ReMeDi - Enabling Access to Rural Healthcare

ReMeDi - Enabling Access to Rural Healthcare

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Last Update: August 27, 2012

Access to basic healthcare is a very big challenge in Rural India, and globally. 70% Indians live in villages, but 74% Doctors are in the urban areas. Attempts to take doctors to the rural areas have repeatedly failed. People are mostly treated by un/semi-qualified personnel. Those who can afford private healthcare have to spend much more than their urban counterparts. Diseases are detected late. Tens of millions of people get pushed below the poverty line annually because of healthcare expenditures alone!
This problem can be turned into a huge business opportunity (a USD 30 Bn market), if quality healthcare is made available through technology that can work with limited infrastructure, available skill-set, and is affordable
ReMeDi™ (Remote Medical Diagnostics) solution is indigenously developed to address this need. With many years of experiments over multiple geographies, partnerships, revenue models, service delivery models & channels, it has evolved into a platform linking the healthcare ecosystem partners together; becoming the largest rural e-healthcare network in India, with 450 rural centers reaching nearly 7000 villages.
Our mission is to Enable Access of Quality Rural Healthcare affordably by providing end-to-end solution; with appropriate Technology as the key differentiator
Full Impact Potential of ReMeDi in India is to be the access point for 25% of the Indian population over the next five years, bring quality and affordable care, and be solution of choice

Type: for profit

The Problem

70% population lives in rural areas, yet 74% doctors, 75% dispensaries and 60% hospitals are in urban areas. 60-80% private practitioners are semi or un-qualified and absentee rate at government rural clinics is ~40%. For rural population, healthcare is 1.5 times costlier. Quality healthcare is sought very late in disease-cycle, resulting in huge expenses. ~80% of healthcare financing is out-of-pocket. Doctor to population is lower by 6 times, hospital beds to population ratio 15 times lower, per-capita public health expenditure 7 times lower. There is a huge demand-supply gap for the Primary & Rural Healthcare. The largest provider is a completely fragmented set of unorganized, at best semi-qualified private practitioners. The Government channel lacks efficiency and equipment, NGO channel is heavily dependent on donor funds, lacks systemic scaling and is mostly verticals based, and the private sector is unorganized and lacks skills. Hospitals like Glocal & Vaatsalya in the towns, NRHM support, RSBY are welcome initiatives, but still can't address rural primary care need, where ailments can be arrested much earlier in the disease cycle. Earlier telemedicine initiatives could not operate with the limited infrastructure and skill-set available in villages. In addition, viable business model & healthcare continuum were missing. In this context, ReMeDi™ has demonstrated appropriate technologies augmenting local skill-set as an effective method to address this need.

The Solution

ReMeDi™ was designed and built to make available a remote healthcare solution that •works on limited infrastructure and scarce human & material resources •can be operated even by someone not trained in health •is affordable to the rural poor •supports each component of primary healthcare delivery An indigenously developed, low-cost ReMeDi™ Medical Data Acquisition Unit and ReMeDi™ Software can measure basic physiological parameters like electrocardiogram, temperature, blood-pressure, oxygen saturation, and heart & lung sounds in real-time, and provide patient’s vital information to a remote doctor for preliminary diagnosis. The video conferencing between doctors and patients works at bandwidths as low as 32 Kbps. With images taken using a normal web camera, doctors can provide eye care, dermatology and ENT services. The system has inbuilt redundancies to deal with disruptions inevitable in low resource settings. A person with basic literacy - typically a high school graduate - can operate ReMeDi™ technology with minimal training. Training processes are also considered a part of technology itself. The ReMeDi™ solution captures delivery processes, and has evolved to provide a seamless platform for multiple providers in the ecosystem to come together to provide efficient & meaningful healthcare delivery – the village telemedicine centers, mobile health workers, diagnostic centers, clinics, pharmacies, secondary/tertiary care units and a Central Medical Facility

Example

There are presently three models that ReMeDi™ is deployed on, and all have been identified as replicable and scalable: • NGO centric • Healthcare Outreach centric • Government centric In all models, existing infrastructure and local capacity are leveraged to ensure long term sustainability. ReMeDi™ integrates end-to-end healthcare delivery processes. NGO model – a social franchising structure which is made operational by harnessing efficiency of the private sector, economy of scale to drive down costs, and linkages with the public sector. Telemedicine serves as a value-added service to providers (rural tele-clinics, diagnostic labs & peri-urban clinics) who subscribe to the system. Central Medical Facility (CMF) employs doctors for consultations. Healthcare Outreach model – includes a few factors of the NGO model with a hub and spoke architecture: paramedics providing services in villages are connected to a CMF. A small fee charged to the patients generates sufficient revenue for operational profitability. Government model – the ReMeDi™ platform makes the existing system efficient. Last year alone, there have been more than 85,000 paid rural tele-consultations. 75% of the patients visiting telemedicine centers avoided further travel. Patients exhibit high level of confidence with 40% patients being repeat visitors for different episode of illness. The access to quality healthcare is much nearer and quicker for a villager. CHMI report has identified telemedicine as one of the five innovative approaches to watch-out for, highlighting WHP-Neurosynaptic model.

