
Apollo Telemedicine is largest and oldest telemedicine
network in India founded by Apollo Hospitals in 1999. •Changing the mindset of the people towards telemedicine.
•Winning the trust of the patients of rural areas.
Apollo Hospitals has two concurrent businesses in rural •Standardize the protocol of interaction between doctors and
healthcare and telemedicine, one is under the banner of Apollo tele-medicine center.
Telemedicine Network Foundation and other is Apollo Reach
Hospitals. Healthcare Delivery Model
The company was started way back in 1983 by visionary doctor The patients were advised from doctors from the distance
Dr. Prathap Reddy when private healthcare was not so popular in varying from 200 to 2800 Kms.
India.
The technology had enabled the telemedicine centers to scan and
mail the X-Ray’s and other medical
Apollo Telemedicine Networking Foundation The details of the patients were transferred to be multi-specialty
hospital by using desktop software.
First project of Telemedicine was implemented in the village
of Aragonda in state of Andhra Pradesh by building 50 beds
hospital connected to Apollo multi-specialty hospital of
Chennai.
Video conferencing tools supplied by the Indian Space Research
Organization (ISRO) were used to make tele-medicine possible
to reach the villages of India.
One tele-consultation with the super specialized doctor is done at
price of US $ 11.2-16.7 and 50 US $ if overseas consultation is
being done.
7. Case 1.1: Apollo Telemedicine
ISRO Offering Primary and Affordable & Quality Managing customer Poor Patients
Secondary Healthcare health-care services in data online (Subsidized)
State services Tier-2 cities and rural
Governments Tele-Medicine areas Rich Patients
Medical
Equipment
Suppliers
Doctors Video-conferencing
through tele-medicine
Para-Medical staff centers
Diagnostic Setup
Medicines
Infrastructure (Hospital, Equipment, Staff) Fees for specialist tele consultation
Resources (Doctors, Paramedical staff) Fees for Primary and Secondary
Training, ICT Setup, Software Healthcare Services
Medicines
8. Case 1.1: Apollo Tele-Medicine
Social Benefits
Social Costs
Access to quality and affordable healthcare to all, expert
Tacking the cultural differences and creating
opinion to the patients
awareness
Metrics
Organization Structure & Leadership
Number of specialists tele-consultations,
Centralized, Technology driven, multi-skilled Average
doctors and staff time taken per patient, system downtime, Cost per
patient, quality of service, number of tests
Results
Today, ATNF has more than 150 tertiary hospitals which are connected to 35 specialty hospitals
across the globe.
Today, Apollo had done 69000 tele-consultations done by more than 100 tele-consultation
centers setup across the globe.
The Aragonda hospital has done more than 2000 consultations had been provided in the last
10 years from direct video interaction with specialist doctors.
9. Case 1.2: Apollo Reach Hospitals
Apollo Reach Hospitals
In 2008, Apollo started its initiative Apollo reach hospitals to deliver low cost quality healthcare in Tier-
2 cities, sub-urban and rural areas.
Apollo reach hospitals also extend the telemedicine network of the group which helped the people of
the villages to get the best advice at their reach.
Challenges
The Apollo reach hospitals faced the critical challenge of availability of the doctors as people don’t
want to work in smaller cities.
Innovation in Business Model
The Apollo reach hospitals targets both rich and poor patients in equable manner.
The revenue comes from the high income people and affordable healthcare was provided to the
low income people on the other side.
The health insurance covers RSBY hospital expenses up to Rs. 30,000 ($667) for a family of five
people.
The transportation costs were also covered up to a maximum of Rs. 1000 ($23) including Rs. 100
($2.23) per visit to the hospital or doctor.
Apollo had also signed a loan of 50 million dollars from International Finance Corporation to
open up more reach hospitals and telemedicine center in 2010.
