[Editorial Analysis] In telehealth, scaling up the Indian advantage

Mains Paper 2: Health
Prelims level: e-Sanjeevani
Mains level: Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

Context:

• In the wake of novel corona virus pandemic and fear of transmission, health-care providers have been reassigned from other specialties to COVID-19, restricting high quality care for other conditions.

• A survey by the World Health Organization (WHO) in 105 countries (July 2020) pointed essential services were disrupted in the majority of countries, with immunization, antenatal and childcare services among the most widely affected.

• About 45% of low-income countries incurred at least partial disruption of over 75% of services, relative to only 4% of high-income countries. Almost 60% of services were at least partially disrupted in South East Asian countries.

COVID-19 impact on essential services:

• In India, detection of tuberculosis cases was down by 50% in April-December of 2020 relative to the same period in 2019, and antenatal care visits were down by 56% in the first half of 2020.

• The blood sugar control for diabetics was at risk, increasing the chances of adverse events requiring hospitalization, including worse outcomes in the case of COVID-19 infection.

• The Cancer care has been badly affected in many countries, as well as diagnosis and treatment of other non-communicable diseases.

• The pandemic has exacerbated inequalities in health care people living in rural and remote areas were further disadvantaged by not being able to travel to cities to seek specialist care.

• The pre-existing shortage of specialists in many rural areas led to care being delayed or not happening at all.

The Enhancement of technology use:

• The acceleration in the use of digital technologies has mitigated the impact of COVID-19 to some extent. Virtual consultations avoid the risk of COVID-19 transmission and are helping to bridge this socio-economic divide.

• The Indian government’s e-Sanjeevani platform offers both provider-to-patient interactions and provider-to-provider interactions, where patients visit Smartphone-equipped community health officers in rural health and wellness centers; these in turn connect to general practitioners and specialist doctors through a hub-and-spoke model.

• The Private providers and non-governmental organizations (NGO) have also expanded virtual access to underserved populations.

The urgent need to increase the efficiency:

• The scale of unmet demand, there is an urgent need to increase the efficiency and effectiveness of every minute spent in virtual care interactions.

• There are lessons we can learn from the pandemic that can be applied usefully to how we deliver health care.

• Remote-shared medical appointments in which multiple patients with similar medical needs meet with a clinician at once and each receives individual attention can greatly increase telehealth capacity by eliminating repetition of common advice.

The Utilising shared appointments:

• Remote shared medical appointments essentially virtualise in-person shared medical appointments (SMAs) which have been offered successfully in the United States for over 20 years.

• Patients get more time with their clinician, albeit not in private. SMAs enable peer support and peer-to-peer learning.

• Providers who have offered SMAs have found them to improve both productivity and outcomes for many conditions, notably diabetes. SMAs could help tackle India’s widespread “sugar” problem.

• The eye hospital found that in shared appointments, patients spur one another to engage more and ask more questions. Such virtual peer interaction could be welcome in the current paradigm of social distancing.

The e-Sanjeevani and alternate telehealth platforms:

• The e-Sanjeevani and other telehealth platforms could consider offering virtual shared medical appointments.

• Patients in different villages, with similar conditions can be seen at once remotely by a generalist or specialist, during the pandemic.

• Once transmission risk subsides, seeing patient groups within each village centre will help build supportive bonds, enable sharing of local knowledge, and likely attract supplementary providers.

The e-Sanjeevani:

• The eSanjeevani is a telemedicine service which is implemented under Ayushman Bharat health initiative for doctor-to-doctor interaction.

• It aims to connect all 1.5 lakh health and wellness centre which has been established under Ayushman Bharat. This service is also available to Android users.
• The hospital provide e-sanjeevani opd, OPD is an online doctor consultation system that is totally free.

The importance of information access tools:

• Providers can offer virtual group information sessions accessible via smartphone in which a health-care worker explains the benefits of COVID-19 testing and vaccination and answers questions, reaching potentially quite large audiences.

• Engaging in real time with a care provider in an interactive format will likely encourage safe behaviours to a greater extent than if the same information is provided without interaction.

• In switching to radically different care delivery models requires rigorous testing combined with mentoring, training and behavior change for both patients and providers.

• The unique telehealth capacity crisis which COVID-19 has created is drawing interest to virtual SMAs.

• The Training platforms such as ECHO, which train primary-care providers in many States through an online platform can accelerate adoption and should also guide implementers on how to gather data that can be used to scientifically validate this care model.

The advantage for India:

• Relative to other nations, India is well poised to ramp up telehealth. Data plans are cheaper in India than anywhere.

• It is possible to get 1.5GB of data a day for a few hundred rupees a month, and Indians from all socioeconomic groups regularly enjoy group video chats with friends and relatives.

• Having a group interaction with a care provider on an appropriately secure platform is certainly conceivable.

Way forward:

• WHO’ s Global Strategy on Digital Health, adopted by the World Health Assembly, is a call to action providing a road map for nations to rapidly expand digital health services.

• With innovation in systems thinking, learning and adaptation, new digital tools bring an opportunity to leapfrog into a reality of ‘Health for All’.

• All services were affected, due to covid-19 including essential services for communicable diseases, no communicable diseases, mental health, reproductive, maternal, newborn, child and adolescent health, and nutrition services, now slowly improving through telehealth.

• The Emergency services were the least disrupted, although 16 countries reported disruptions across all emergency services. The most severely affected service delivery platforms were mobile services, often suspended by government, and campaigns, for example as used for malaria prevention or immunization.

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