Visiting lower income rural India households can be an eye opener in many ways. They may lack a steady income, a pucca home with a toilet and household appliances, and find it a challenge to access cooking fuel and clean drinking water, but the odds are high that they will own a mobile. It is rather intriguing to see this ubiquity of the humble mobile – what started as a device for the elite, now finds itself so deeply embedded in the mainstream.
The fact is rural India has climbed on to the technology bandwagon with the help of their mobiles. Irrespective of literacy levels or economic status, people have adopted mobile technology and the internet. WhatsApp, Facebook, YouTube – have re-defined how people communicate and share information.
The good news is that this wave of digital adoption is also helping change people’s lives for the better. Take healthcare, which is a priority area for socio-economic development. The smartphone has become an instrument that enables healthcare providers to achieve scale and sustainability in health interventions. It is helping to overcome obstacles that have been hard challenges for decades — physically reaching remote rural places, connecting with the community, delivering quality health services with some degree of consistency, maintaining and accessing records, and so on.
With Universal Health Coverage (UHC) fast becoming a national priority in India, it has become important to bridge these gaps, and digital tech has the potential to make this possible.
The biggest challenges of UHC are rural reach and adequate capacity building. One of India’s biggest deficits is the low numbers of skilled healthcare providers. India’s doctor-patient ratio stands at 0.8 doctors per 1,000 people which is lower than the WHO guideline of 1 per 1,000. A recent WHO study found a deficit of 600,000 doctors in India. In addition, distribution of health workers – doctors, specialists, nursing staff, technicians, etc — is a concern as most skilled professionals prefer to stay in urban areas, where their income opportunities are greater. This has left India with a deep fault line between rural and urban sectors, with rural communities not getting adequate access to specialized care.
This deficit in skilled resources reflects in our maternity health indices. Although there are more women opting to have institutional deliveries (about 80% as compared to 40% a decade ago), Maternal Mortality Rate is still high (122 as compared to the SDG target of 70 deaths per 100,000 live births). Studies indicate that s many as 80% of maternal deaths in India are preventable with timely health care.
This is where digital plays a game-changing role. Digital is an unconventional, smart, efficient path towards India’s dream of universal healthcare. Today digital tech enables unique solutions at the ‘edge’, ie the point of care or interaction between healthcare provider and beneficiary. Many of these solutions were unimaginable even 10 years ago.
Tech is triggering change in the healthcare system on both the demand and supply side. In terms of supply, tech is enabling reach and scale at levels that were earlier not possible. For instance, digital solutions can increase the penetration of quality care mechanisms to remote parts of the country through telemedicine and remote training sessions for healthcare staff. Regarding the demand side, tech has tremendous potential to give a voice to the beneficiary or patient.
Some great examples of digital interventions making a difference in areas that need it the most are Project ECHO and Safe Delivery App. Project ECHO is based on the principle of democratizing medial knowledge. Using a hub and spoke model it digitally connects frontline or grassroot centres with experts around the world, giving healthcare personnel opportunities to learn from their counterparts in the developed world, thus leading to improved levels of care. In India, ECHO facilitates case-based learning modalities and provides quality improvement support for private maternity facilities at the grassroots level.
Safe Delivery App, another innovative tech solution, is a knowledge app that helps healthcare providers take decisions at critical points of childbirth. It prompts the worker for information and guides them to the right decision, such as whether to recommend tests, or a doctor consultation, or a visit to a hospital, or to call an ambulance. The app supports the frontline healthcare provider with the right information and it also connects the worker with the doctor and the health facility. More than 3,000 frontline resources have benefitted from this app.
Technology also has an important role to play in empowering women to demand better quality care. Together For Her (TFH), a digital platform, through an innovative feedback mechanism empowers women with the voice to demand quality care. It educates pregnant women on what quality maternity care entails and enables new mothers to give objective and actionable feedback on the care they received. Healthcare providers thus get insights into their own quality and are compelled to raise the bar in their services. TFH has been adopted by more than 1,000 facilities in Maharashtra and Uttar Pradesh and there are more than 37,000 reviews and engaging more than 100,000 women.
While such platforms are not substitutes for skilled resources, they do help improve access and supply of quality health care. Built on the backbone of India’s IT technology leadership, digital tech is helping to build capacities and creating awareness. It helps a developing nation like ours to optimize our limited resources and bridge geographic and class barriers. Today digital tech is taking us closer to our goal of universal access to quality healthcare and helping to build a better, healthier India.