54 percent of patients think telemedicine is not reliabile, 30 percent aren’t comfortable with technology and data privacy is an area of concern along with regulatory approval for LEO-based internet access.
Five hundred and forty-two.
That is the number of medical colleges in India.
As of 21 May 2020, there are 542 medical colleges and 64 stand-alone PG Institutes in India whose qualifications are recognized by the National Medical Commission. It is the highest number of medical colleges for any country in the world. Not surprisingly then, we have the second-highest number of doctors globally.
But given our 1.3 billion population, the doctor-patient ratio is abysmal — nine doctors per 10,000 people, as against to 42 in Germany, 28 in the UK and 26 in the US. For its 1.4 billion people, China has 3.61 million doctors, nearly thrice that of India. Similarly, though India has around 3.2 million nurses and produces 335,000 nursing professionals every year through 5,085 institutes, there are only 15 nurses for every 10,000 individuals.
Despite all government schemes, access to healthcare continues to be a problem for the average Indian citizen. India faces a lack of trained healthcare administrators in the public sector. The COVID-19 pandemic has brought to the surface this shortage and shortcomings of the public health system even more evidently.
The government of India spends 1.2 percent of its GDP on healthcare, the private sector spends about 2.2X that. In total, a dismal 3.8 percent of the country’s GDP is spent on healthcare. In comparison, Brazil spends eight percent while EU countries spend 10 percent. Between 2015-16 to 2020-21, there has been a mere 0.02 percent increase in the health budget in India.
Heavens might be the answer
With no indication of the government intending to spend more on the sector, or the private sector remaining urban-centric, what should we do? Look towards the heavens for direction? Actually, that may really be the best thing to do.
An important change in healthcare consumer behaviour is the acceptance of digital platforms as an alternative to physical access to doctors and hospitals. The pandemic has created the need for a healthcare ecosystem that is integrated digitally to enable reach for patients and doctors who refrain from in-person visits to avoid infections. Healthcare consumers are showing interest in the adoption of different teleconsultation and e-pharmacy platforms.
While the adoption levels are rising, is there a promising growth of virtual care? The report says adoption levels will be retained in the future after the pandemic subsides. This is due to unprecedented times and this uncertainty may fuel transformation in the teleconsultation space as well. COVID–19 will be the inflexion point leading to 20–25 percent adoption to teleconsultation which has the potential to grow continuously.
Is there a solution?
Can this trend become a saviour for those without access to healthcare? This shift has three important pillars:
1. An integrated digital healthcare ecosystem
The first pillar is already in the process of forming. As platforms get created, a virtual marketplace opens up for providers. The Tata Super App, Jio Mart and a few others are already taking shape.
2. Access to the ecosystem via uninterrupted internet bandwidth
Satellites are already being used to enable internet access. Billions of dollars are now being invested in a new generation of satellites that orbit the Earth at a low altitude. These low earth orbit (LEO) satellites can better connect remote and inaccessible regions. Many new groups of these satellites, known as constellations, are in development. However, some are partially deployed, with more than 1,500 satellites in orbit and thousands more in the pipeline. Starlink, a constellation being built by SpaceX, has already launched 1,445 satellites and is testing its service in North America, Europe, and New Zealand. OneWeb, another satellite broadband provider, has placed 182 LEO satellites in orbit. Other companies, including Asia-based ones, are planning to join in.
3. An affordable smartphone
Jio Phones – a joint venture of Reliance Jio and Google – announced earlier this year, the launch of a smartphone that costs less than $50 (INR 3650). This low-cost smartphone, called JioPhone Next is aimed at helping roughly 300 million users in India who are still on a 2G network to upgrade their gadget to access faster networks.
Google has also entered into a 5G cloud partnership with Jio Platforms. This will help more than a billion Indians connect to a faster and better internet, and help Jio build new services in sectors like health, education and more.
Laying the foundation
All this can potentially lay the foundation to create access to healthcare in the hinterlands of this vast country. With LEO-led global internet coverage, high-speed connectivity can become a reality even in remote regions. As satellite internet quality improves, expanding the applications and services that can be used will be possible. Competition should reduce broadband prices and connectivity can improve network infrastructure resilience even in regions prone to natural disasters.
Of course, there are challenges. While 54 percent of patients questioned the reliability of the online diagnosis, 30 percent are not comfortable with the use of technology and the virtual sphere. Data privacy also remains a key area of concern, as does regulatory approval for LEO-based internet access. But these can be attributed to the natural diffusion process of new technology or behaviour and should sort out sooner than later.
Also, digital health is unlikely to solve the root cause of the problem — woefully inadequate medical infrastructure. We all have to only think of the horrors of April and May 2021 when the second wave highlighted the lack of basic healthcare access to millions.
However, technology is a strange animal. It tries to solve these large issues. Will AI evolve to an extent where it can fill in for primary care doctors?
Will deeper and broader access to the internet increase rural incomes so that folks can actually pay for healthcare, even if remotely?
Will a de-centralised tech economy render physical boundaries irrelevant and allow our citizens to seek help from doctors in other countries?
Will Moore’s law allow more access to better healthcare at more affordable prices?
At present, there seems to be very little to cheer in terms of the creation of government-led healthcare access. Even the current stakeholders and incumbents in the market seem to have little incentive to change status quo. In such a scenario, healthcare access will indeed, seem to drop from the heavens.
The author is a former Executive Vice President at GlaxoSmithKline Pharma and an alumnus of the Takshashila Institution.