State looks at telemedicine to combat lack of doctors, staff in PHCs

To overcome lacunae, such as lack of adequate doctors and staff in public health institutions, and ensure that medical care is made available promptly to people in far-flung areas, the state government is planning to enable electronic diagnosis and treatment through telemedicine. The state public health department is establishing ePHCs through corporate social responsibility (CSR) funds at locations across Maharashtra for last-mile connectivity.

Officials admitted that basic public sector health-care infrastructure, like primary health centres (PHCs), is inadequately staffed and underutilised, prompting the need for such electronic interventions and cloud-based health-care solutions. The paramedical staff at the ePHCs will use the teleconferencing facilities to consult doctors and specialists and send test results to them for off-site diagnosis and referral.

"We are doing this with Hewlett Packard Enterprise… they are giving us five ePHCs," state principal secretary (public health) Sujata Saunik told dna, adding that it will be an arrangement to ensure that people with minor health problems can be treated. In addition, a demonstration ePHC was set up on the premises of the Vidhan Bhawan during the monsoon session of the legislature.

An ePHC will consist of a PHC set-up in a pre-fabricated structure with video-conferencing, medical diagnostic equipment and cloud-enabled technology to electronically capture the data of patients among other facilities.

"The information will be transferred by Internet to a central location where the diagnostics will be prepared. In remote locations where doctors are not available with us due to various reasons, we can deploy trained manpower to operate these machines to capture the data. This data will be transferred to our hospitals for diagnostics and, accordingly, treatment of the patients can be started," Saunik noted.

She added that while an expenditure of Rs4-5 crore was incurred on constructing a new PHC and related facilities like residential quarters, this infrastructure saw sub-optimal utilisation compared to the 15 to 20 people who should work there.

"If we can save this money and erect ePHCs in remote areas, then we can provide services without creating that kind of burden on the government," said Saunik. Five ePHCs will be set up as part of a pilot project at Harisal in Amravati, which will also be Maharashtra's first digital village, Potegaon (Gadchiroli), Akkalkuwa (Nandurbar), Goratal (Palghar) and Gopinathgad (Beed).

These locations have been chosen for visibility and their remoteness and will be equipped with scalable solutions.

"Initially, these will be simple diagnostic centres and, gradually, the capacity of the staff will be developed through training. It requires some skills and medical officers and ANMs will be needed... It cannot be a total replacement of a proper functional health clinic," said Saunik, when asked about whether the personnel at the site will be able to handle emergencies.

"The ePHCs will be useful at sites where we have no doctors but other personnel, such as nurses. They can conduct diagnostic tests and contact specialist doctors for further treatment. Doctors who have MBBS degrees can also do likewise and treat patients," said Dr Mohan Jadhav, director general of health services.

However, Dr Abhijit More of the Jan Arogya Abhiyaan pointed out that telemedicine was not a substitute for primary health care and said that since this (primary care) was the foundation of the health-care system, most resources should be deployed there. "Unfortunately, we focus more on tertiary care and on unnecessary and costly technologies," he added.