By Dhirendra Pratap Singh
Ambari Ponenayani is a remote village in MahamayaTehsil in Dhubri District of Assam. Still this village is waiting for Industrial development. Healthcare, Education, Drinking water, Road and Electricity are the main concern of this village. During the Corona pandemic, CSC Telemedicine is making a very significant contribution to healthcare in the region, and is being used in a variety of ways. VLE Roshidul Alam runs his CSC centre at Ambari Ponenayani. He has helped 800 patients with telemedicine service in this area in last one month.
Preparing a robust system of Primary Health Care Centers to provide quality responses to situations of public emergency is no trivial matter. Mainstreaming telemedicine is the most transformative change CSCs have made to provide Primary Healthcare in the post-coronavirus disease (Covid-19) world without compromising on quality of care and outcomes. Recently, Hon’ Minister Shri Ravi Shankar Prasad, said, “After the coronavirus pandemic, healthcare will be a big movement in India. CSCs should work as the centres of Primary Healthcare.”
Primary care can play a significant role in the COVID-19 response by differentiating patients with respiratory symptoms from those with COVID-19, making an early diagnosis, helping vulnerable people cope with their anxiety about the virus, and reducing the demand for hospital services. CSCs Digital Doctors are playing a critical role in managing the epidemic and providing continuity of services.
Because of the lockdown, there is also a difficulty in accessing healthcare for many patients in rural areas. For those with chronic illnesses, such as tuberculosis, diabetes and hypertension, restricted access to drugs and services could be life-threatening. By the nature of being closer to the communities, CSCs as primary care providers can significantly ameliorate the situation.
Village Panchayat Domba is located in Verno Tehsil of Gumla district in Jharkhand, India. It is situated 10km away from sub-district headquarter Verno and 33km away from district headquarter Gumla. The area is majorly lacking in healthcare infrastructure. Villagers have to travel to Public Health Centres in neighbouring villages or to the district hospital when they have more serious ailments. Public transport is not so efficient and private vehicles are hired, often at very high costs.
CSC in Domba GP is bridging the gap between villagers, physicians and health systems, enabling everyone through telemedicine service. The patients come in contact with VLE Kanchan Prasad Keshri, who runs a CSC in the village Domba, Block Gumla in Jharkhand. The VLE informs them about the telemedicine service provided at his CSC. The people who are suffering from other medical ailments during this time can receive care from home, without entering medical facilities, minimizing their risk of contracting the virus.
The VLE Kanchan is also helping to reduce the spread of the virus to mass populations and the medical staff on the frontlines. Initially they were reluctant to consult the doctor over video-conferencing, but gradually as they realized the benefits of services they stared availing it in large numbers. So far, VLE Kanchan Prasad has registered more than 200 patients under telemedicine service in last one month. CSC telemedicine is only platform which allow consultation with Allopathic, homeopathic and Aryuvedic doctors besides Unani doctors in some states. CSC can buy medicine and supply to patient as per doctors’ prescription.
More than 1500 CSC wellness centres across the country are delivering the quality health services which include prevention, promotion, and primary medical care to all age groups. These centers provide basket of services like: Telemedicine, Point of care diagnostics services operated by a trained phlebotomist, Generic Medicines, Homeopathy medicines & Wellness Products, Yoga & Meditation training, basic eye testing and reader glass dispensation.
Woman VLE Dr. Rajani Sodera who runs CSC wellness centre in Susnigariya gp, Jharkhand, says, “CSC Swastham Kendras are envisaged to provide an integrated curative and preventive health care to the rural population with emphasis on preventive and promotive aspects of health care.”
Fear, worry, and stress are normal responses to perceived or real threats, and at times when we are faced with uncertainty or the unknown. So it is normal and understandable that people are experiencing fear in the context of the COVID-19 pandemic. VLE Dr. Rajani Sodera says, “Faced with new realities of working from home, unemployment, home-schooling of children, and lack of physical contact with other family members, friends and colleagues, it is important that we look after our mental, as well as our physical, health.” The VLE is providing guidance and advice during the COVID-19 pandemic for villagers, health workers, old age persons, people in isolation to help them look after their mental health.
