Next revolution of telemedicine in India hinges on its ASHA workers

With efficient upskilling and proper institutional support, India's ASHA workers can become a driving force in delivering digital health solutions for our nation

Updated: Jul 7, 2021 06:29:41 PM UTC
Image: Rebecca Conway/Getty Images

How has your life changed in the past year and a half? Are you working from home? Did you have to cancel travel or holiday plans? Any of these disruptions will seem minor against the disruptions seen in the health sector.

Throughout the world, health services collapsed under the burden of Covid-19. In India, regional disparities made the situation worse. In India, 71 percent of the country’s population lives in rural areas, whereas only 34 percent of doctors practice there. The pandemic exposed the historical underfunding and under-resourcing of public health in India.

The only solution to this humanitarian crisis is equitable access to healthcare in the country. That is a long term goal. In the short term, we need urgent solutions to deal with the skewed doctor-patient ratio. We need better distribution of infrastructure, resources, and medical expertise that are concentrated in urban centres today. We need rapid innovation to connect medical expertise with people in every corner of the country.

The technological connect
Telemedicine presents the shortest and most cost-effective path to addressing India’s healthcare challenges. It can deliver quality care even in remote corners of the country. During a pandemic, it helps maintain social distancing and reduces the risk of contagion for everyone involved. The technology to enable it is available but the success on the ground has been limited. What is the missing link needed to make it work?

Any solution to a health problem cannot be merely biomedical. This is especially true in India, where rural patients trust the in-person ‘touch and feel’ experience more than a voice on the phone or a face on the screen. For telemedicine to succeed, we need to build trust in the system through a human connection. Successful models of telemedicine, like the Aravind Eye Hospitals in Tamil Nadu, also demonstrate this.

The human connect
Accredited Social Health Activists (ASHAs) were introduced under the National Rural Health Mission (NRHM) in 2005. They are the first point of contact between the community and the healthcare system. They are residents of the village that they serve. Over the years, they have become the focal point of public health program implementation in India.

There are close to nine lakh ASHA workers in the country. Geographically and contextually, they are best placed to become the human connection between the doctor and technology on one end and the patient and the community on the other.

ASHA workers receive training and are responsible for referral and escort service for reproductive and child health, nutrition, health education, and promoting universal immunisation, amongst other roles. However, they are underutilised on the ground. Despite training, there are gaps in their knowledge and skills. They work on an incentive-based model. Even during the pandemic, when their services are critical, they barely make Rs 3,000 per month. The amount doesn’t even cover bare necessities and, in my opinion, should not qualify as a livelihood.

We need to empower ASHAs and other community health workers like Multi-Purpose Health Workers (MPHWs) and Auxiliary Nurse Midwives (ANMs) to strengthen the healthcare system using telemedicine from the ground up.

Empowered livelihoods for robust healthcare
How do we enable this cadre of healthcare workers, who already have the basic training, to understand the context and appreciate healthcare?

1. Solutions to upskill and reskill community health workers. These skills should help them fulfil higher-order roles like telemedicine coordinators in low technology and low resource settings.

2. Soft skills: As telemedicine coordinators, they should be equipped with positive behavioural skills. This will help them have empathetic and impactful interactions with patients.

3. Decision-making: They have to be empowered to be autonomous for on-ground decision-making and handling exceptions.

4. Security: They need monetary empowerment in terms of social security, job security, and insurance. Micro-entrepreneurial training and capital enablement will give them a growth path and help them create opportunities.

5. And finally, any solution must target these issues remotely as we live in a country of immense proportions and don’t have the luxury of time.

We need to create and implement solutions that will ensure effective, smooth and streamlined delivery of healthcare services and bridge the last mile gaps. The need of the hour is rapid social innovations that help community health workers grow into telemedicine coordinators. With efficient upskilling and proper institutional support, they can become a driving force in delivering digital health solutions for our nation.

P.S. If you or someone you know is working on this problem, or working on a solution that can impact this area, point them to Upjeevika’s Telemedicine Livelihood Challenge here:

The writer is a Co-Founder & CEO of LabourNet.

The thoughts and opinions shared here are of the author.

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