Mainstream, VOL LIV No 51 New Delhi December 10, 2016
Envisioning Health Mobility in India
Sunday 11 December 2016
by Pradeep Nair
This article attempts to envision the vivifi-cation of the health sector with the substructure of technological, digital and mobile revolution in the country. The healthcare sector is the primary service provider and welfare set-up which also contributes largely to the Indian economy in terms of revenue and employment generation. The growing outreach of the digital technology and mobile phones would change the face and scope of the health services and its delivery. It would not only fasten up the access and excellence in medical facilities but would also change the perception of and about health. This would boost up the community health practices, preventive health care and breaking up of epidemic diseases. The article simultaneously underlines the need to check the overt commercialisation of health and health services which may confine health for wealth instead of inclusive health and medical practices and services.
Healthcare and the Indian Economy
The healthcare sector is the third largest contributor to the Indian economy in terms of the potential to generate revenue and employment. The Indian healthcare sector encompasses hospitals, pharmaceuticals, medical equipment and supplies, medical insurance and diagnostics. Among the primary subsectors of the healthcare sector, hospitals and pharmaceuticals account for the largest revenue, contributing as much as 71 per cent and 13 per cent of the total revenue annually. The sector is expected to grow to US $ 158.2 billion in 2017 from US $ 81.2 in 2014-15. The per capita healthcare expenditure has increased at a compound annual growth rate (CAGR) of 10.3 per cent from US $ 43.1 billion in 2008 to US $ 88.7 in 2015. Further, the growth of mobile and wireless communication-based healthcare is expected to reach US $ 0.6 billion for India in 2017. India shipped 26.5 million smartphones in Q2 2015 which is up by 44 per cent from 18.4 million units for the same period last year. Thus, the mobility-based health industry is brimming with new health applications, devices and services.
The Indian healthcare industry has grown considerably in recent years, contributing around $ 30 billion, which amounts to five per cent of the GDP and is all set to cross $ 280 billion by 2020. In terms of percentage of GDP, India spends less on healthcare services than many of the developing economies of the world. Even though the government earmarked approximately $ 55 billion for healthcare under the 12th Five Year Plan, the investment is not adequate to meet the target of universal healthcare. At current growth rates, the health infrastructure will be unable to keep pace with the increasing demand of better healthcare for all. India will end up with a total bed density of around 1.7 to 1.9 per 1,000 people against the global average of 2.9, and the WHO guidelines of 3.5 in coming years. The health service providers’ density will also be remain only 1.7 per 1000 by 2022.
Indian Healthcare: Some Blatant Facts
India ranks 112th on the World Health Organi-sation’s (WHO) ranking of the world’s health system. The doctor-to-patient ratio for rural India, as per the Health Ministry statistics, stands at 1:30,000, much below than the WHO’s recommended 1:1,000. The overall healthcare spending (public and private) accounts a mere four per cent of India’s GDP, far below than the average of 9.5 per cent across the Organisation for Economic Co-operation and Development (OECD) countries. Even in this, the private healthcare sector accounts for more than 70 per cent of this spend; while the public healthcares spend is only 1.4 per cent. In term of the total health expenditure per capita, India spends about one per cent of its GDP on public health, compared to three per cent of China and 8.3 per cent of the United States. In 2015, the Union Budget had allocated 33,150 crore INR for the healthcare sector and raised the health insurance premium from Rs 15,000 to Rs 25,000 and from Rs 20,000 to Rs 30,000 for senior citizens. The allocation is much less than other BRIC nations.
With the rising middle class population, the average real household’s disposable income will be double from 2010 to 2020 leading to an increased expenditure on healthcare. It is estimated that by the end of 2020 the country will require an additional 1.8 million new beds to fulfil the targeted two beds per thousand people. The emerging challenges will be the infrastructural requirement for primary and community health centres, nursing homes, clinics, hospitals; and the skill gap-shortage of doctors and trained para-medical staff. The solution is the deployment of wireless mobile communication technologies and its linkages to the rural areas to bridge the gap between the increasing healthcare demands and the services need to provide.
