Details for Reform Option "Telemedicine at General Hospital, Arunachal Pradesh"
Background: The major health problems causing morbidity and mortality among infants and mothers are diarrhoeal diseases, parasitic infestation, hepatitis, enteric fever and other water borne diseases. Malaria and tuberculosis are the major leading causes of death. Other diseases are leprosy, goiter, anaemia, respiratory diseases and limited HIV screening activities along with asthma. One major problem that concerns the health officials is alcoholism, which is extremely high in Arunachal Pradesh
Action: Information and Communication Technology (ICT) is now being used extensively to improve the reach of health services. The Government of Arunachal Pradesh launched the Telemedicine project in April 2004 in Naharlagun, which is about 10 kms from Itanagar. The main objectives of this were:
To provide Continuing Medical Education (CME) training for General Duty Medical Officers on various health issues.
Quick medical advice
This facility caters to the rural people in and around Naharlagun and Itanagar. The Government of Arunachal Pradesh commissioned the Indian Space Research Organisation (ISRO) to provide the hardware and software for the project. The North Eastern Council (NEC) provided also provided financial support. The Science & Technology Department of GoAP in partnership with a NGO, Health Foundation.
The first step was to set up the infrastructure at the General Hospital, Naharlagun linking them to premier hospitals across the country. Second, to have telemedicine centre at other hospitals. ISRO gave training to staff identified at telemedicine centre and also lends its support to facilitate smooth functioning of the network.
The GoAP conducted sessions of CME with Medical Officers at Naharlagun and specialists from Fortis Hospital, NOIDA, New Delhi on topics as follows:
Management of Strokes
Management of head injury
In the first phase, one telemedicine centre has been set-up at General Hospital, Naharlagun. 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. This is a 24-hour telesite. When a patient approaches the hospital and requires a specialist’s view, the concerned hospital and doctor are approached. An appointment for consultation from both sides is then arranged. The telemedicine network of Naharlagun is connected to the telemedicine centres of ISRO covering more than 10 hospitals in various parts of India for example: Tata Memorial Hospital, Mumbai; Amrita Hospital, Koche Dr B Borooah Cancer Institute, Guwahati and many more premier institutes.
Results: Encouraging results in terms of patients consulting specialists through Tele-conferencing. In one instance, as per the consultation, two cardiac patients requiring Open Heart Surgery were operated at free of cost at Narayana Hrudayalaya, Bangalore. The hospital has also promised to continue support and assist Arunachal Pradesh for such situations in future also, considering the state’s remoteness.
1.5 lakhs (INR)
General Hospital, Naharlagun, Arunachal Pradesh
Coverage: This was seen both in terms of increase in patients demanding the use of the telemedicine facility and also increasing the range of diseases that could now be covered in the hospital.
Networking: Liasing and networking with specialist doctors at premier institutes in India
Specialist’s advice at local level: Comfort level of the people to discuss their problems did not change as they were with the same doctor but in addition receiving a specialist’s advice.
Affordability: This facility has benefited the poor people of the state who can’t afford the cost of super speciality hospital intervention, since the state does not have any cardiologists and cardio thoracic surgeons.
Increasing knowledge: Besides, all the resident doctors and nurses utilise the Tele site for weekly Tele conferencing on CME programme on various selected topics and are kept updated on the latest techniques and management.
No proper network, increase in network system is required, particularly at the district level, which is under active consideration. The General Hospital, Naharlagun will soon be transformed into a hub station for connecting all district hospitals.
Lack of Resources
- Broadband connectivity with video-conferencing facility.Computers.
- Dedicated technical staff to manage the telemedicine centre, 24 hours.
- Demand for specialist services.
- Funds to set up such centres.
- Telemedicine training facility.
Who needs to be consulted
Government officials who have set up the telemedicine centre.
Doctors at the hospitals linked to the General Hospital telesite.
Good. Telemedicine Centre at General Hospital, Naharlagun, will continue till the GoAP continues supporting. The Programme does not require huge funds so it is easily sustainable.
Chances of Replication
Good. After the positive response from this TC, 2 more new centres are being planned in other districts of Arunachal Pradesh.
Manisha Ghose, Research Consultant, Central Bureau of Health Intelligence, and Paromita Ukil, Research Consultant, ECTA. January 2007.