mHealth Still Needs a Residence, Even in Rural India
by Ben Thurman
Careering down the serpentine road from Araku to Visakhapatnam, in the Eastern Ghats of Andhra Pradesh – one eye on an ailing girlfriend in the back seat of our battered Ambassador and one eye trying to appreciate the majestic scenery despite the severity of the situation – I began to ponder the difficulties of inhabiting such a remote location.
Indeed, Araku, less than a hundred miles from Visakhapatnam – the second largest city in Andhra Pradesh – is hardly that remote. Yet, it took us two hours, 1600 rupees and a semi-physical confrontation with a taxi driver to cross the mountain range to the nearest hospital. For the outlying tribal communities without the financial reserve that we enjoy, the journey would not be possible in the event of critical illness or childbirth.
Despite government initiatives to make vital healthcare more accessible to the rural poor – including the public-private partnership that established the ‘108’ Emergency Response Service – the problem remains disturbingly simple:
India does not have enough doctors, and those that it has are not willing to practise in the ‘interior’. Although India produces 45,000 medical graduates each year, the National Rural Health Mission reported in 2011 that 67% of rural positions are unfilled, with doctors wooed by the high salaries and urban postings of the private sector.
The Medical Council of India seeks to address the problem by making a six-month rural placement mandatory for all MBBS students, admitting that medical education is ‘at present … urban and big town-centric’. But with little incentive to practise in the rural hinterland after graduation, this seems to be little more than a stop-gap solution. India’s failure to provide affordable and accessible healthcare to its rural population – still an overwhelming majority at around 70% – requires a more innovative approach, one that has been developed by Amit Jain, President and CEO of e-Health Point.
Speaking at the Khemka Forum on Social Entrepreneurship in November last year, Amit explicated his ‘pioneering and futuristic social business model’ that in its short existence has impacted the lives of hundreds of thousands in underserved rural and peri-urban communities. e-Health Point operates a multifaceted approach comprising safe drinking water, telemedical video consultations, diagnostic tests and an affordable, licensed pharmacy on site.
With the goal of ‘democratising’ healthcare, e-Health Point has built a comprehensive model that provides quality and affordable services without discriminating against gender, caste or socio-economic status. Women and children – so often denied medical attention – constitute 60% of its clients; mobile consultation has reduced the travel costs that previously prevented people from seeking out medical consultation; pharmacies are managed to ensure that medication remains affordable; and, in doing this, hundreds of jobs have been generated.
Since 2009, e-Health Point has reportedly conducted over 30,000 consultations, processed some 35,000 prescriptions, and provided safe drinking water to half a million people. The potential for wide-scale change in healthcare for underserved communities has drawn organisations from USAID to Bloomberg to recognise Amit as one of the world’s most promising social entrepreneurs.
Yet at the Khemka conference, Amit emphasised the ‘pioneering’ nature of his business that combines technology with ‘bricks and mortar’. Issuing a caveat that technology alone cannot drive change, he highlighted the unique multi-service platform as the reason for e-Health Point’s success. Although advances in the application of mobile technology can affect positive social change, it has to be relevant and usable – not ‘technology for technology’s sake’.
His point is pertinent; one of the biggest pitfalls of m-Health is that patients are often unable to follow up mobile consultation with necessary medical attention: if a patient does not or cannot access primary care, the diagnosis is futile. Beyond technological solutions, there is an urgent need to change the entire health ecosystem. By combining the best of mobile technology with tangible infrastructure – on site pharmacies and safe drinking water facilities – e-Health Point has evolved a new approach to enable rural communities to access quality healthcare.
But it is a solution that is still developing. Despite its plaudits, there is little evidence to support the theory that m-Health has changed healthcare. Regardless of the increased occurrence of misdiagnosis in mobile consultation and misunderstanding in self-tracking devices,
mobile technology needs to be integrated with more touch points that influence health – pharmacies, clinics, hospitals and, crucially, doctors.
Despite claiming demonstrable ‘social impact’, it is unclear if pharmacies and safe drinking water represent sufficient infrastructure to change the whole health ecosystem and influence attitudes and practices towards healthcare. Whilst m-Health makes consultation more affordable and accessible, has it impacted the number of people seeking a medical opinion? And thereafter, how often are diagnoses followed up with necessary treatment?
The ‘global m-Health opportunity’ is a rapidly emerging market, estimated by McKinsey at $50 billion. Undeniably, there is huge potential to harness mobile technology to address operational challenges, distribute information and improve accessibility to consultation and diagnosis. However, it is still a nascent market; entrepreneurs are adapting and searching for the right model to affect widespread social change.
Whilst we should continue to make use of technology and develop mobile solutions for healthcare, rural India still demands increased infrastructure – more ‘bricks and mortar’ – for the nation’s poorest and most geographically marginalised to access the healthcare they require.
Ben Thurman is an IDEX Accelerator Fellow, a career launch-pad for aspiring social enterprise practitioners. Fellows undergo six months of leadership and business development training by working full-time with social enterprises in India. IDEX Accelerator is supported by Gray Ghost Ventures, an Atlanta-based firm of impact investors.
(Photo Courtesy of Subject)