Digital India: How Telemedicine Safeguards Women's Health In Rural Communities

In March 2020, the govt legalised and promoted telemedicine and with this, Intelehealth’s canvas became bigger

When Jangi Devi’s infant developed angry red rashes all over his body few days after he was born in Jharkhand’s Gumla district, she and her mother-in-law were at a loss on how to tackle the problem. Rashes could be nothing very serious but could also imply something grave that might follow. With the primary health care center a distance away and no male member free to ferry them, the duo decided to visit a health and wellness center within walking distance operating under the government’s e-Sanjeevani programme.

At the center, Jangi Devi was connected to Dr Nalanda Singh in Ranchi who did a detailed chat to diagnose what the reason could be. After exploring all angles, the doctor suggested that the family sheds the long-held tradition of wrapping the newborn in a coarse blanket—something the community had been doing for decades and tries swaddling him in some softer fabric.

From what the doctor could discern, this seemed to be the main culprit. The mother agreed almost immediately but it took the doctor another 40 minutes to counsel and convince the mother-in-law to agree to give up what was a long held belief in the community.

Tele-Treatment As Ready Aid

A few days later, the duo again revisited the center to report that the rashes were gone and the baby was doing well. A simple no medication solution. The mother-in-law also went on to advise other mothers at the Anganwadi in the community to break free of this practice of using the coarse cloth that led to the problem.

Not far away in another remote area, Priya Kumari developed a high fever during her B-Ed exams. A local doctor diagnosed it as malaria and medicated her accordingly but the fever did not subside. She went back to the doctor who suggested admission and put her on a drip for three days but after she left the hospital, the fever recurred.

After two ineffective treatments despite physical examinations, she decided to go in for a telephonic consultation through e-Sanjeevani. The doctor who did a detailed questioning and diagnosis was sitting far away, could not physically examine her but prescribed medication based on her questions and the answers.

Although not very convinced of what the outcome might be after two bad experiences, Kumari took the medication and was both surprised and overjoyed to find her fever did not return.

For all practical purposes, she seemed cured. What physical examinations and treatment by a local doctor on hand could not achieve, someone sitting a few hundred miles away had solved.

Healthcare for All

These are just two instances of how the government's e-Sanjeevani programme has been deployed with the aid of a tech start-up—Intelehealth, working towards increased access to healthcare for underserved communities all over India but especially in the more remote parts.

Founded in 2016 by Biomedical Engineer Neha Verma— Intelehealth can be described more as a “calling” for the 31-year-old who even as a student, had worked in Mumbai’s slum communities at Santa Cruz as a volunteer and witnessed first hand how difficult it was for women to access any healthcare services, let alone quality services even in a city as bustling and as metropolitan as hers.

Subsequently, when Neha herself needed some mental counseling to extricate herself from a personal upheaval, she realised how difficult it was to access such services even for someone as privileged as herself.

But it was only after Neha found herself at the John Hopkins Center for Bioengineering Innovation and Design that she could envision her dream turning into reality. The programme where she was a global health innovation fellow, taught one how to develop low-cost technology-based solutions to improve healthcare access for underserved communities across the globe.

It was here that Neha met her two co-founders—Soumyadipta Acharya who is the graduate programme director at the Community Based Inclusive Development (CBID) and Amal Afroz Alam—a fellow student at the school from Bangladesh and the tech brain behind the non-profit start up.

Health App’s Post-COVID India Outreach

It was then that the Who, What, Where, Why and When of Intelehealth crystallised for the three founders. Prior to 2020, Intelehealth had just started in India and done a few small pilot projects but it was COVID that changed everything.

In March 2020, the government legalised and started aggressively pushing telemedicine and with this, Intelehealth’s canvas also broadened. It started working in conjunction with the government’s e-Sanjeevani programme from November 2020 in many states to reach underserved populations through primary health centers across states.

“We are providing support through training, and implementation but the doctors or health care workers are not provided by us," explains Neha.

To cite an instance, Intelehealth partnered with the Jharkhand government to facilitate the successful rollout of the e-Sanjeevani software. From 40 tele-consultations a month, the number has soared up to 70000! In this state alone, their presence is now in 24 districts, up from five in 2020.

Since then, Intelehealth has been spreading its wings across India and has now reached 1.29 lakh people through health service consultations and provided treatment to 2.22 lakh through curative telemedicine services. "The total population covered so far is around six million through a total of 2232 frontline health workers and 550 doctors who have been supported by the organisation and its reach."

“For someone who can afford it, there are many offering services like Practo, Apollo, MG among others but very few cover the population that needs it most urgently, in particular, rural women," argues Neha, who had her own personal life experiences that made this the space the one she wanted to fill the gaps for urgently. The start-up is funded primarily by philanthropic capital from CSR funds, NGOs and foundations as of now.

How the App Offers a ‘Safe Space’ for Rural Women

But it’s not as if the whole effort has been a cake walk since the word go. As she and her team members soon realised, setting up an app to offer last-mile delivery of health services to a rural population was one thing and getting them to use, trust and choose it, was quite another.

Unlike the urban animal who does virtually everything on his mobile device today, this was an alien concept among rural households, particularly in grandmothers, wives, mothers-in-law, daughters, and so on. Few of them owned a device and many viewed it with utter suspicion. So one of their first learnings was that behavior change is necessary for them to get anywhere at all.

There were a few other epiphanies the Intelehealth team had. One, they realised that the rural populations in the country were facing a pretty severe and often undetected triple burden of disease : communicable ones, non-communicable ones, and a range of stigmatised ones especially post pandemic. The former included COVID, flus and other infectious diseases, the second included a range of diseases including tuberculosis, diabetes and hypertension and the stigmatised ones which include HIV, mental health disorders, depression and substance abuse addictions.

They also found that the frontline health workers who were often the only ones available for any kind of assistance were very underappreciated and worked under very trying circumstances.

And last but the most important factor for Neha personally, the gender bias was even starker when it came to women’s health care in these areas. Women were two times less likely and would spend 1.5 times more than their male counterparts to get access to even an indifferent quality of health services.

It quickly became evident that telemedicine has the power to create safe and accessible spaces for women and their data shows that 70 percent of those using such services are women in rural areas. Moreover, it worked even better for stigmatised diseases including sexually transmitted ones (STDs), mental health issues for which women were too “embarrassed or ashamed” to seek help.

Many of the realisations above have guided and shaped the thinking and journey of Intelehealth, which is still in its infancy and has global ambitions. With an ocean of underserved populations, the start-up still has a long road to cover and many epiphanies to uncover as it tries to succeed in its lofty mission. How far it reaches will determine the quality of life for millions of women around the globe.

(Anjuli Bhargava is a senior writer and columnist based in Goa. This is an opinion article and the views expressed are the author's own. The Quint neither endorses nor is responsible for them.)