Budget: $500,000 - $1 million

Marketplace

Rural Healthcare is an estimated USD 30 Bn market in India. However, it is difficult to access, due to lack of established delivery channels. Several approaches have been taken towards addressing this market: •Semi-urban Hospital chains, e.g. Glocal, Vaatsalya: hospitals for primary & secondary care. Use of HMIS, and a few mobile solutions. •Social Franchising, e.g. Janani: link private sector resources and public sector infrastructure for efficient program delivery. •Earlier Telemedicine attempts, eg. VRCs: Expensive infrastructure, rely on high skill-set, absence of viable business model. •Vertical based Initiatives, e.g. cardiology, eye-care services: technology based, some sustainability. •WHP and e-Healthpoint Services: use ICT for tele-consultations, operate with different population aggregation, operators, models •Medical helpline, e.g. 104 •Mobile based information collection & diagnostics initiatives elsewhere in the world, e.g. Dimagi In telemedicine, there are a few Medical Devices, Software as well as Healthcare Service Providers as players. Neurosynaptic differentiates itself as the largest channel & an end-to-end platform provider, seamlessly integrating components of healthcare delivery at the ground level, with a reach in rural areas. It takes a collaborative approach and operates through Integration, Distribution and Implementation partners. It presently has a revenue model of sale and support of hardware and software, and customization services

Team Members

December 15st, 2012

A total of 120 more rural ReMeDi centers have been set up since June 1st in the states of Bihar, Karnataka, Rajasthan by our partners, along with the completion of training for these 120 center operators and more than 5,750 health workers.

ReMeDi now reaches 45 Million population!!

In 4 short years, ReMeDi™ has already served rural Indians in 20 districts in 5 states of India – Uttar Pradesh, Bihar, Madhya Pradesh, Karnataka, and Tamil Nadu. There were more than 200,000 paid rural consultations. 75% of these patients did not have to travel beyond their village for healthcare...

August 27st, 2012

50 more rural ReMeDi centers have been set up since June 1st in the states of Bihar, Karnataka, Rajasthan by our partners, along with the completion of training for 61 center operators and more than 3300 health workers.

ReMeDi now reaches 25 Million population!!

Connections:

Growth Tracker

Stage: Milestone 3 of 5
Start
05/31/12
End
Impact Report
Increase in reach
Date 08/27/12
50 more rural ReMeDi centers have been set up since June 1st in the states of Bihar, Karnataka, Rajasthan by our partners, along with the completion of training for 61 center operators and more than 3300 health workers. ReMeDi now reaches 25 Million population!!
Achievement
Milestone Reached!
Date 09/01/12
Milestone
Delivery of additional 400 ReMeDi units for rural telemedicine centers (a total number of 1300+ units sold for rural telemedicin
Date of Completion 09/27/12
Completed
Manufacturing & Delivery of 200 units for rural centers
Completed
Manufacturing & Delivery of balance 200 units for rural centers
Milestone
Augmenting team for expansion
Date of Completion 11/30/12
In Progress
Raising investments
In Progress
Hiring of Senior Management Team
Milestone
Mobile Phone based Wireless Diagnostic Device for the Rural Health Worker
Date of Completion 12/14/12
Completed
Completion of Design, prototype
In Progress
Completion of Clinical validation and standards compliance of the device
Completed
Usage Training program for Rural Health Workers
In Progress
Manufacture & supply more than 500 units of wireless diagnostic devices for Rural Health Workers
Achievement
Milestone Reached!
Date 12/15/12
Impact Report
Reach and Benefits to the Rural Patients
Date 12/15/12
A total of 120 more rural ReMeDi centers have been set up since June 1st in the states of Bihar, Karnataka, Rajasthan by our partners, along with the completion of training for these 120 center operators and more than 5,750 health workers. ReMeDi now reaches 45 Million population!!
Milestone
Establishing at least 120 more village telemedicine centers with Partners, covering a total of 7000 villages and >2Cr population
Date of Completion 12/31/12
Completed
Carry out training for 120 operators and doctors; Set up and operationalize support and maintenance network
Completed
Complete Installation of at least 120 Rural telemedicine centers with a minimum average 20 centers/month with partners
Completed
Continue expansion to establish a total of more than 800 rural telemedicine centers
Milestone
To be the preferred access point of 25% of Indian population
Target Completion Date 12/31/16
In Progress
Completion of 10,00,000 live consultation
In Progress
Reaching to over 8.5 Cr population in 30-35 districts by end 2013 with more than 1500 centers and 15000 rural health workers
In Progress
Expand reach to a third of Indian geography by 2014
Milestone 3
Augmenting team for expansion

Comments & Activity

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Comments & Activity

Comments

Sameer Sawarkar profile img
Fri, 10/05/2012 - 10:37

Sameer Sawarkar has recently been elected as "Ashoka Fellow" by the Ashoka Foundation as a recognition for the work in the area of telemedicine for primary healthcare. Congratulations for this recognition!!! - Neurosynaptic Team

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Sameer Sawarkar profile img
Mon, 10/22/2012 - 13:13

Finalists of India Social Entrepreneur of the Year (SEOY) Award 2012 just announced. Neurosynaptic is one of the three finalists!!!
http://www.indiainfoline.com/Markets/News/Finalists-of-India-Social-Entr...

