21 research outputs found
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Accessing Specialist Services via Telemedicine in India
India is a huge country with a population of diverse social and cultural backgrounds. The majority of its population lives in rural areas. The burden of disease continues to be high in the country with life expectancy at around 68 years, much lower compared to countries in the East Asian region and other advanced economies. As per International Standards, MMR at 130 per 100,000 live births and IMR at 37 per 1,000 live births are high.
The public healthcare system in rural areas in India is not only inadequate in terms of population coverage, but is also underutilized due to poor quality of healthcare services. Further, chronic absenteeism of healthcare staff and grossly lacking availability of specialists makes the situation worse. Majority of the population of specialists/doctors live in cities and small towns. Telemedicine can be an ideal solution in such situations. Telemedicine makes use of telecommunication technologies which can enable patients in rural areas to get consulted and spoken to by specialists remotely. It can act as a tool to bridge the wide gap in the access to quality healthcare specialist services between the rural and urban areas.
In India, Indian Space Research Organisation (ISRO) is the pioneer in the field of telemedicine. The other key players are the Department of Information Technology (DIT) under Ministry of Communications and Information Technology, Ministry of Health and Family Welfare, Ministry of External Affairs and the state governments. Some of the premier medical institutions and corporate hospitals are also actively involved in the telemedicine activities in India.
The present paper gives a detailed account of the telemedicine technology, its importance and various areas of application. The telemedicine initiatives in Indian context are presented in detail. Further, research and development in the field of telemedicine in India is discussed. A brief account of key challenges related to implementation of telemedicine in India are also highlighted
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Health and Wellness Centres: Expanding Access to Comprehensive Primary Health Care in India
India’s achievements in the field of health leave much to be desired and the burden of disease among the Indian population remains high. Infant and child mortality and morbidity and maternal mortality and morbidity affect millions of children and women. IMR at 37 per 1,000 live births and MMR at 130 per 100,000 live births are high by international standards, and life expectancy at around 68 years is much lower than in China, other countries in East Asia, and the advanced economies. Fertility rates are still very high, and the population continues to grow rapidly, pressing hard on India’s fragile ecosystems and natural environment.
Several infectious diseases are re-emerging as epidemics. Many of these illnesses and deaths can be prevented and/or treated cost-effectively with primary health care services provided by the public health system. An extensive primary healthcare infrastructure provided by the government exists in India. Yet, it is inadequate in terms of coverage of the population, especially in rural areas, and grossly underutilized because of the dismal quality of healthcare being provided. In most public health centers which provide primary healthcare services, drugs and equipment are missing or in short supply, there is shortage of staff and the system is characterized by endemic absenteeism on the part of medical personnel due to lack of control and oversight.
As a result, most people in India, even the poor, choose expensive healthcare services provided by the largely unregulated private sector. Not only do the poor face the double burden of poverty and ill-health, the financial burden of ill health can push even the non-poor into poverty. Among the 50 low-middle income group nations, India is the 6th biggest out-of-pocket spender. The household out-of- pocket expenditure accounts for 67 percent of the total health expenditure.
Last year, the Government of India embarked on a path to achieve Universal Health Coverage for all the citizens of India. In the Union budget 2017-18, the government announced the Ayushman Bharat Yojana, comprising of two major initiatives – the National Health Protection Scheme and the Health and Wellness Centres (HWCs).
The present paper gives a detailed account of the Health and Wellness Centres Initiative under Ayushman Bharat Yojana launched by the government. The role of Information and Communications Technology (ICT) in the delivery of comprehensive primary health care through HWCs is examined. Further, the areas of opportunities and key challenges related to the Health and Wellness Centres Initiative is discussed in detail.
While we conclude that the newly designed HWCs initiative has several novel features that have the potential to vastly benefit the rural populations, at the same time it is critical to keep in mind the following broad issues if the HWCs have to succeed on scale: 1) a much higher level of public health spending in general and much higher outlays for HWCs in particular; 2) proper recruitment, comprehensive training, effective control and oversight and timely and adequate payments for the various health functionaries; 3) an effective and efficient management structure for the HWCs; and 4) commensurate physical infrastructure and human resources in the sub-centers and the Primary Health Centers converted into the HWCs with the growing needs of the regions.
