Bridging the urban-rural divide

The disparity in healthcare infrastructure between rural and urban areas has long been a topic of concern. Urban areas often benefit from advanced medical facilities, a higher concentration of healthcare professionals, and better access to cutting-edge technologies. In contrast, rural areas and tier 2 and tier 3 frequently struggle with limited resources, fewer healthcare providers, and challenges in accessing specialised care. However, each setting has developed unique and innovative solutions tailored to its specific challenges, presenting opportunities for cross-learning and adaptation.

Sharing his views on this, Dr S. Gurushankar, Chairman, Meenakshi Mission Hospital and Research Centre, Madurai mentions, “Healthcare in India varies significantly between rural, tier 2 and tier 3 cities, and urban areas. Rural regions often lack quality healthcare, with patients visiting facilities only at the last moment due to limited resources. The doctor-to-patient ratio is 1:11082 in rural areas, far from the WHO recommendation of 1:1000. Most doctors practice in urban areas, leaving rural communities dependent on an underresourced public health sector.” 

 Disparities in healthcare infrastructure 

A report by Praxis Global indicates that approximately 30 per cent of hospital beds and 50 per cent of healthcare facilities are situated in rural areas, which account for around 67 per cent of the total population in India. The rural regions exhibit a concerning doctor-to-patient ratio of approximately 1:25,000, significantly below the World Health Organization’s recommended ratio of 1:1000. Dr Sanjeev Singh, Medical Director, Amrita Hospital Faridabad highlights that understanding the disparities is crucial for developing strategies that ensure equitable healthcare access for all. 

He says, “In today’s rapidly evolving healthcare landscape, ensuring equitable access to quality healthcare is more critical than ever. While advancements in medical technology and treatment have significantly improved health outcomes in many urban centres, rural and smaller cities often lag behind, highlighting the urgent need for development at all levels. Addressing these disparities is essential for building a healthcare system that serves all populations effectively.”

Abrarali Dalal, Director and CEO, Sahyadri Group of Hospitals, Pune shares some stats and says, “According to the National Rural Health Mission, rural India, which accounts for about 70 per cent of the population, has only about 40 per cent of the country’s hospital beds. This disparity leads to delayed treatments, increased travel for medical care, and generally poorer health outcomes. According to National Health Profile 2022, the distribution of beds between rural and urban areas is notably imbalanced, with rural hospitals comprising 36.5 per cent of the total beds and urban hospitals holding 63.5 per cent. This highlights significant disparities in healthcare infrastructure between urban and rural settings.”

 

Innovative solutions in urban and rural healthcare 

In urban centres, the integration of advanced technology has transformed healthcare, streamlining processes and improving patient outcomes. However, in the vast rural expanses, the heart of healthcare beats differently. Here, community health workers (CHWs) are the lifeline, serving as a crucial link between the community and formal healthcare systems. These unsung heroes navigate challenging terrains and overcome numerous obstacles to deliver essential care, ensuring that even the most remote villages have access to vital health services.

Talking about the innovation in urban healthcare, Dr Singh emphasises, “Telemedicine and Tele ICU for example, has revolutionised access to specialist care in urban settings and can be instrumental in bridging the gap in rural areas. Additionally, urban centres often implement comprehensive electronic health record (EHR) systems that streamline patient information and enhance care coordination. Adapting these technologies to fit the context of smaller cities and rural areas can significantly improve the efficiency and quality of care provided in these regions.”

Explaining the pivotal role of CHWs in rural healthcare delivery, Dalal shares that they act as a bridge between the community and formal healthcare systems. These workers, often locals trained in basic healthcare practices, provide essential services such as maternal and child health care, immunisations, and health education. Another notable innovation is the use of solar-powered healthcare facilities, which ensure uninterrupted power supply for critical medical equipment in areas with unreliable electricity.

unreliable electricity. Programs like the Accredited Social Health Activist (ASHA) scheme train local women to provide basic healthcare services, significantly improving maternal and child health outcomes. In Maharashtra, ASHA workers have been instrumental in reducing maternal and infant mortality rates. By providing antenatal care, educating mothers about nutrition, and ensuring timely immunisations, ASHA workers have created a healthier community. Their efforts have led to a significant decrease in maternal deaths and improved overall health indicators in the region.

