TELEMEDICINE: A solution to the burgeoning healthcare needs to bridge the demand supply gap of patients and healthcare professionals

 

TELEMEDICINE: A solution to the burgeoning healthcare needs to bridge the demand supply gap of patients and healthcare professionals

By: Sanjeeb Kumar Samal

Recently I had been to villages remote to Bhubaneswar, the capital of Odisha to conduct health camps free of cost under the Corporate Social Responsibility (CSR) scheme of our company. We moved with a team of general practitioners and with medicines. The dates were announced in advance in order to get a good attendance. Normally 100 to 500 patients turned up in each of the health camp. Some familiar patterns of disease prevalence were observed among the patients who attended the health camps. Aged persons with complaints of knee pain would be common phenomena in all the health camps. In one of the camps I was surprised by one observation. The measure of blood pressure of some female patients showed very high value, which to me was unlikely. On seeking a reason for that the doctors told me that the village folks take lot of water dipped rice with high salt in their diet (in eastern part of India intake of watered rice is common by the poor section of populace)  and the salt is causing the elevated blood pressure.  The doctors accompanying used say that lot of patients will be found malaria positive in the health camps considering the environmental conditions of our venues, but so was not the case. I wish this had a correlation with the ongoing National Vector Borne Disease Control Programme (NVBDCP) under National Rural Health Mission (NRHM) which has given clear cut guidelines and tools to eradicate vector borne diseases like malaria, dengue, filariasis and kala-azar. It was a pleasure to see that the pathology technicians in our team would bring along rapid test kit lots from public hospital to detect the vector borne diseases.

I used to think that non communicable diseases (NCDs) are absent in the rural areas in comparison to urban areas. But, the observation I had in that health camp and interaction with doctors did change my perception. The NCDs of cancer, cardiovascular diseases and diabetes have found their ways into rural heartlands due to urbanization, tobacco consumption, alcohol consumption and physical inactivity. An epidemiological transition is taking place in the rural areas as well. In fact the Government of India has taken cognizance of the fact and has recently launched the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) in the year 2010.

It’s well known that the NCDs are fast grappling the urban Indian population and simultaneously undeniable that the NCD monster is steadily raising its head in the rural mass as well. This calls for deployment of specialists in the rural areas treat the rising numbers of NCD patients.

The Government led initiatives are slow and usually takes too long time in addressing the disease prevalence and very likely that the status quo will continue in the future. If the Year-2011 reports are any indicator of how things are placed in current scenario, the following table elucidates, out of 19,236 specialist posts 12,301 are in shortfall in the 4,809 total CHCs (Community Health Centre: Secondary health care centers for rural population) of our country

Table: Requirement Vs. Deployment of specialist doctors in CHCs

States

Total CHCs functioning

Required (4 specialists per CHC)

Sanctioned

In Position

Vacant (sanctioned-in position)

Shortfall (required- in position)

Himachal Pradesh

76

304

NA

9

NA

295

Bihar

70

280

280

151

129

129

Assam

108

432

NA

216

NA

216

Orissa

377

1,508

812

438

374

1,070

Uttar Pradesh

515

2,060

2,060

1,894

166

166

Chhattisgarh

148

592

592

82

510

510

Jharkhand

188

752

124

66

58

686

Rajasthan

376

1504

1068

569

499

935

Madhya Pradesh

333

1,332

778

227

551

1,105

Uttarakhand

55

220

210

78

132

142

All India

4,809

19,236

9,831

6,935

3,880

12,301

 

 

 

 

 

 

 

 

 

Source: http://www.indiaspend.com/sectors/rural-india-faces-60-shortage-of-doctors

There are seemingly two options to combat the menace.  One is to increase the postings  of medical/paramedical professionals and second is to apply Information & Communication Technology (ICT) to bridge the distance between the doctor and patient in the existing set up.

Telemedicine is considered as the next game changer in healthcare by leveraging electronic & telecommunication advancement to connect the patients and doctors separated by distance. Treatments is possible over video calls, conferencing calls from consultation to tertiary treatments in mental health, dermatology etc. Telemedicine will also be useful in seeking second opinion and providing continued medical education to health care professionals.

Source: ISRO Site

With innovations in the logistics associated around the telemedicine system, issues like lack of awareness, non –affordability, distance from the healthcare centre and fear of falling into the trap of moneymaking private hospitals, which prevent the villagers from seeking quality healthcare can effectively be addressed.

Telemedicine is in a much nascent stage in India. Organizations such as ISRO, SPGIMR Lucknow , PGIMER Chandigarh , Govt. Medical Colleges of Orissa,  Apollo Telemedicine Network Foundation, Telemedicine Society of India and some private tertiary care organizations are taking pioneering steps in promoting telemedicine. Suitable policies by the Government and entry of entrepreneurs will make Telemedicine an acceptable medium of providing healthcare services to larger and underprivileged section of the society.

