Mainstreaming telemedicine is probably the most transformative change hospitals have made to offer healthcare within the post-coronavirus illness (Covid-19) world with out compromising on high quality of care and outcomes. The Board of Governors in supersession of the Medical Council of India (MCI) issued Telemedicine Apply Tips on March 25 to strengthen supply in a post-Covid-19 world, with a concentrate on Well being and Wellness Centres (HWCs) that present preventive and first healthcare inside a 5 km radius on the grassroots stage.
“We had already put in six months of labor into the rules and when the coronavirus pandemic occurred, we expedited it. Expertise platforms had been one thing obtainable and getting used, however weren’t regulated, which uncovered each sufferers and suppliers to challenges. These pointers present steering materials for reference, that may be refined earlier than they turn into an annexure to the MCI Act, enabling regulation,” mentioned Dr Nikhil Tandon, professor and head of the division of endocrinology and metabolism, All India Institute of Medical Sciences (AIIMS), who’s a member of the Board of Governors in supersession of the MCI that drafted the regulation.
Telemedicine is being utilized by docs to attach with sufferers, and by mid-level supplier/well being staff to attach sufferers with docs with out sufferers having to bodily go to a hospital or clinic.
Telemedicine has already helped decongest AIIMS, which moved its out-patient division companies on-line from April Eight to allow sufferers entry therapy and care throughout lockdown.
“Even submit lockdown, it should assist cut back the burden on the secondary hospitals and enhance documentation, data-collection, prognosis and care with out risking the security of the sufferers or the well being staff. It’s already getting used with success in some states for reproductive and youngster well being and tuberculosis notification and outreach,” mentioned an epidemiologist within the well being ministry, requesting anonymity.
There’s a persistent scarcity of docs, well being staff and hospital beds within the nation, particularly in rural areas and densely populated underserved states. India has 1.1 million allopathic docs registered with the Board of Governors/State Medical Councils in December 2019, in keeping with the Nationwide Well being Profile 2019.
India’s public well being expenditure is simply 1.28% of its GDP, with the per capita public well being expenditure being Rs 1,657 in 2017-18. The rising value of therapy has led to inequities in entry, with folks in underserved rural areas and concrete slums among the many worst hit. For folks dwelling in rural areas fully depending on authorities hospitals and clinics, the federal government allopathic doctor-patient ratio is 1:10,926, reveals NHP 2019 knowledge.
“Assuming 80% availability, it’s estimated that round 9.26 lakh docs could also be really obtainable for lively service,” mentioned minister of state for well being and household welfare Ashwini Kumar Choubey within the Lok Sabha final 12 months. The supply is at all times decrease as a result of some retire, some cease working, transfer to hospital administration, whereas others go abroad with out getting their names struck off the register.
For a inhabitants of 1.36 billion, this makes the doctor-population ratio 1:1,457, which is decrease than the WHO beneficial norm of 1:1,000. Along with docs, India has just a little greater than two million registered nurses and midwives, a lot of whom want an infection management coaching to look after sufferers with communicable ailments, akin to Covid-19 and tuberculosis.
“Cell apps, telemedicine, digital well being are all nice and welcome, however can’t assist any nation leapfrog fragile and under-resourced well being programs,” mentioned Prof Madhukar Pai, Canada Analysis Chair in Translational Epidemiology & International Well being, and Director, McGill International Well being Applications, McGill College, Montreal.
“I can see that working in a strong healthcare system. How can it work in settings with poor web entry, illiteracy and excessive poverty? We merely can’t code our approach out of the healthcare mess we’re in. Digital tech merely can’t substitute a practical, sturdy public healthcare system,” mentioned Dr Pai.
Over the previous two years, group well being officers (CHO) have emerged as the primary level of preventive and first healthcare for an growing variety of folks in rural India at HWCs, the place telemedicine is an integral a part of outreach and well being companies. They provide main well being companies akin to measuring blood stress and doing easy pinprick exams for malaria, blood glucose ranges and haemoglobin, and shelling out over-the-counter medicines for fever and ache.
Since CHOs are normally certified nurses or practitioners of different programs of medication with extra coaching in group medication, they can’t prescribe medicines, change prescription therapy or give injections, however can even ask sufferers to proceed prescribed treatment – akin to for diabetes, hypertension, amongst others — after a video session with the physician on the nearest main or group well being centre.
Earlier than these pointers, there was no laws or pointers on the follow of telemedicine by video, cellphone, and on-line platforms, which embrace the online, apps, chats, and many others. The prevailing provisions below the MCI Act, 1956, MCI Laws 2002, Medicine & Cosmetics Act, 1940 and Guidelines 1945, Scientific Institution Act, 2010, Info Expertise Act, 2000 and the Info Expertise Guidelines 2011 primarily ruled solely the follow of medication and data expertise.
“There are challenges, together with connectivity, however the attain and help telemedicine offers is super. Since April 8, the endocrinology division reached at the least 60% sufferers who wanted follow-up recommendation, with out their needing to go to the hospital or physician in the course of the lockdown,” mentioned Dr Tandon.
Telemedicine can enhance attain, but it surely can’t substitute a robust main well being system, which depends on competent well being programs and suppliers. “I hope the largest concern with public well being supply post-Covid is the popularity that common well being protection is important for any nation to face a pandemic. Many international locations are studying that you just can’t construct healthcare capability throughout a disaster. It takes time and funding to construct a great public well being system. India has didn’t put money into well being for many years and this should change post-Covid19. Well being spend should at the least enhance to 2.5% of GDP, at a minimal,” mentioned Dr Pai.