A two-way street of learning 

Dr Gurushankar stresses that urban and rural healthcare systems can learn from each other to create a more robust network. Urban areas can adopt personalised care models from rural settings, while rural areas can benefit from urban medical technologies. By embracing collaboration, we can build a healthcare system that serves all populations, bridging the gap between rural, tier 2 and tier 3 cities, and urban areas. Priyadarshi Mohapatra, Founder and CEO, CureBay opines that rural areas have pioneered cost-effective healthcare models. Innovative hybrid models integrating eClinics, digital franchisees, and a network of healthcare providers demonstrate how technology and empathy can bridge critical healthcare gaps. These models often include significantly reduced consultation fees, discounted rates on medications, and membership programs that offer comprehensive benefits such as complimentary consultations, diagnostic examinations, reduced prices on medications, and access to ambulance services and other amenities. These initiatives highlight the need for accessible and economical healthcare services in remote regions.

Dalal also opines, “Adapting rural innovations to urban settings and vice versa requires a nuanced approach. For instance, telemedicine, successful in urban areas, needs to be tailored for rural regions by addressing connectivity issues and training local healthcare workers. Conversely, urban areas can adopt the CHW model by modifying it to fit the urban context, focusing on health education and preventive care in underserved urban communities.”

According to Dr Singh, to successfully adapt rural innovations to urban settings and vice versa, it is crucial to consider the unique characteristics of each environment. Strategies should include flexible implementation plans that respect local contexts and involve stakeholders from both rural and urban areas. For example, urban centres can adopt community engagement models from rural areas to enhance preventive care, while rural areas can implement scalable versions of urban telemedicine platforms to improve specialist access. The key is to tailor these innovations to meet the specific needs of each community.

The growth of hospitals in tier 2 and tier 3 cities in India has the potential to create substantial opportunities for various stakeholders in the healthcare industry, including diagnostic service providers and medical device manufacturers.

Aryaman Tandon, Managing Partner, Healthcare, Praxis Global Alliance shares some interesting insights on the same and says, “Diagnostic labs can offer cost-effective testing options without compromising on quality to cater to the price-sensitive segment. Establishing collection centres in easily accessible locations within tier 2 and tier 3 cities and mobile collection units to reach surrounding remote areas can help unlock the potential. Companies can partner with local hospitals and clinics to offer diagnostic services. They can also work with government health departments to participate in public health programs and screenings, enhancing brand visibility and credibility. Developing lower-priced test packages tailored for the local population, such as comprehensive health check-ups, along with home collection services, can provide a competitive edge while enhancing convenience and customer satisfaction.

Similarly for medical device manufacturers, “The growing number of hospitals in tier 2 and tier 3 cities expands the market for medical devices. Manufacturers can tailor their products to meet the specific needs and affordability constraints of these cities. As healthcare facilities in these cities upgrade and modernize, there is an opportunity for medical device manufacturers to provide advanced and innovative technologies, such as telemedicine tools and point-of-care devices.”

Policy recommendations for fostering innovation exchange 

 

Equitable access to healthcare needs to be built on pillars of knowledge exchange, funding, infrastructure and technology. Sachidanand Upadhyay, MD at Lord’s Mark Industries shares, “Develop a policy framework that incentivises the creation of scalable healthcare solutions adaptable to various settings. This should include subsidies for companies that successfully implement innovations across different environments. Implement grant programs that fund collaborative initiatives between urban innovators and rural healthcare providers. These grants should support pilot projects that adapt urban technologies for rural applications and vice versa. Develop comprehensive technology networks that connect urban and rural healthcare systems, facilitating real-time data sharing, telemedicine consultations, and remote diagnostics. This approach promotes mutual learning and the adaptation of best practices. Establish mobile innovation labs that travel between urban and rural areas to demonstrate new technologies and gather feedback. These labs will enable hands-on learning and the customisation of solutions for diverse environments and Create mentorship programs where urban healthcare leaders assist rural counterparts in adopting advanced technologies, while rural providers offer insights on resourcefulness and community engagement.

Dr Singh highlights that Policy recommendations play a vital role in fostering innovation exchange between different healthcare systems. Governments and healthcare organisations should establish frameworks that encourage collaboration, funding, and knowledge sharing between rural, tier 2 and tier 3 cities, and urban areas. Policies should support pilot programs, provide financial incentives for adopting successful models from other regions, and facilitate the integration of innovative technologies. By creating an environment conducive to innovation exchange, we can ensure that all populations benefit from advancements in healthcare, leading to improved health outcomes nationwide.

Way forward 

Equitable access to healthcare is not just a goal; it is a necessity for a healthy society. The journey towards healthcare equity requires commitment and collaboration from all stakeholders, including governments, healthcare providers, and communities.

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