Keywords: Health and Wellness Centres, Ayushman Bharat, Information and Communications Technology, ICT, Indi
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ICT Initiatives in India to Combat COVID-19
The great loss of life and economic damage COVID-19 has wrought across the world has not left India untouched. In these tough times, Information and Communications Technology (ICT) has emerged as a key means of both resolving challenges caused by the pandemic and responding to the new reality of the everyday. Government at the central and state levels has actively engaged with the private sector to develop ICT solutions, particularly identification, isolation, contact tracing, and treatment, to deal with the evolving situation in the country. Of particular benefit have been the growing number of mobile applications and Artificial Intelligence (AI) based tools which have emerged during this time. However, the use of ICT involves its own set of challenges, especially concerning privacy safeguards. Governments must ensure the use of ICT is fair and proportional not only during the times of pandemic, but also in the post-COVID-19 era. Countries like South Korea and Hong Kong illustrate emergent best practices for the use of ICT in such crises
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COVID-19 in Rural India
India is the second-worst affected country in the world by COVID-19 pandemic. Although the Government of India took various initiatives to curb the spread of coronavirus in the country which included a 3-week nation-wide lockdown to begin with (from March 25 to April 14) and which later was extended thrice up until May 31, 2020, increasing testing, setting up quarantine facilities, COVID-19 treatment facilities, contact tracing through Aarogya Setu application and many more, but these efforts fell short when it came to suppressing the pandemic. Especially, because of lockdown, when the migrant workers were forced to leave cities and travel back to their homes in rural areas, the COVID-19 infection which predominantly affected the urban areas until then also reached rural areas of the country. Overtime, the proportion of COVID-19 cases in rural areas has risen. Rural districts in the states of Andhra Pradesh, Maharashtra, Karnataka, Uttar Pradesh and Assam witnessed a significant rise in COVID-19 cases. Many factors pose a big challenge for rural India in dealing with COVID-19. These include scarcity of medical staff, equipment and health facilities, social stigma, fear of ill-treatment at the health facility, fear of losing income on being quarantined etc. Post-COVID complications are also emerging as a new threat in dealing with the current crisis.
Health and Wellness Centres (HWCs) under Ayushman Bharat and Accredited Social Health Activist (ASHA) workers can play a crucial role in dealing with COVID-19 in the rural areas. ASHAs are involved in conducting house-to-house visits, reporting symptomatic cases, carrying out contact tracing, maintaining documentation, monitoring the situation and creating awareness about COVID-19 in the community. But, ASHA workers are facing many challenges such as increased work load, lack of protective equipment and training, they are underpaid, stigmatization, caste discrimination, domestic violence etc. India needs to develop a strategy specific to rural settings to deal with the COVID-19 situation.
We believe that at a time when the federal and state governments are dealing with the challenges emanating from the Covid-19 pandemic, this crisis should be seen as an opportunity to strengthen the public health system in India. This would entail, among other things: 1) a much higher level of public health spending; 2) comprehensive training, effective control and oversight and timely and adequate payments for the ASHAs; 3) an effective and efficient management structure for the health facilities at the village, block and district levels; and 4) commensurate physical infrastructure and human resources in the sub-centers and the Primary Health Centers with the growing needs of the regions
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COVID-19 in India: Disease Burden, Managing the second wave and Innovations
The second wave of COVID-19 caused havoc across India. It was twice as severe as the first one.
More than 400,000 COVID-19 cases per day were being reported. The worst affected states were Maharashtra, Kerala, Karnataka, Tamil Nadu, Delhi and Andhra Pradesh. The spike in cases was largely assumed to be the result of leniency in COVID-19 appropriate behaviour, such as people were not wearing masks, resumption of economic activity, gathering in large numbers e.g. in marriages, political meetings, rallies, IPL matches, religious gatherings like Kumbh Mela etc.
67 percent of India’s population above the age of six years has been exposed to COVID-19 according to a national serological survey conducted by ICMR, the findings of which were revealed on July 20, 2021. The survey was conducted during June and July across 70 districts of 21 states. These are the very same districts where three earlier rounds of sero surveys were conducted during May-June 2020; August-September 2020 and December-January 2020/21.
On January 16th 2021, India launched the world’s largest vaccination drive and as of July 15, more than 391,340,491 vaccine doses had been administered across the country. The vaccine has been administered in a phased manner with the initial focus being on priority groups like health workers, frontline workers like the police workforce, municipal workers, defence personnel etc., people above 60 years of age and those between 45-60 years with co-morbidities. From May 1, 2021, people between age group 18-45 were also eligible for vaccination. But, until a substantial proportion of the population is vaccinated, precautionary measures like wearing masks, sanitization, regular hand washing and physical distancing must remain the mainstay.
Inter-departmental coordination has been the cornerstone in dealing with COVID-19 situation in India. Various departments such as Health, Tourism, Defence, Information and Communication Technology (ICT), Finance etc. took various initiatives in collaboration with other departments to deal with the pandemic. Challenges posed by COVID-19 also sparked a wave of innovations across sectors in India. A host of new interventions were implemented by various departments, such as health, agriculture, education, police, railways etc.