10. Case 1.1: Apollo Tele-Medicine
ISRO Diagnostic Tests Affordable & Quality Primary & Secondary Poor Patients
health-care services in Healthcare (Subsidized)
State Governments Tele-Medicine Tier-2 cities and
Consultation rural areas Insurance Offer Rich Patients
Medical Equipments (RSBY)
Suppliers Primary and
Secondary Healthcare
Doctors Face2Face Consultation
Para-Medical staff Video-Conferencing
Diagnostic Setup
Infrastructure (Hospital Setup, Equipment etc) Primary and Secondary Healthcare
Resources (Doctors, Paramedical staff) Money from Insurance
Training, ICT Setup, Software Medicines
11. Case 1.2: Apollo Reach
Social Costs Social Benefits
Publishing Papers to create the awareness Access to quality and affordable healthcare
Inclusion of poor people (paramedical staff)
Metrics
Organization Structure & Leadership
Poor-Rich Patients Mix, Average time taken per
Centralized, Technology driven, multi-skilled
patient, system downtime, Cost per patient, quality
doctors and staff
of service
Results
The inclusive business model of Apollo Hospitals had helped to reach sustainable
revenues
ranging from Rs 6000 ($132) to Rs. 7000 ($154) per bed.
It is estimated that more than 1, 00,000 patients who earn less than 2$ per day had been served
from Apollo reach hospitals.
The group aims to open 15 more hospitals and serve more than 400,000 patients by 2015. The
group also aims at opening 1000 telemedicine centers by the end of 2012.
12. Case 2: E-Health point Services
E-Health Point services is owned by HealthPoint Services India (HIS) Healthcare Delivery Model
started its operations in 2009 in partnership in Ashoka Foundation and
Naandi Foundation in the state of Punjab. Tele-medicine consultation was done by HIS urban health
center where doctors give their advice and diagnose by
Three projects were started simultaneously at different places by video-conferencing tools.
providing the services of tele-medicine, diagnostic services,
pharmacy and clean drinking water supply to around 10000 people. Doctors were recruitment from local areas so that there are
no linguistic disadvantages and they are especially
In 2011, E-Health Points (EPHs) are operational with more than 80 trained to for providing tele-consultations.
EPH centers spreading over seven districts of Punjab.
EPH also has the facility of performing near 70 tests and
Innovation in Business Model equipped with devices like digital stethoscope, blood
pressure monitoring machine and ECG.
The services were offered with a nominal fees of less than 1$ mostly to
make it affordable for rural households. The average cost of each medical test was just $1.
The subscription was given at a very nominal fees of 1.5$ per month and
gives 20 liters of clean drinking water daily which has helped in
decreasing the water-borne diseases in rural areas.
The medicines were given to patients by licensed pharmacy available at
EPH and are sold at a discount of up to 50% on the listed prices and
directly procured from channel partners of the companies to get the cost
advantage.
13. Case 2: E-Health point Services
Ashoka Pharmacy Affordable & Quality Primary Healthcare Poor Patients
Foundation health-care services in
Tele-Medicine rural areas Clean Water Rich Patients
Naandi Consultation
Foundation Providing Clean Water
Government
of Punjab
Doctors Video-Conferencing
EPH Centers
Video-conferencing
Setup
Center Staff
Infrastructure (Tele-medicine center, Equipment etc)
Resources (Doctors, Staff) Tele-medicine Fees, Medicine revenues and Clean
Training, ICT Setup, Software water subscription
14. Case 2: E-Health point Services
Social Costs Social Benefits
Organizing awareness and information sessions Access to quality and affordable healthcare to the poor
Metrics
Organization Structure & Leadership
Number of Patients, Average time taken per
patient, system downtime, Medicine sales and
Collaborative, Inclusive, Technology driven
water subscription, service quality
Results
EHP has done about 29000 tele consultations, 15000 diagnoses and 35000 prescriptions have
been given since its inception to September, 2011. T
he impact and wider reach of EHP at bottom of the pyramid can be understood by the way
that it has around 3,50,000 daily users of clean water in rural areas.
15. Case 3: Piramal E-Swasthya
Piramal E-Swasthya was started in 2008 as a social healthcare Healthcare Delivery Model
initiative of well established pharmaceutical company Piramal
Healthcare in collaboration with Dean Nitin Nohria of Harvard Business
School.
