From online diagnostics to healthcare ATMs, India's big plans for mobile health

The government of India is now India is betting on technology to improve plug the big gaps in rural healthcare – the shortage of human resources, and accessibility and affordability of healthcare. The National Health Systems Resource Centre set up in 2007 under the National Rural Health Mission is the apex body for technical assistance on healthcare and is in charge of setting up mobile health, or mHealth, infrastructure. Speaking to Scroll.in, Dr Jitendar Kumar Sharma, head of healthcare technology and innovations at the centre outlined what the system is designed to do.

How does the government want to use technology in healthcare?

We are essentially starting our broad spectrum of services with diagnostics, because it is a gateway to health. In diagnostics we have a pathology programme and a teleradiology programme. All these things are happening in public-private partnership mode, and has already rolled out in many states – Andhra Pradesh, Mizoram, Maharashtra, Uttarakhand and Uttar Pradesh. There are about 29 states that has rolled out at least one of the programmes.

How does this work on the ground?

Let me explain the pathology programme. What do you do when you need to get a blood test today? You call a laboratory that takes your sample and sends you the result, right? The pathology programme identifies a statewide partner who deputes a phlebotomist (people trained to draw blood) every morning in each primary health Ccentre. The samples are then collected, shipped, and results are sent in six hours. The entire pathology programme has gone into publicprivate partnership.

For CT scan and dialysis, or anything that is heavy capex oriented (heavy capital costs), we are giving space in the district hospital where the private provider sets up the machinery and provides for human resource. We pay for the test, under the National Health Mission. This is the programmatic smart health that is happening.

The biomedical maintenance programme is another vertical. We have Rs 4,564 crores worth of medical equipment in 29 states, of which Rs 1,015 crores of equipment is not working. We did not have engineers. For buying spare parts you would need to get three quotations in the government. Now, statewide tenders are being floated to select a partner who can provides for engineers, spare parts and a smart monitoring for the machine. You can track online once again.

What kind of innovations are we talking about?

We have the National Health Innovation Portal where many people upload their innovations with details. If we find them interesting, we evaluate them for approval. Some of the programmes that have been scaled up come from here. Some of the innovations are from the government itself.

There is a very interesting innovation. At the sub-centre level we have the Auxiliary Nurse and Midwife, or ANM, who is not authorised to prescribe medicines. What we did was we floated the idea of health ATM. In a primary health centre, we have a multipara monitor that acquires all the patient vitals and throws it up to a medical call centre via SMS without internet on GSM base. The doctor in the call centre picks up all vitals and if required speaks to the patient. He or she then prescribes a drug as he is entitled to under Drugs and Cosmetics Act. The command comes as a SMS.

We have used a aerated drink vending machine in the primary health centre and sub centre through which the medicine which the doctor prescribes gets dispensed. One just need to change the spring size and it can dispense drugs. The vending machine works on the principle of spring rotation and you know the stock position of drugs in the facility. Essentially what is happening now is that the nurse is able to throw up a diagnosis, doctor is able to prescribe, medicines are being dispensed and medicines are being given by the nurse to patient. This is happening in 25 sites in Andhra Pradesh, 100 proposed in Uttar Pradesh, three in Orissa, three in Himachal Pradesh, and four in Madhya Pradesh. The patent for this healthcare ATM is with the Government of India.

We do not spend much on health – a little less than 2% of Gross Domestic Product. Are we looking to innovations to replace healthcare services in the country?

Not really. Our strategy to strengthen healthcare in the country is to increase the focus on core activities of health care which is clinical.

Healthcare is a mix of core clinical activity and non-core supportive ancillary activity. We have been running laundry, linen, and logistics in the name of healthcare. What government has clearly opined is that the health departments in governments need to focus on core activities like patient care. The supportive ancillary activity has to go in public private partnership, which means somebody who supplies IRCTC for trains should be able to supply the benchmark laundry in your hospitals. You don’t have to do laundry. When you put all these activities in public private partnership, you are able to get cost effective rates. You reduce your ancillary costs.

There are many districts in the country where there are no doctors and basic health facilities. In such a scenario, won’t talking about innovations be a contradiction of sorts?

These things have to work in tandem. If you come from Katras in Jharkhand to Ranchi, you would have covered Malawi to Massachusetts. That is the reality. The issue is there is an extent to which planners can do. There is a whole lot of things that the local government has to do.

When things seem to be absurd without even basic facilities we are essentially seeing the local government not coming up to expectations.

How do you think frontline workers ASHA, ANM are adapting to technology?

Again it’s the manner in which you package. If you tell them “this is mHealth and you need to do this, and send your vitals through a tab”, it might just be a migration. But if you package it with something that value adds to her work, her core deliverables, that is patient care.

For instance, the ANMs are supposed to measure haemoglobin. One approach could be that you ask them to get it measured, put it on tab, and information goes into patient data base.

You can measure haemoglobin using Sahli’s method using N/10 hydrochloric acid, which you cannot store in a village. We have a digital haemoglobinometer which takes the image of the conjunctiva (eye) through a phone and gives you digital hemoglobin. It is good enough for screening. We have approved it as an innovation through the National Health Innovation Portal.

You can actually take haemoglobin digitally without running into the risk of a needlestick injury for ANM or ASHA or cross infection. That information also goes into the database. Using this innovation is getting her closer to her core deliverables. It is not system seeing efficiency in her work. It is she who is seeing efficiency in her work.

How do we use these innovations in the villages and smaller towns where internet connectivity is intermittent?

Internet connectivity is improving. But, whenever we develop mhealth tools we also should look at its adaptability with GSM base. In the absence of internet, it should go as SMS.