Telemedicine for Bharat: What is the Right Model?

Jagdeep Gambhir, Founder & CEO, Karma Healthcare emphasises on approaches and methods that can be implemented in rural areas to deliver telemedicine with optimum potential while still retaining the human touch magic

‘We have to learn to live with COVID-19’ – that’s the new normal these days. Health systems across the country are being tested. Today many people are avoiding visits to healthcare facilities fearing potential exposure to COVID-19. They also run the risk of being severely impacted from other health conditions, possibly resulting in higher mortality.

Access to equitable primary healthcare is a story of disparity that we often shy away from, even though 45 per cent of the population travels more than 100 km to access a higher level of care, according to a study. India has only one-sixth of the number of doctors required and 70 per cent of health infrastructure is concentrated in the top 20 cities. Many people often end up seeking care from informal providers – that potentially leading to higher expenditure and improper treatment. This contrast is a story of Bharat vs India.

‘Telemedicine’ seems to be the buzzword these days. For telemedicine to be successful in the rural milieu, we need to take a deeper look at various available models and how they are designed to work.

Telemedicine can be deployed in two ways: 1) Assisted and 2) Non-Assisted. The non-assisted model relies completely on technology, while the assisted model is technology-enabled and integrates a human conduit into the process. A non-assisted model requires high level of education and familiarity with the treating doctor to do an audio-video consultation. Both the above may be missing for people in rural areas.

Having worked in the field of nurse-assisted telemedicine since the last five years, our experience tells us that an assisted model tends to have more acceptability and relevance in rural areas.

While designing digital intervention for rural areas, we should factor the following behavioural and design aspects:

• Problems of usage arising from technological barriers such as lack of smart phones, fear of unknown technologies, and new methods.
• Problems of communication arising from language barriers related to dialect between doctor and patient, and not being able to comprehend medical terms.
• Problems of trust arising from habit, conditioning, and the comfort of physical contact. Rural India is a community closely woven by interactions, discussions, and consultations. The placebo effect is still a valid human truth in medicine. Trust in the doctor is as much of a key ingredient in healing as the medicine itself.

These deep behaviour change issues could be solved by having an assistant in the process. Non-assisted models are comparatively easier to scale, while the assisted model brings with it a nuanced approach that includes complexities to yield more impact and better access. There are inherent issues of scaling up with an assisted approach, but it has been deployed in other industries such as banking correspondents, common-service centres, and rural e-commerce hubs.

There is no sure shot recipe for success, but the intention is to suggest that if we further sharpen the amazing interventions and projects built so far in telemedicine and incorporate the much needed human touch, we can better impact lives in rural areas. A combination of scale and depth is what we should aim to achieve because a one-size-fits-all solution for Bharat may be a disservice to the diversity that our country has.