Tokyo, Japan, 4-5 February 2013 Challenges in developing Countries & E-Health Rajendra Pratap Gupta, Member, World Economic Forums Global Agenda Council – Digital Health ITU Workshop on E-health services in low-resource settings: Requirements and ITU role (Tokyo, Japan, 4-5 February 2013)

Tokyo, Japan, 4-5 February 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

Tokyo, Japan, 4-5 February eHealth is no more an innovation now. It is a basic necessity of every healthcare system Rajendra Pratap Gupta

Tokyo, Japan, 4-5 February 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

Tokyo, Japan, 4-5 February Priorities for the Developing World MDGs 4 & 5 – MCH Healthcare delivery in rural areas NCDs Training of *HCWs * HCW – Healthcare Workers

Tokyo, Japan, 4-5 February 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

Jeevandainee Project - Maharashtra Tokyo, Japan, 4-5 February

Sample report – High risk patients Tokyo, Japan, 4-5 February

Tracking high risk pregnant women Tokyo, Japan, 4-5 February

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 % in MMR

Tokyo, Japan, 4-5 February Healthcare Delivery in Rural areas 70 %( about 830 million ) of Indias population lives in rural areas India has about 6,40,000 villages Absenteeism of doctors is 40 % in rural settings

eHealth delivering in low resource settings Tokyo, Japan, 4-5 February 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 fee, sustainable village centers Covering 40 Mn population. To increase to 70 Mn by end of % traffic of patients who have earlier visited for a different ailment Equipment Stethoscope Temperature Blood Pressure ECG SPO2 (opt)

Rural Health Centre Tokyo, Japan, 4-5 February

Tokyo, Japan, 4-5 February 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. ind_en.pdf

Tokyo, Japan, 4-5 February 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.

eHealth has the solution for RPM* Tokyo, Japan, 4-5 February Biometric Screening – SpO 2 – Blood Pressure – Blood Sugar – Spirometry – Total Cholesterol – ECG – Triglyceride – Body Composition – HBA1C – Ultra-sound – X-Ray – Doctor consultation * Remote Patient Monitoring

Tokyo, Japan, 4-5 February Training of *HCWs India has approx *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

mHealth – addressing the challenge Tokyo, Japan, 4-5 February 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

Tokyo, Japan, 4-5 February Challenges for eHealth Lack of data in support of eHealth Successful & scalable eHealth projects Technical competence amongst policy makers to understand eHealth

Tokyo, Japan, 4-5 February 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 ).

Conclusions and Recommendations Tokyo, Japan, 4-5 February When it comes to eHealth, we have achievedtechnical maturity, but the lack oforganizational maturity is proving to be a big bottleneck in unlocking the potential of eHealth Rajendra Pratap Gupta