This document is based on secondary data collected from government documents and websites, news reporting, media interviews, newspaper articles, various national and international journals and private websites. The present paper discusses current scenario of COVID-19 in India, COVID19 vaccination drive, innovative approaches to address vaccine hesitancy in India, interdepartmental coordination and innovation across sectors in dealing with COVID-19 situation. We also put forward recommendations to deal with the surge in COVID-19 cases in future and to scale up innovations and undertake research studies to identify gaps and address challenges.
CSD Working Paper Series - COVID-19 in India: Disease Burden, Managing the second wave and Innovation
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India’s National Digital Health Mission
India is using Information and Communication Technologies (ICTs) to leapfrog economic development in key sectors: health, education, infrastructure, finance, agriculture, manufacturing, and perhaps most important, governance. In doing so, India is increasing Internet penetration by increasing Internet subscribers and digital literacy. These have acted as the key drivers for the Indian Government to envision digitalization in its various sectors including health care. The Government of India laid emphasis on digitalization in India’s healthcare sector in its National Health Policy, 2017. The National Digital Health Blueprint, 2019 recognized the need to put together a National Digital Health Mission (NDHM) which can act as the foundation on which national digital health ecosystem can be built. On the nation’s 74th Independence Day, the Government of India embarked on its journey to achieve Universal Health Coverage by launching the National Digital Health Mission. NDHM intends to create a holistic and comprehensive digital health ecosystem that will lay the foundation of a strong public digital infrastructure, digitally empower individuals, patients, doctors, health facilities, and help streamline the delivery of healthcare services and related information. However, it is important to emphasize that the success of NDHM is dependent on its adoption by the centre and states, by public and private entities and by individuals and decision makers. It is also crucial to analyse international experiences in order to learn from their achievements and mistakes
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Artificial Intelligence and Healthcare in India
Artificial Intelligence (AI), also referred to as the new electricity, is the emerging focus area in India. AI refers to the ability of machines to perform cognitive tasks like thinking, perceiving, learning, problem solving and decision making. Most of the AI systems rely on historical large datasets for predicting future trends and outcomes at a pace which humans would not be able to match. The development of AI in India is in the initial stages and there is no regulatory body focused solely on AI. However, recently, Government of India has taken various initiatives related to AI such as establishment of Artificial Intelligence Task Force, formulation of NITI Aayog's National Strategy for Artificial Intelligence #AIFORALL, setting up of four Committees for AI under Ministry of Electronics and Information technology etc. Some of India’s state governments have also taken few initiatives, such as establishment of Centre of Excellence for Data Science and Artificial Intelligence (CoE-DS&AI) by Karnataka, Safe and Ethical Artificial Intelligence Policy 2020 and Face Recognition Attendance System by Tamil Nadu, AI-Powered System for monitoring driving behaviour by West Bengal, AI System to fight agricultural risks by Maharashtra etc. As with any other technology, AI brings with it a span of opportunities and challenges.
In healthcare, AI could be beneficial in mining medical records; designing treatment plans; forecasting health events; assisting repetitive jobs; doing online consultations; assisting in clinical decision making; medication management; drug creation; making healthier choices and decisions; and solving public health problems etc. AI could be very helpful in areas where there is scarcity of human resources, such as rural and remote areas. AI technology has been helpful in dealing with COVID-19 in India. It has helped in preliminary screening of COVID-19 cases, containment of coronavirus, contact tracing, enforcing quarantine and social distancing, tracking of suspects, tracking the pandemic, treatment and remote monitoring of COVID-19 patients, vaccine and drug development etc. The path for adoption of AI driven healthcare in India is filled with a lot of challenges. The unstructured data sets, interoperability issues, lack of open sets of medical data, inadequate analytics solutions which could work with big data, limited funds, inadequate infrastructure, lack of manpower skilled in AI, regulatory weaknesses, inadequate framework and issues related to data protection are some of the key challenges for AI-driven healthcare.
