As the second-most populous country in the world, India faces an unequal distribution of doctors catering to its population. This gap has become even more evident during the Covid-19 pandemic.
According to a World Health Organization (WHO) assessment in May, since the Covid outbreak, people living with non-communicable diseases (NCDs) have become more vulnerable to becoming severely ill or dying from the pandemic.
When the lockdown began, in India 30 per cent fewer cardiac emergencies reached rural health facilities in March 2020 compared to previous years.
People living with NCDs are at a greater risk of suffering from severe symptoms and mortality from Covid-19. People with diabetes are up to three times more likely to have severe symptoms or even die from Covid-19, and the situation is likely to be worse for people with uncontrolled diabetes.
Similarly, a meta-analysis showed that hypertension, cardiovascular, and cerebrovascular diseases increased the odds for severe Covid-19 by 2.3, 2.9, and 3.9 times, respectively.
In India, nearly 5.8 million people die from NCDs (heart and lung diseases, stroke, cancer, and diabetes) every year. So it becomes critically important to ensure that access to NCD treatments remains uninterrupted, especially during a time where the risk of these conditions has been exacerbated.
Covid-19 has not only increased the risk of living with NCDs but also diverted resources from other ailments to curbing the pandemic. With hospitals and other primary care centres focussed on containing the virus, patients are wary of going to hospitals for other ailments, out of fear of contracting the virus.
Adopting tech solutions
At the beginning of the lockdown, the government and industry came to realise that rapid technological adoption was the only way forward for stabilising the economy despite the disruptions. Among the many innovations and initiatives that emerged, telemedicine has helped ensure that the healthcare system has not reached a breaking point.
The Health Ministry and the NITI Aayog released Telemedicine Practice Guidelines in March to ensure that access to medical advice did not become a challenge due to social distancing norms and for the high risk people living with NCDs.
The guidelines, coupled with the tele-consultation services — e-Sanjeevani and e-Sanjeevani OPD — have been used to effectively improve the delivery of health-care services using information and communication technologies in exchange for valid information diagnosis, treatment, and prevention and management of diseases, etc.
In April 2020 Punjab became one of the first States to vitalise 500 telemedicine spokes placed out of Health and Wellness centres located within villages and a centrally located telemedicine hub with medical experts and operating through the e-Sanjeevani platform.
Soon the number of consultations done per day exceeded 100 and the calls were primarily of people affected with cardiac diseases and Diabetes mellitus. As of September 26, the teleconsultation platforms have been implemented in 23 States and the e-Sanjeevani OPD platform has completed a landmark milestone of 4 lakh teleconsultation.
Zoom in consultations
Since the start of the pandemic, there has been a 500 per cent rise in telemedicine consultations, with 80 per cent of the users being debutants. The States that have registered the highest number of consultations include Tamil Nadu (2,03,286), Uttar Pradesh (1,68,553), Kerala (48,081), and Himachal Pradesh (41,607).
Several private initiatives to build telemedicine capacities for pre-screening of Covid-19 also emerged. Initiatives such as Cough Against Covid by Wadhwani AI emerged to build artificial intelligence that could distinguish between the coughing patterns of those with Covid and those with other maladies.
Other examples such as Project Stepone, which worked closely with State governments of Karnataka, Punjab, Odisha, and Maharashtra, helped in a preliminary screening of people with flu-like symptoms in the early days of the lockdown.
The use of digital care for positive health outcomes, especially for people with multiple co-morbidities related to chronic diseases is possible because of the availability of remote monitoring and virtual care tools supported by devices like affordable smartphones and artificial data solutions, are proving to be the next major booming industry in India.
In response to the pandemic, many Low- and Middle-Income Countries (LMICs) expanded access to telemedicine to maintain essential medical care . New telemedicine-promoting policies and ubiquitous mobile phone access in many LMICs now raise the possibility that telemedicine could help bridge gaps in care for chronic medical conditions going forward.
Telemedicine services especially in the health and wellness centres at the grassroots level wherein a mid-level health worker can connect the patients to the doctors through technology in providing timely and best possible care. It is essential to continue to sustain such initiatives post the pandemic as they can help decrease accessibility costs to quality healthcare.
The writer is Senior Consultant – Health, NITI Aayog. The views expressed are personal