Dr. Sodera says, “CSC Wellness Centres should be considered an important mainstay in the face of emergency situations, such as the dengue and Chikungunya epidemics and now the Covid-19 epidemic as well. Emphasizing that which is the very soul of primary care, such as knowledge of the catchment area, access, the link between the service user and the health team, comprehensive care, monitoring vulnerable families and following up on suspected and mild cases, is a fundamental strategy both for containing the epidemic and for people with Covid-19 not becoming severely ill.”
Why Primary Healthcare through CSCs
Rural India is suffering from a long-standing healthcare problem. Studies have shown that only one trained healthcare provider including a doctor with any degree is available per sixteen villages. Although more than 70 per cent of its population lives in the village, only 20 per cent of India’s hospital beds are located in rural areas. Most of the health problems that people suffer from in the rural community and in urban slums are preventable and easily treatable. In view of the above issues, role of 3.70 lakh CSCs in primary healthcare of rural India assume significance. It provides effective healthcare to the rural population throughout the country. VLEs as Digital Doctors are acting as a link between the health centres and the villagers.
In the light of suggestions made by Hon’ Minister, CSCs as Primary Healthcare centres, can act as:
Universal access to integrated comprehensive public health services;
Child health, Water, Sanitation and Hygiene;
Prevention and control of communicable and non-communicable diseases, including locally endemic diseases;
Revitalization of local health traditions and main-stream Ayurvedic, Yoga, Unani, Siddha, and Homeopathy Systems of Health (AYUSH); Promotion of healthy lifestyles.
52 years old VLE Muhammad Limkheda is serving villagers especially women and people from marginalized communities through Tele-medicine service in Meghnagar village, Jhabua district. Due to COVID-19, people were not getting medicine in Meghnagar. VLE Mohammad Limkheda and his friend Aliasgar go to Dohad 56 km from village on his own motorbike and distribute medicine to needy.
With the help of Digital Doctor, many chronic patients have scheduled tele-consultations to avoid face-to-face clinic visits and hence minimize their risks of exposure to COVID-19 in Meghnagar. CSC Telemedicine provides a 24/7 lifeline for patients to connect to their providers. This offers great comfort and assurance to the patients in these trying times, the VLE Muhammad Limkheda says.
The VLE adds, “With Covid-19 cases spreading across the country, face-to-face consultations can be risky for both patients and doctors. Under the circumstances, remote consultations over the phone or video calls can help patients access health care while also limiting their and doctors’ exposure to the disease.”
CSC Telemedicine provides convenience and cost-effective medical care. Recently, it has become more comprehensive, expanding to acute and chronic conditions, and migrating from hospital to home and mobile devices. In its simplest and low-tech form, visits to the doctors in village panchayats are not necessary and a simple telephone call or video conference can be facilitated instead.
Apart from this, CSCs have provided Data Entry Operators to all ICMR approved Covid-19 Labs of the country for helping the government improve data collection process of Covid-19 tests.
Universal healthcare and CSCs
In the light of Digital India program, CSCs are using ICT tools and addressing health challenges in remote areas, generate awareness about health entitlement, deliver preventive and promotive health services, empower people and support communities to look after their own health. To ramp up CSCs as the primary healthcare systems would go a long way in not only managing the epidemic but also strengthening the health systems in the medium and long run. It will pave the path to guaranteeing right to health, bringing social justice in the discourse on health, higher attention on equity and ‘leaving no one behind’ with inclusion of marginalized communities.
Thousands of Digital Doctors like Roshidul Alam (Assam), Kanchan Keshari (Jharkhand), Muhammad Limkheda (Madhya Pradesh) have offered an example of entrepreneurship through in the country. The entrepreneurs living in far flung areas of the villages were not trained for this, but they had an amazing perseverance. They developed his common qualities and this became their weapon.