A pediatrician (2L) talks with a mother as she conducts a general health checkup on children at a government rural child health care centre at Gollahalli village on the outskirts of Bangalore on July 1, 2021. (Photo by Manjunath Kiran / AFP)
India’s low public expenditure in healthcare over the years has resulted in an under-performing public health system. The lack of access to quality healthcare is particularly acute in the rural areas in India, which accounts for about 70 percent of India’s population. A host of private organisations, both for-profit and not-for-profit, have stepped in over the last three decades to address this healthcare access challenge and have developed different care models to serve the rural population. In the following discussion, we provide an overview of the three primary care models currently at play and share insights on how these models and the overall rural healthcare system will evolve in future.
Mobile Medical Team (MMT)
Typically, the MMT model consists of a clinical team of a medical consultant, paramedic, pharmacist, and social worker visiting un(der)-served communities periodically in a customised van or bus carrying medicines, consumables and equipment. These teams are often funded by public funds, charitable organisations, large public or private corporations, and in some cases are part of large healthcare providers. The teams provide a broad set of services that include but are not limited to education related to preventive care, immunisation, primary health consultation, basic diagnostic services, free medicines, and referrals to specialised healthcare providers and counselling services.
Local Care Provider (LCP)
Based on the realisation that rural communities either do not have a nearby public Primary Healthcare Centre (PHC) or the local PHC lacks the needed resources and infrastructure, private organisations (often NGOs) have established local clinics and health centres. Often these centres are staffed by nurses, paramedics, and social workers and have a small pharmacy. These staffs are members of the local community. In some cases, these clinics have an attending physician visit once or twice a week. Similar to MMTs, the clinics focus on primary care and diagnostic services, and referrals, along with educational and health awareness activities. Many of the LCPs have strong maternal and child care programs supported by a strong community health workforce; women from the local community are recruited and trained as community health workers. The advantage of LCPs over MMTs is the improved access to care all week, local capacity and capability build-up, and improved trust of the community.
Telemedicine-based Service (TBS)
ISRO, along with private players such as Apollo
and Narayana Health, started telemedicine services
in the early 2000s to ensure that health facilities in semi-urban and remote areas can connect with tertiary hospitals in large cities for clinical consultations. Many MMTs and LCPs, serving rural areas have opportunistically adopted telemedicine over the last decade as information and communication technologies improved and became easily available. Today, we are seeing the emergence of e-clinics in rural areas that connect local communities to remotely located doctors for teleconsultations. This creates significant benefits in terms of access to doctors and specialists for specific areas such as ophthalmology, dental care, maternity care, and so on. However, this model still requires the rural patient to travel to a tertiary hospital located in a nearby city, particularly when complex diagnostics, surgeries or other medical interventions are required.
How will these models evolve over the next decade?
The above three models (MMT, LCP, and TBS) have jointly delivered a significant impact in rural healthcare
provisioning and have reduced the load on the public PHCs. To date, the emergence of these three models across rural India occurred in a relatively organic and disjointed manner and was largely driven by the best possible solution that could be set up by well-intentioned organisations and individuals operating under time and resource constraints. However, we anticipate that the next decade will be marked by a much more systematic, disciplined and coordinated approach to address the challenge of providing healthcare to the rural populations.
• MMTs will continue to be important for unserved or under-served areas. We anticipate that many of the well-established rural LCPs will be sponsoring and managing MMTs to serve proximate areas (in addition to the current city-based organisations supporting such initiatives). This will further improve healthcare
access and health literacy, thereby creating more demand for healthcare. Over time, as both public and private healthcare services improve in rural areas, MMTs will be restricted to small pockets with no nearby well-functioning PHCs and where care delivery via LCP is operationally infeasible and/or financially unviable.
• In the current un(der)-served markets, both LCPs and TBSs will be developed in tandem. However, given the challenges of resourcing rural locations, we anticipate the TBSs will grow at a faster rate. Over time, we will witness the strong presence of LCPs across the country, providing primary care services. These LCPs will tap into TBSs for expert inputs or secondary care.
• MMTs and LCPs will leverage TBSs a lot more systematically and consistently and the TBS solutions will be adapted to be more empathetic to the needs of rural consumers. The inability of city-based doctors to communicate in local dialect with the rural patient and their limited understanding of the norms, values, behaviours, diets of the rural population has been a common challenge across many TBS solutions offered in recent years.
More broadly, the rural healthcare system will benefit from five distinct trends over the next decade:• Human Resource Development:
Rural clinical staff will be increasingly trained and supported to deliver care that is significantly beyond their current experience, training, qualifications. This will be enabled by TBS support, on-job training and new professional degrees and certificates designed to meet the needs of the rural workforce. Finally, many of the current unaccredited informal care providers (often referred to as quacks) will get absorbed in the formal workforce of LHCs and on-ground TBS support teams. • Increased Technology Adoption:
Much higher rates of adoption of a broader suite of technologies will go well beyond telemedicine
. For example, a large number of rural LCPs will likely adopt electronic health records, patient digital health cards, point-of-care digital devices, AI/ML-based digital analytics.• Emphasis on Health Literacy and Preventive Care:
The rural providers will strengthen community engagement and increase focus on health literacy and preventive care to manage demand. Given the current increasing rates of non-communicable diseases (NCDs) in these communities, preventive healthcare will be the sustainable approach to balance health care provisioning, capacity development, and cost considerations.• New Referral Pathways and Funding Mechanisms:
LCPs will design economical, high-quality referral pathways for complex conditions that cannot be managed in rural areas or via TBS. This will likely involve public and private providers in smaller cities and towns. The penetration rate of health insurance products is expected to increase as entrepreneurs develop innovative insurance products and explore other healthcare mechanisms for the rural market. • Improved Public Healthcare System:
The central and state governments will continue to strengthen the rural healthcare system using a host of initiatives related to efficient use of current funding, increased funding, strengthening of the PHC network and establishment of newer clinic models, improved infrastructure and staffing, staff training, and adoption of telemedicine
. Over time, we anticipate improved on-ground coordination and collaboration between the public and private systems in rural areas. Budhaditya Gupta (Healthcare Expert) and D.V.R. Seshadri, Indian School of Business (ISB)
[This article has been reproduced with permission from the Indian School of Business, India]