Friday, October 29, 2010

Just technology won't do; we need many, many more doctors, nurses to make health care for all a reality

Coming to the larger aspect of health care in our country, today a doctor in Chennai can check the heartbeat of a child in Bilaspur, or study the tumour of a child in Nigeria. There is no doubt that medical practitioners empowered by technology are working wonders in India. But only in pockets. Is human health improving overall? Is health care accessible and available at an affordable cost to our millions? The answer is No.

Health care in any case is a relatively new term. Not so long ago, it was the doctor with the stethoscope who was almost synonymous with the word ‘medicine’. Today, people talk about e-health and health care that can be had 24/7, well, virtually. But this sort of service, even if readily available, caters only to the urban dweller, the elite. Preetha Reddy, Managing Director, Apollo Hospitals Ltd, did say recently that health care providers face many challenges, particularly in suburban and rural areas in India, and adds that leveraging ICT for greater geographical spread and effective cost management is the key to providing quality solutions across the country.

I am not saying no progress has been made. The Tamil Nadu health department, for example, uses technology to benefit patients and is a sort of role model for the rest of the country. The department implements the ‘108 emergency service’, the Kalaignar Insurance Scheme and other welfare schemes. The state has made progress in reducing infant and maternal mortality, as well as birth and death rates. Life expectancy at birth has risen to 65.4%, mainly due to the provision of good health care. Based on authoritative information, there are about 8,000 health sub-centres in TN villages, 1,422 primary health centres spread across major villages, 235 taluq hospitals, 29 district headquarter hospitals, and 18 medical college hospitals. Even so, the state government depends on private hospitals to cater to patients, especially in the area of super-specialties.

The Kalaignar Insurance Scheme is a boon for the poor who can now receive life-saving treatment for critical diseases in government as well as in private hospitals. From issue of smart cards to Web-based authorisation to disbursement of claims, it is all IT-driven. The insurance scheme primarily caters to those with an annual income of less than Rs 72,000; the sum insured is Rs 1 lakh for four years. Today, 1,33,60,439 families have been enrolled; 1,88,000 patients have been operated upon; and Rs 502 crore have been disbursed as claims.

However, for all the advancement in health care, statistics tell a different story. According to Sangeeta Reddy, Executive Director, Apollo Hospitals Group, every 90 minutes, 18 women die in India for want of access to appropriate maternal health care facilities. Painting a worrisome picture, Reddy insists there is a global health care crisis in terms of a large population that is beyond reach. In India, which has 600,000 and more villages, the incidence of disease is increasing as is the aging population; the cost associated with technology is rising, resulting in production losses. New diseases are surfacing, prompting new answers and new methodologies.

Reddy says India needs to grow the number of its doctors two- to three-fold, the number of nurses three- to four-fold, and technicians five-fold. “It will take 32 years if the brick-and-mortar way of teaching is followed. We need to change the way we teach. E-health and tele-medicine will not provide the complete solution but are significant tools in the hands of policy makers. It is also for doctors to enhance their reach and nurses to increase their productivity,” she says.

Reddy is for a national electronic medical record repository. The electronic medical record or EMR contains a person’s data from birth and is an important tool in preventive care, with its ability to track a person’s lifestyle; it can also become a part of clinical research. If a unique identity number can be created for every Indian, why not an EMR, she asks. Reddy sees in the iPhone many enabling possibilities, including 6,000 health applications. Thus, the EMR, the mobile phone, mobile medical units, and multiple enabling technologies such as imaging, analysis and molecular assay, can transform the way health care is delivered in rural India, she is certain, if there is appropriate convergence.


(Some inputs for this article have come from deliberations at a Connect 2010 session in Chennai focused on providing healthcare for Generation Next, a CII initiative.)

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