About the author: Sanjeeb Kumar Samal, an engineer by profession, a healthcare enthusiast and an aspiring healthcare entrepreneur. The author can be reached sk_samal@yahoo.com

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Auditing of the unused budgetary allocations for Healthcare sector

DMAI

Rajendra Pratap Gupta

President & Board member

 

December 27th, 2012

Dr. Murli Manohar Joshi

Chairman

Public Accounts Committee

6, Raisina road, New Delhi 110001

 

Ref: Auditing of the unused budgetary allocations for Healthcare sector

Dear Dr. Joshi,

Greetings from the Disease Management Association of India (DMAI).

This has reference to the meeting at your residence on 25th December 2012, and the discussions that we had on the Public Accounts Committee report on NRHM  (PAC NO. 1939). I have gone through the PAC report submitted by your good self to the Parliament. I wish to draw attention to the following references in your report;

Page 9: Mission Steering Group (MSG) was required to periodically monitor progress of the mission and to meet twice a year.  Audit scrutiny revealed that MSG met only four times in four years instead of 8 times as per the laid guidelines.

The delegation of powers to the MSG and EPC (Empowered Programme Committee) was subject to the condition that a progress report regarding NRHM, also indicating deviation from the financial norms and modifications in ongoing schemes, would be placed before the cabinet on an annual basis. However, during the past four years, the Mission had submitted a progress report to the Cabinet only once in August 2008 (as per the PAC report).

Page 12: Public Private Partnerships (PPP) in RCH services is not up to the expected levels

Page 18: Regarding composition & functioning of the VHSC (Village Health & Sanitation Committee)

Secretary Health’s statement,

“To be very honest with you, we have got a survey done recently by the Institute of Population Sciences, and yesterday they gave us a presentation. It is not a very happy picture on the village health societies. In many of them, people did not know if they existed; they did not know who the members are; they did not know if they are functioning; that was the finding of the planning Commission’s mid-term review also, when they had gone round the country and seen… that is VHND. There is certainly a vision in the NRHM when it was designed. That has not been fructified……….

“ Our experience with Panchayat raj is not good. They also complained about it. Half of the fund is not spent because he is the co-signatory – either he is not living in the village or if he is, he harasses her and why should she sign? The entire Panchayat raj system, with due respect, has not really worked; the ideal is one thing, but practically it is not; those who take interest, have got excellent experience, but those who are not interested, it is not good. It is very difficult for these people; it has not worked out well”.

Page 19:  Health Secretary’s response on, “how the ministry ensures that the disbursal of funds by the state health societies to VHSCs is monitored”?

“This is a huge task for the states. They are finding it very difficult to keep a track of so many small accounts. But we have given them accountant at every block level. In a block there will be some 100 VHSCs. He should have been able to get these accounts and see what they have spent on and do the auditing. We will have to streamline it further and get them to do the auditing. But we suspect about Rs.100-200 Crore lying unspent. That is our present assessment”

Page 20: Table 3 highlights the gap between the funds released and expenditure.

Page 23: Point 55, “ However, the Ministry have clarified that actual utilization of the funds allocated shall depend upon a number of factors in particular the absorptive capacity of the system. In fact, one of the argument put forward by many is that while the actual allocation in the Eleventh Plan was lower than the original plan allocation, the actual expenditure has still been lower i.e. the system has not been able to utilize the curtailed outlay”

Page 28: “It may be observed that rural households account for around 55 % of the total out of pocket expenditure within the country”

Page 31: Audit examination revealed that 71 PHCs (11 per cent) in 15 states were functioning without an allopathic doctor. In 518 PHCs (86 per cent) of 28 States / UTs, an AYUSH doctor had never been appointed. 69 test checked PHCs were functioning without an allopathic doctor or an AYUSH doctor. This meant that population residing in their sphere of coverage had no doctor available at all in the public domain. In Andhra Pradesh, Haryana, Himachal Pradesh, Kerala, Madhya Pradesh, Mizoram, Punjab, Sikkim, Tripura and Lakshadweep, none of the test checked centres had an AYUSH doctor.

Page 33: “As per norms, Specialists are appointed only at CHCs level and not at PHCs level. As per the data available in Bulletin on Rural Health Statistics in India (Updated up to March 09), a total of 5789 specialists are in a position at CHCs across the country, as against the sanctioned posts of 9028 specialists…………”

Dr. Joshi, as discussed during our meeting, it is imperative that the PAC / CAG, or any competent independent regulator, starts the audit of unspent funds allocated for each social sector so that the benefit of the plan reaches the targeted population. As DMAI, we would be interested in pursuing this issue further with the concerned authorities. Also, a clear and enabling policy framework is required, so that the bureaucrats can take decisions without fear on fund allocation utilization, and the absorptive capacity of the system increases to 100 %.

I have been visiting the rural sub-centres and have been gathering first hand information about the impact of NRHM. This communiqué is marked to the PMO and MOHFW for information. Will meet you shortly with more details

Thanks for your continued support

Best wishes for a great year ahead, & tons of good wishes for your birthday, in advance. Wish you good health & long life.

With best regards

Rajendra Pratap Gupta

CC:  Dr.Manmohan Singh, Prime Minister,

Shri Ghulam Nabi Azad, MOHFW

Dr.Syeda Hameed, Member, Planning Commission

Secretary – MOHFW

DGHS

President , PHFI