Details for Reform Option "Telemedicine Project, Chhattisgarh"
Public health is of major concern to Government of Chhattisgarh (GoC) as key health indicators, such as infant mortality rate, maternal mortality ratio and expectation of life at birth, are far below the national average. About 80% of Chhattisgarh’s 21-million population live in rural areas, of which one-third belong to scheduled tribes and one-fourth to scheduled castes. The population density is 154, which is much below the national average of 310. The state suffers from acute shortage of healthcare facilities and a lack of trained medical personnel. There are only two medical colleges serving a population of more than 10 million. Delivery of public health services becomes even more challenging where the terrain is difficult with large areas under forest cover; villages in these areas are sparsely populated and remotely located.
Following the formation of the state on 1 November 2000, the government of Chhattisgarh (GoC) in 2002 published the e-government roadmap (included in References), a vision document of GoC, clearly mentioning the opportunities for harnessing Information and Communication Technology (ICT) to improve the reach of health services.
One of the e-governance issues taken up by the government was telemedicine project, which aimed to provide quick medical advice and facilities to the rural areas of Chhattisgarh. The specific objectives were to enhance specialised health services, distance Continuing Medical Education (CME) and training; monitoring national health programmes and management of information system.
The GoC commissioned the Indian Space Research Organisation (ISRO) to provide the hardware and software for the project. The first step was to set up a super-specialty node at Government Medical College, Raipur and Bilaspur and link them to premier hospitals across the country. Second, to have telemedicine node at district hospitals.
In the first phase, 3 telemedicine centres were set-up: Medical College Raipur, District Hospital, Jagdalpur, Community Health Centre, Marwahi. Now, all the districts have the facility. Each telemedicine centre has a separate room. The software for communicating information about patients includes data on patient identification number, name, age, sex, location, date of sending the information, electronic medical record and referred doctor. ISRO gave 2-day training to staff identified at telemedicine centres across the state. ISRO has placed a support engineer to facilitate smooth functioning of the network.
Pre-determined time slots have been shared with users to consult doctors at All India Institutes of Medical Sciences (AIIMS), New Delhi and B.R. Ambedkar Memorial Hospital, Raipur. The telemedicine network of Raipur is also connected to more than 150 telemedicine nodes of ISRO (As on May 2006, ISRO network covers 165 hospitals - 132 remote/rural/district hospitals/health centres connected to 33 speciality hospitals located in major cities) spread across India (see third and fourth website reference given).
The use of ICT was more frequent at the initial stages of the project. Between 2002 and 2006, Raipur Medical college received 194 electronic medical records; of which 70% cases have been diagnosed and reports sent while the rest are still pending. In addition, the Medical College has been able to conduct simultaneous training programmes for paramedical students at Raipur and Jagdalpur (Bastar district). Fortis Hospital, Noida has also shown interest to provide telemedicine services free of cost to Raipur Medical College.
The slow progress seems to be result of technical snags and inadequate trained technical staff to handle the telemedicine network.
INR 40 lakhs (4 million).
Medical College, Raipur and district hospitals.
Reach: Extends the reach of specialist services to patients living in difficult and inaccessible areas, where it is difficult to find even a general physician in the vicinity.
Diagnosis and treatment: Patients usually prefer to visit local doctors for their ailments. Therefore, telemedicine offers local doctors the required assistance for diagnosis and treatment of difficult cases
Training: Where local resources are limited, the interactive medium can be effectively used for conducting training programmes.
Continued Medical Education: Staff and doctors can keep abreast of ongoing advances in medicine sitting at their office.
Staff: The telemedicine centre requires technicians to handle the operations. At the very least, part-time assistants need to be hired who will do the teleconferencing.
Training: Inadequate training on maintenance of installations and equipment by ISRO to computer operators working at nodal centres is a major challenge for the smooth functioning of project.
Essential facility: The telemedicine centre should have a dedicated telephone facility so as to enable the technical staff to communicate with ISRO on technical problems.
Efficiency: Frequent technical snags de-motivate users.
Infrastructure/connectivity: The capital cost and maintenance cost are considerably high. There is also need to ensure that there is enough bandwidth available for the project to continue. Besides, each district hospital has to have facilities such as X-ray, CT scan, MRI, Film scanner and equipped pathology slides so that the reports can be sent to specialist hospitals.
Lack of technical support: It can take weeks for telemedicine equipment in rural areas to be repaired.
Broadband connectivity with video-conferencing facility.
Dedicated technical staff to manage the telemedicine centre.
Demand for specialist services.
Funds to set up such centres.
Telemedicine training facility.
Who needs to be consulted
Government of Chhattisgarh.B.R. Ambedkar Medical College,
Patients who have received help through telemedicine.
It is sustainable if used efficiently.
Chances of Replication
It can be replicable if the government finds it a cost-effective means to improve the quality of training and provide access to specialist services in remote corners of the state.
Dr. Nandini Roy, Research Consultant, National Institute of Medical Statistics. June 2006.