India is a village based economy, as about 68 percent of its population (about 833 million people) live in 6,40,930 villages; the size of the villages varying from a population of less than 100 to about 70,000. Villages are not only the ‘feeder points’ (of providing raw material and manual labour) for urban areas, but are also the majority consumer market for urban industries and hence , ‘Smart Villages’ are essential for sustainability of smart cities project and Make in India. The issue of Smart villages is not about ‘fitment’ but of ‘sustainability’ of the entire economy. Also, when we talk of inclusive growth, villages cannot be left behind, else the growth of the country is not sustainable.
If we look at all the major initiatives of the Modi Government like; the Digital India Mission, Make in India , Swachh Bharat Mission , National Rural Livelihoods Mission, Pradhan Mantri Jan Dhan Yojana and Deen Dayal Gram Jyoti Yojana; all of them dovetail into the ‘Model villages’ / ‘Smart Villages’ mission . The former President of India, Dr. A.P.J. Abdul Kalam had initiated the PURA Project ( Providing Urban Amenities in Rural Areas) to bridge the divide between the have’s and have not’s. All these initiatives clearly indicate that without uplifting villages, India cannot grow sustainably.
Also, let’s rethink on one important future prediction – that by 2050, 60 % of the population will live in towns. I believe that due to the increasing density, pollution and declining quality of life in towns, over the next 20 years, we will see reverse migration starting, i.e. people living in urban and mega metros will start migrating towards hinterland / semi-urban / villages, as these areas will be less polluted and more peaceful and will offer a much better quality of living conditions. We must be prepared for ensuring that the building blocks of managing the living of a modern family are an essential part of the Smart village design as villages will be the main hub of activity in the next three decades.
Building blocks for Smart Villages :
One has to understand that, to make the villages smart, one needs to have the underlying theme of being ‘asset light ‘ & ‘low cost’ and, the over arching theme of digitization. These will be driven by IOT / Sensors. Almost all the challenges in rural areas are an opportunity for deployment of technology as a smart solution. Future of the village lies in adopting ‘idiot proof’, ‘future proof’ and low-cost technologies that can be used and serviced by the residents and can serve them well!
Building blocks of health for Smart Villages :
If 68 % of the population of the country (living in villages) is not healthy, then the growth of the country is at stake. Healthy population is the best insurance against recession and slow growth. We have to ensure that we provide enough options for people to adopt a healthy lifestyle and stay fit to be productive, and for this to happen, we need to leverage technology to its optimum use, integrated seamlessly into the daily life of the residents of the village.
It is expected that in the next 5-7 years, every household will have access to a phone , house , potable water and electricity and road and hence it is good to consider mobile phone as the basic necessity besides food , clothing , water, electricity and shelter. All the services from the government must converge to mobile-based platforms.
For health in a smart village, we need to visualize the following building blocks;
Mobile Electronic health record (m-EHR) is the starting point for health in a Smart village, as without Electronic health record , people cannot deliver healthcare using technology and these electronic health records should not be PC based but mobile based.
Once we have the m-EHR, the next thing we need is a pin-code wise geo tagging of all healthcare facilities and professionals, so that people can reach nearest healthcare provider or professional keeping the golden hour concept as the basis .
Also, one of the major draw back in distant / rural areas is the delay in getting the data and incidence of diseases, and hence, we need live data and electronic event reporting . Live data will not only lead to timely interventions, but also help in demand based supply chain, thereby ensuring appropriate supplies and reducing stock outs
Also, today there are enough point of care, non- invasive diagnostics which can be deployed for Health Screening using mobile platforms . Using these technologies, diseases can be detected on time, leading to appropriate interventions . We all know that tertiary care eats up about 75% of all healthcare costs and major part of the household savings, and hence technology driven POC (Point of care) screening would be the most effective way to manage healthcare from a cost, prevention and outcomes point of view
Also, as long as we focus on the allopathic doctor based healthcare system, we will not be able to address the issue of shortage of doctors in rural areas , and hence , we will need to use technology to its best across the continuum of care. We will need to move from the ‘Golden Hour’ rule of providing critical care in 40 minutes to a ‘Golden minute’ rule of providing health advice over phone in less than four minutes, and this is very much doable. Also, there are enough studies, which prove that, about 65-80 percent of the time, we don’t need a face-to-face consultation with a doctor. Given the fact that majority of the expenditure in healthcare is on infrastructure and salaries, we must empanel practicing doctors to provide services to the rural people and pay them per consultation. This will make healthcare accessible for the population and more affordable to the exchequer.
The next logical building block would be an ePrescription, so that, after the doctor’s tele-consultation with the patient, s/he can send an ePrescription which is digitally authenticated. This will lead to delivery of medicines either though an ATM machine dispensing medicines or routing the same through a local chemist.
I have visited rural areas across the country and found that sub-centres typically cost between Rs.7.00 lacs to more than 14.00 lacs, plus the salaries and maintenance . I think it is time that the government makes a policy to replace sub-centres with mobile health centres – eHealth centres, which can move the direction of healthcare services from the current ‘to the doctor’ to ‘to the household / population’ approach, and moreover, these mobile health centres can also double up as an ambulance as and when needed. Doctors can come from the nearest semi-urban and urban areas, examine the patient, treat them and go back in the evening. This might work better than the sub-centres in one remote part of the village where the patient has to take pains to travel for kilometers to see the so called absentee doctor !
