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Challenges in developing Countries & E-Health

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

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Challenges in developing Countries & E-Health

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  1. 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

  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 ICT Rajendra Pratap Gupta

  3. eHealth is no more an innovation now. It is a basic necessity of every healthcare system Rajendra Pratap Gupta

  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

  5. Priorities for the Developing World • MDGs 4 & 5 – MCH • Healthcare delivery in rural areas • NCDs • Training of *HCWs * HCW – Healthcare Workers

  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

  7. Jeevandainee Project - Maharashtra

  8. Sample report – High risk patients

  9. Tracking high risk pregnant women

  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

  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

  12. eHealth delivering in low resource settings Equipment • Stethoscope • Temperature • Blood Pressure • ECG • SPO2 (opt) • 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

  13. Rural Health Centre

  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

  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.

  16. 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

  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

  18. mHealth – addressing the challenge • 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 18

  19. Challenges for eHealth • Lack of data in support of eHealth • Successful & scalable eHealth projects • Technical competence amongst policy makers to understand eHealth

  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 ).

  21. 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

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