1. Tokyo, Japan, 4-5 February 2013 Challenges in developing Countries & E-Health Rajendra Pratap Gupta, Member, World Economic Forums Global Agenda Council – Digital Health 2012-14 Office.rajendra@gmail.com ITU Workshop on E-health services in low-resource settings: Requirements and ITU role (Tokyo, Japan, 4-5 February 2013)

2. Tokyo, Japan, 4-5 February 2013 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. Tokyo, Japan, 4-5 February 2013 3 eHealth is no more an innovation now. It is a basic necessity of every healthcare system Rajendra Pratap Gupta

4. Tokyo, Japan, 4-5 February 2013 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. Tokyo, Japan, 4-5 February 2013 5 Priorities for the Developing World MDGs 4 & 5 – MCH Healthcare delivery in rural areas NCDs Training of *HCWs * HCW – Healthcare Workers

6. Tokyo, Japan, 4-5 February 2013 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 Tokyo, Japan, 4-5 February 2013 7

8. Sample report – High risk patients Tokyo, Japan, 4-5 February 2013 8

9. Tracking high risk pregnant women Tokyo, Japan, 4-5 February 2013 9

10. 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. Tokyo, Japan, 4-5 February 2013 11 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

12. eHealth delivering in low resource settings Tokyo, Japan, 4-5 February 2013 12 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 Equipment Stethoscope Temperature Blood Pressure ECG SPO2 (opt)

13. Rural Health Centre Tokyo, Japan, 4-5 February 2013 13

14. Tokyo, Japan, 4-5 February 2013 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. Tokyo, Japan, 4-5 February 2013 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* Tokyo, Japan, 4-5 February 2013 16 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

17. Tokyo, Japan, 4-5 February 2013 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 Tokyo, Japan, 4-5 February 2013 18 360 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

19. Tokyo, Japan, 4-5 February 2013 19 Challenges for eHealth Lack of data in support of eHealth Successful & scalable eHealth projects Technical competence amongst policy makers to understand eHealth

20. Tokyo, Japan, 4-5 February 2013 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 Tokyo, Japan, 4-5 February 2013 21 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