Telemedicine in Rural India

I n a developing country such as India, there is huge inequality in health-care distribution. Although nearly 75% of Indians live in rural villages, more than 75% of Indian doctors are based in cities [1]. Most of the 620 million rural Indians lack access to basic health care facilities [2]. The Indian government spends just 0.9% of the country's annual gross domestic product on health, and little of this spending reaches remote rural areas [3]. The poor infrastructure of rural health centers makes it impossible to retain doctors in villages, who feel that they become professionally isolated and outdated if stationed in remote areas. In addition, poor Indian villagers spend most of their out-of-pocket health expenses on travel to the specialty hospitals in the city and for staying in the city along with their escorts [4]. A recent study conducted by the Indian Institute of Public Opinion found that 89% of rural Indian patients have to travel about 8 km to access basic medical treatment, and the rest have to travel even farther [5]. Telemedicine may turn out to be the cheapest, as well as the fastest, way to bridge the rural–urban health divide. Taking into account India's huge strides in the fi eld of information and communication technology, telemedicine could help to bring specialized healthcare to the remotest corners of the country [6,7]. The effi cacy of telemedicine has already been shown through the network established by the Indian Space Research Organization (ISRO), which has connected 22 super-specialty hospitals with 78 rural and remote hospitals across the country through its geostationary satellites. This network has enabled thousands of patients in remote places such as Jammu and Kashmir, Andaman and Nicobar Islands, the Lakshadweep Islands, and tribal areas of the central and northeastern regions of India to gain access to consultations with experts in super-specialty medical institutions [8]. ISRO has also provided connectivity for mobile telemedicine units in villages, particularly in the areas of community health and ophthalmology [9]. This encouraging early success in reaching patients—together with recent technological advances in India, such as the proliferation of fi ber optic cables, the expanding bandwidth, and the licensing of private Internet service providers—has encouraged ISRO to set up an exclusive satellite, called HealthSAT, to bring telemedicine to the poor on a larger scale. The proposed satellite would not only serve remote areas of India but also those in other poor countries …