• Patient comes to the Piramal Swasthya
Innovation in the Business Model
Sahayaka (Health Worker) for treatment
E-Swasthya doesn’t charge any consultation fee from the patients, they
just charge the expense of the medicines.
• Health Worker tell the symptom to the call
The medicines were made available to the health workers for selling to center executive
the patients to generate instant revenues.
The marketing was done in a very effective manner to engage the
rural people and BoP households through regular messages, drug • Call center executive feeds the symptoms
remainders and publication of articles on telemedicine. as input into clinical decision support
system
Challenges
The patients are not ready to buy all medicines as prescribed or • Clinical Decision Support displays the
just don’t complete the full course of medicine. recommended prescription based on
various algorithms
Recruit the motivated health workers which can take the model to the
next level.
• Doctor validates the prescription and if
To address this challenge, E-Swasthya has launched pilot project with required talk to the patient
Government of Rajasthan to recruit ASHA (Female Government Health
workers).
16. Case 3: Piramal E-Swasthya
Government of Pharmacy Affordable & Quality Primary Healthcare Poor Patients
Rajasthan health-care services
Tele-Medicine in rural areas Health worker Rich Patients
Tata Consultancy
Services Selling Water
purification tablets
Vision Spring and
reading glasses
Aquatabs
Doctors Video-Conferencing
Health workers
Call center Health worker
Clinical Support
Systems
Infrastructure (Call center) Medicine revenues
Resources (Doctors, Call center Staff, Health
worker)
Training, ICT Setup, Clinical Support System
17. Case 3: Piramal E-Swasthya
Social Costs Social Benefits
Awareness through publishing newspaper articles Access to quality and affordable healthcare to the poor
Metrics
Organization Structure & Leadership
Number of Patients, Average time taken per
patient, system downtime, Medicine sales and,
Innovative Technology driven
service quality
Results
E-Swasthya has treated 40,000 patients through several pilot projects which were deployed .
E-Swasthya gets on an average 1.2 patients per health worker per day in 50 operational villages.
To cover all the costs including the operational, technological and personnel and make the model financial
sustainable in the long run, it is required to achieve 1.7 patients per health worker per day on an
average for 1000 villages. The figure is quite achievable as already many villages have witnessed more
than 3 patients per health worker per day.
18. Conclusion
Tele-medicine has emerged as a sustainable business which can cater the healthcare needs of the rural
people and bottom of pyramid.
Tele-medicine is extremely helpful in primary and secondary healthcare, however more advancements
are required to replicate the model for tertiary healthcare in rural areas.
The use of information & communication has removed the distribution and geographical challenges in
delivering the primary and secondary healthcare in rural areas.
ICT has significantly reduced both the infrastructure and operating cost for delivering the quality
healthcare services to rural areas.
Tele-medicine has been used as market development tool by the companies to create a new market for
getting an expert doctor advice without meeting him in personal.
The emerging business models looks very promising but it’s very early to comment on their long term
scalability and sustainability. The next 2-3 years will actually show clearer picture of the future of tele-
medicine in India.
The treatment of the poor segment at cheap and affordable price is a huge social capital created by these
business models.
By giving treatment to the poor segment and people in rural areas, these business models are contributing in
the inclusive growth of India full filling the dream of “healthcare to all”.
19. Recommendations
Government hospitals should be converted into public private partnership models to make them more profitable and effective in
delivering the healthcare.
Companies need to make tele-medicine as their core activity rather than a side activity. They need to offer full basket of healthcare
services in order to make their business models more sustainable and scalable.
There is also a need of more advanced healthcare information management system like Nokia health tools. Healthcare information
systems can play a crucial role in preventive healthcare and creating the awareness about healthcare with the increasing penetration of
mobile phones in rural India.
The government need to give adequate subsidies and tax benefits to the companies operating in rural healthcare to make their
business models more scalable which can enhance the reach of tele medicine to different parts of the country.
It is very important that bigger companies should enter the market the tele-medicine and rural healthcare industry to develop the
market and make it more scalable and sustainable.