Smart villages have the potential to extensively deploy Digital Tools / IOT, and flip the ‘doctor centric’ & ‘Tertiary care’ model in the coming decade and lead the way for containing the cost of healthcare`
This is a part of the speech delivered at the Vibrant Gujarat summit 2017. Views are personal
Rajendra Pratap Gupta
President & Board Member
February 13, 2013.
Dr. M.M. Pallam Raju
Union Minister for Human Resource Development
Government of India
Shastri Bhawan, C- Wing, Dr.Rajendra Prasad road.
New Delhi- 110001
Subject: Implementing strategies focusing on Child Health through Ministry of Human Resource Development
I am sure this finds you doing well.
This note is a follow up on my earlier communications on including health education in school / college curriculum. Please refer
- Communication regarding Child Health dated 11th Feb,11 http://dmai.org.in/sites/default/files/Unhealthy_Promotions_MOHFW.pdf
- Communication dated July 11, 2011 on the UN High level summit for Heads of States. http://dmai.org.in/sites/default/files/Note%20to%20PMO%20for%20UN%20Summit%20on%20NCD’s%20%20September’11.pdf
- Communication dated 8th August 2011 regarding, Right to Preventive Care & child health . http://dmai.org.in/sites/default/files/Right%20to%20Preventive%20Care.pdf
- Communication to Shri Kapil Sibal, Former HRD Minister, for including health in the school curriculum. http://dmai.org.in/sites/default/files/Healthcare%20in%20School%20Curriculam.pdf
- Communication dated October 10th, 2012 to Shri Ghulam Nabi Azad, Union Minister of Health & Family Welfare on ‘Pre-emptive care’ focused on child health. http://dmai.org.in/Pre-emptive-Care-A-new-model-of-care.pdf
- My address at the United Nations, on why we need to focus on Child Health? http://www.youtube.com/watch?v=qCTKC4ndjsc
Implementing strategies to ensure good heath among children would require collaborative working between the
Ministry of Human Resource Development along with Ministry of Health & Family Welfare & the Ministry of
Women & Child Development & the Ministry of IT & Communications . We have been following this issue very
closely, and have sent numerous proposals and met up with various officials from time to time.
The following, if not yet implemented, would be a good step to promote child health ;
1. Start a chapter on hygiene & oral care from class 1 onwards
2. Create animated pictures and videos for children’s health that could be multilingual, and can be screened nationally in classes or using mobile health as a medium to disseminate the audio visuals .
3. Have a chapter and subject called ‘Essentials of health’ , which is exam based
4. Define child health and check-up guidelines on the lines of vaccination charts till the age of 15 years. This can
be done by the Ministry of Health & Family Welfare and incorporated in the school curriculum.
5. Child obesity is a serious issue, and this can be addressed by giving right knowledge about ‘Calorie exchanges’. Since parents teach the children, they will also get educated on the same and impact the family’s health. This must be added in school curriculum from class 3 onwards
6. Work outs or Yoga / mediation must be introduced in all schools
- All schools must have ideal height / weight / age charts in all classes, and every 6 months these must be reported in the half-yearly and annual report card. The same way as attendance, neatness , punctuality etc. are reported in class report cards at the PTMs (Parents Teachers meetings)
- It would be a great move if we start giving out 3 %marks or give a grading of A, B or C ( A for being fit for standards , B for borderline & needs improvement & C for being much below the child health metrics ), for various health indicators like dental hygiene, height and weight (BMI – Body Mass Index ), hemoglobin, Vitamin B & D etc.
- Each school / college should have a full-time doctor / health educator
- Junk foods & associated calorific intake needs adequate attention in school level awareness campaigns
- Children do not realize the importance of having adequate quantity of water, and since, in school, they are sometimes restricted to go to toilets, it is high time that the guidelines are issued to all schools for adequate water consumption & availability of drinking water & toilets in school (It might sound trivial, but it is very
Hope this issue will be given the highest priority and attended at the highest level. We will be raising this issue in parliament though members of Parliament from different political parties
For this generation, we are already too late, but we must ensure that the next generation is a healthy one.
In hope of the needful
Rajendra Pratap Gupta
Shri. Ghulam Nabi Azad, Union Minister for Health & Family Welfare.
Shri Kapil Sibal, Minister for Communications & IT
Smt.Krishna Tirath, Minister of state (I/C) for Women & Child Development
Dr.Syeda Hameed, Member, Planning Commission, GOI.
Shri. T.K.A. Nair, Advisor to the Prime Minister.
Shri Keshav Desiraju, Health Secretary, GOI.
Shri Ashok Thakur, Secretary, Min. of HRD.
Shri Prem Narain, Secretary, Min. for Women & Child Development.
Dr.Jagdish Prasad, DGHS, MOHFW
Dr.K.Srinath Reddy, President, PHFI.