It is recommended that government should support companies to invest in AI; encourage public private partnerships in the domain of AI and Health; enact and effectively enforce laws and legislation related to AI and Health; frame policies addressing issues related to confidentiality and privacy in the AI-driven healthcare; and establish a certification system for AI-based healthcare solutions. To adopt AI-based healthcare, it is important to train workforce in AI so that they can carefully handle sensitive health information, protect data against theft and use AI systems effectively. It is also crucial that healthcare decisions based on AI solutions should have a rationale and are explainable
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COVID-19 in India: Issues, Challenges and Lessons
COVID-19 has not left any part of the world untouched and India is one of the worst affected countries in the world. The cases in India are rising steadily with each passing day. As of August 10th 2020, India has over 2.3 million (the second million coming in exactly three weeks since the country hit a million infections on July 16, with 42 percent of the new cases coming from Andhra Pradesh, Karnataka, Uttar Pradesh, West Bengal and Bihar) confirmed COVID-19 cases and 46,188 reported deaths. The worst affected states of India include Maharashtra, Tamil Nadu, Andhra Pradesh, Karnataka, Delhi and Uttar Pradesh. Another growing concern is that interior parts of the country are emerging as new hotspots. Four states in eastern India, namely, Odisha, Bihar, Assam and West Bengal are increasingly reporting positive cases. The two main reasons being reported for this surge in cases in rural areas are the returning migrants from major cities who did not undergo screening or were asymptomatic and the poor healthcare infrastructure in the rural settings. Out of a total of 739 districts in India, 13 districts (across 8 states and a union territory) account for 1 in seven Covid-19 deaths. The 13 districts are: Kamrup Metro in Assam, Patna in Bihar, Ranchi in Jharkhand; Alappuzha and Thiruvananthapuram in Kerala, Ganjam in Odisha, Lucknow in UP; North 24 Paraganas, Hooghly, Howrah, Kolkata and Maldah in West Bengal, and Delhi. These districts account for nearly 9 percent of India’s active cases and about 14 percent of COVID-19 deaths. Over the spring and summer, the COVID-19 situation in India has really deteriorated and could get much worse on the current trajectory with around 60,000 cases being reported per day and around 900 daily deaths.
Lockdown and travel bans due to COVID-19 have impacted almost every sector including tourism, hospitality, and education. To deal with the coronavirus crisis, the central government has undertaken various initiatives like monetary relief package under Pradhan Mantri Garib Kalyan Yojana, Uttar Pradesh Rojgar Abhiyaan, Atma Nirbhar Abhiyaan etc. The state governments have also undertaken various initiatives like Operation SHIELD, 5T Plan, Mission Fateh, Snehar Paras etc. We describe these briefly. Some regions in India have successfully contained COVID-19 like the state of Kerala, the district of Bhilwara in Rajasthan and the slums of Dharavi in Mumbai. In order for a strategy of containment and recovery to succeed, it is vital to keep using public health measures to suppress the epidemic, that is to drive R < 1. Besides the infection rate, it is vital to closely monitor the positivity rate and the case fatality ratio (death rate) and rely not so much on the recovery rate which is what seems to be happening currently. Eventually, in all likelihood, as the pandemic subsides, close to 97 plus percent cases are likely to recover implying a 2 or 3 percent death rate. India needs a epidemic control strategy to be developed and put in place to control and contain the spread of the infection in the country, something that is not being done currently. Due to COVID-19, while most countries are facing the twin crises of public health and the consequent economic downturn, India has an additional challenge to deal with, namely a massive migrant workers crisis. While it is hard to say what long-term impact this home migration might have, but some trends were quite clear so we made a few recommendations to the government in May that we list along with some lessons for India to learn from elsewhere. On the economic front, a deep and prolonged economic slowdown is inevitable
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National Teleconsultation Service in India: eSanjeevani OPD
India’s achievements in the field of health leave much to be desired. Infant and child mortality and morbidity and maternal mortality and morbidity affect millions of children and women. The burden of disease continues to be high in the country with life expectancy at around 69 years, MMR at 113 per 100,000 live births and IMR at 32 per 1,000 live births still remain high.
The public healthcare system in rural areas in India is not only underutilized due to poor quality of healthcare services, but is also inadequate in terms of population coverage. Further, gross shortage of specialist and chronic absenteeism of healthcare staff makes the situation even worse. Majority of the specialists/doctors live in urban areas and in such a situation telemedicine offers an ideal solution. The utmost need of telemedicine was felt when OPD services came to a halt due to nationwide COVID-19 lockdown. To deal with the situation, on April 13, 2020, the Ministry of Health & Family welfare launched National Teleconsultation service via an online portal “eSanjeevani OPD – Stay Home OPD”.
This paper provides a detailed account of National Teleconsultation portal, eSanjeevani OPD. The paper discusses the current status of eSanjeevani OPD, its salient features, challenges in the way of successful adoption of eSanjeevani OPD and comparison of eSanjeevani OPD with global telemedicine platforms. Further, this paper also proposes a pilot study to explore the factors that act as barriers and facilitators for the utilization of eSanjeevani OPD