Mobility in Healthcare
Today, mobility is one of the most promising innovations and is expected to transform the way healthcare services reach the patient. India has witnessed significant activity in the mobile health space with the launch of several different services; however, the majority of initiatives are focused on spreading prevention and awareness messages. Entrepreneurship in mobility for health has now entered the Indian market as lot of the ICT-enabled health solution providers like Rockefeller Foundation, United Nations Foundation, Vodafone Foundation, GSM Association, PEPFAR (President’s Emergency Plan for AIDS Relief) and Health 3.0 have already made their presence in India.
Mobile technologies include mobile phones, personal digital assistants (PDA) and smart-phones like blackberry, palm pilot, iPhone, enterprise digital assistants (EDA), and handheld and ultra-portable computers such as tablet PC, iPad and smartbooks. These devices have a range of functions and applications like photos and video (MMS), telephone and World Wide Web access and software application support. Technological advances and improved computer processing power mean that single mobile devices such as smart phones and iPads are increasingly capable of high level performance in many of these functions. The features of mobile technologies that may make them particularly appropriate for improving health-care service delivery processes relate to their popularity, mobility, and technological capa-bilities. The popularity of mobile technologies has led to high and increasing ownership of mobile technologies, which means interventions can be delivered to large numbers of people. The mobility of mobile technologies means that many people carry their mobile phones with them wherever they go. This allows the temporal synchronisation of the intervention delivery and allows intervention to claim people’s attention when it is required. For example, healthcare consumers can be sent appointment reminders that arrive the day before or morning of their appointment. Real-time (synchronous) communication also allows interventions to be accessed or delivered within the relevant context, that is, the intervention can be delivered and accessed at any time and wherever it is needed. For example, at the time healthcare service providers see a patient, they can access the management support system providing infor-mation and protocols for management decisions to whoever requires them. This is relevant for providing clinical management support in settings where there is no senior or specialist healthcare provider support or where there is no such support at night or at weekends. As mobile technologies can be transported wherever one goes, interventions are convenient and easy to access.
The rapid advancements in mobile communi-cation technology is providing enormous benefits to all the stakeholders in a healthcare system by helping them to track the genuineness of medicines, enhancing patient-care provider communications for updates regarding diagnosis and treatment, and to monitor the improve-ments in the treatment through real time data. The information which was distinct at one time and is placed at different places—hospitals, clinics, laboratories, pathologies— is now possible to store at one place accessible by the patients and the service providers 24x7 from anywhere at any platform—web, mobile, desktop, iPad, tablet. All this happens because of the wireless mobile technology and the shift taking place in the mindset and behaviour of the patients, healthcare providers, pharmacists, para-medical staff, and the technology vendors. Due to this the impact on the quality of health-care is now clearly visible to a large extent.
To take this development further, the require-ment is to collaborate across the healthcare industry to integrate technology systems, applications and workflows. This will unleash the power of health mobility to facilitate safe and secure exchange of accurate and timely information and will further increase the efficiency of healthcare service providers. It will also help to improve quality in the healthcare system. When the authentication of medication is possible electronically before the patient leaves the care centres, the benefits will go far beyond improved patient care. Electronic information of critical healthcare available and accessible on finger-tips means saving of time wasted on wired phone, fax machine, physical travel thus assuring that the patients will get immediate and right treatment quickly after the problem is diagnosed.
Gesellschaft für Konsumforschung (Society for Consumer Research, Germany) Report 2015 on Smartphone Prices.
India Brand Equity Foundation (IBEF) Report 2015.
Industry Report, Healthcare: India, The Economist Intelligence Unit, July 2014.
International Data Corporation (IDC) Report on Mobile Subscribers, June 2015.
PwC Report—Touching Lives through Mobile Health: Assessment of the Global Market Opportunity, 2015.
Telecom Regulatory Authority of India (TRAI) Report, 2015.
Pradeep Nair, Ph.D, is an Associate Professor and Dean, School of Journalism, Mass Communication and New Media, Central University of Himachal Pradesh, Dharamshala.