Putting a doctor in every village

Krishnan Ganapathy reveals how videoconferencing proved to be a cost-effective bridge between urban healthcare resources and rural patients in India. Professor Krishnan Ganapathy is the Head of Telemedicine for Apollo Hospitals and Honorary Advisor to the Armed Forces Medical Services of India.

I head the Apollo Telemedicine Networking Foundation, which is not only the largest provider of healthcare in Asia with 8000 beds, but also the largest practitioner of telemedicine in the region. As early as 1999 we were the first in south Asia to look at telemedicine as a major method of delivering healthcare to suburban and rural India.

The demographic challenge
With a population well in excess of a billion, we find that 80 per cent of doctors practice in the big cities of the country where only 20 per cent of the national population lives. That works out to something a little less than 1 doctor per 10,000 people in rural areas.

I do not think that India will ever be able to provide good healthcare, particularly secondary and tertiary care, to the mass of its population. Taking myself as an example, I am a neurosurgeon, and Madras, the city where I live, has about 85 neurosurgeons for a population of 4.4 million. This contrasts with less than 80 neurosurgeons for the whole of northeast India, which has a population of 250 million. You will find the same stark contrast for other clinical specialities.

The videoconferencing opportunity
India has 650,000 villages, most of which have no communications links with the outside world. However this situation is fast changing at the initiative of the central government which is funding the establishment of telephony links to 80 per cent of all villages over the next five years. India already has more than 80,000 VSAT receivers in villages – and already high-speed broadband is now available in most big towns.

An interesting feature of the Indian experience is how we are leapfrogging generations of technology – the small towns of India will have wireless connectivity before they have telephones.

Apollo Hospitals started off our experiment in telehealthcare using a limited number of dedicated ISDN telephone lines with up to 512kbs data transfer. Now most of our clinics in the smaller towns have at least 128kps. Obviously this is not ‘BBC quality’ – but it serves the purpose for clinical diagnosis.

To date we have done around 19,000 teleconsultations over the last seven years, from 92 centres in India and seven centres overseas. This can work out to between 4 and 50 teleconsultations every day – and whilst this may look small, it represents the largest multi-speciality deployment of telehealthcare in the developing world. And in less than 3 per cent of cases was the video consultation inadequate, necessitating the participants to postpone and redo the consultation. In these cases it was invariably due to a power failure at the remote site where they do not have back-up generators.

Telehealthcare is good for patients, and for business
We started off seven years ago with the challenge of changing the mindset of patients and doctors. Initially there was resistance from every level – until we showed that there is no loss in data, and that the solution is so inexpensive that it was worth the capital outlay.

The money you save in terms of time spent travelling justifies the initial outlay – which then means that improvements to productivity and to the patient experience represent immediate and quantifiable returns. I have seen at first hand the amount of goodwill generated by our telehealthcare services. Once it has been experienced, a patient then becomes the most powerful advocate for this ‘miracle of technology’ – and it is easy to see why.

80 per cent of our consultations are review cases – where a patient has already visited our hospital, has been investigated and treated. In these cases good videoconferencing can prevent the patient from travelling up to 2500 miles in order to come back to see a consultant. We have calculated that videoconferencing saves between 3000-5000 rupees (US$74-US$123) per patient. If you multiply that by 19,000 you can see what videoconferencing has saved our patients.

Originally I used to see patients who were living no more than a mile or so from where I was situated – now I see patients from across the country and from overseas, all through videoconferencing. I firmly believe that videoconferencing is the future of healthcare in places like India.

Source: PSTM, July 25, 2007