Indrani Sharma profile img
Fri, 12/14/2012 - 06:44

Thank you for your participation in AFI Growth Prize Competition. We have a key question for you:   what is the systems-changing innovation the differentiates your service from other similar services?

Please post your response as comment here, before Dec 15, 2012 to be considered for final evaluation.

Sameer Sawarkar profile img
Sat, 12/15/2012 - 12:01

Excuse us for being verbose, but it is important to set a little bit of context.

With the rural telemedicine network spanning over 4.5 Crore population in the villages over 20 districts through more than 650 e-healthcare centers, Neurosynaptic’s ReMeDi today is the largest rural e-healthcare platform in India. Neurosynaptic is also possibly the only company that has shown sustainability and profitability while exclusively working for rural e-healthcare segment. This growth has been consistent year-on-year for the past five years. It is a result of consolidation and absorption of learnings from a lot of failures prior to 2008.

Lack of access to rural health & healthcare is a well recognized problem in India, and all attempts to carry doctors to villages have yielded very little results. While it is quite clear that technology with local capacity building is the way ahead, very little is understood on the ground level channels to deliver the required services.

Neurosynaptic, at its inception in 2002, had a very naïve (as realized today) view about addressing this huge untapped market, representing a large need of 70% of the population. We assumed that creating devices, software and technology would address it. Accordingly, technology was developed with existing infrastructure, skillsets into considerations, as well as with inputs from the medical community. We created the best of the technology that works on 32 Kbps with audio, video and medical data transfer in real time (and also store-and-forward), and a medical device that works on just 2 watts of power, and could set-up a tele-consultation just about anywhere with any kind of connectivity.

However, as we went in the field with this technology, we realized that not only the technology, but the whole ecosystem required for healthcare delivery is missing! There is a need to re-create the ecosystem. This is when Neurosynaptic went ahead to explore various components of the ecosystem between 2005 to 2007, with various partners, channels, economic, training & awareness, service delivery, charging structures, geographic variations in the needs and solutions, infrastructures, components of ecosystem, etc. The ReMeDi technology, also, during this period, went through quite a few alterations, and became capable of bringing together medicines, diagnostics, doctors, village centers, specialists, as well as various ground level delivery processes. In fact, we refer to Technology here as defined by Prof. Clayton Christiansen of Harvard Business School as “a set of processes which transforms labor, capital, materials and information into products and services of higher value”.

The largest initiative today with our strong involvement, began in 2008 with World Health Partners, systematically scaled from 5 centers in 2008, to 30 in 2009, to 128 in 2010 and over e-healthcare 510 centers today in the most backward states of Uttar Pradesh and Bihar. This covers over 4.5 Crore rural population through 5,750 trained village health workers today. It is expected to scale to 28 districts with in the next year.

The service delivery model here has a horizontal approach rather than vertical program based approach, thus covering wide range of primary ailments, leverages financial resources from all three: public sector, private sector and grants. It also leverages the existing public infrastructure in terms of linking up to the Government network for communicable diseases program as well as engages the large fragmented private sector resources (entrepreneurs), who invest and earn or enhance their incomes out of providing the e-healthcare services. In the last two years the ReMeDi platform has provided more than 200,000 consultations. Patients are charged fees close to a dollar for the services obtained in a transparent manner (thereby saving 6-7 dollars of spend), with the Internet Technology component providing strong checks and balances in the system. The ReMeDi platform today provides the most robust, scalable and proven solution in both the client-server and cloud based models.

We also worked with the Government in deploying telemedicine at 50 PHCs in a district and linking up to the rural and district hospitals as well as tertiary care centers. We also work with Hospitals in a rural outreach clinics model.

We see a visible increase in the interests from the private sector players, and additional enablers like RSBY, and National Health Mission are slowly and steadily creating the financing and delivery mechanisms on the ground. We expect to cover a large footprint in India through the ReMeDi solution and various partnerships.

We have been recognized as Technology Pioneers in 2008 by the World Economic Forum, for our path-breaking approach, Global Indus Technovators in 2006 by IBC at MIT Boston and have been the runners up at the Social Entrepreneurs of the Year 2012 Award by Schwab Foundation, and a few other important recognitions, for our contribution in this field.

Neurosynaptic’s business model involves closely engaging with the healthcare service delivery partners and modeling the ground level delivery process in the Technology Platform, and making access possible through these channels. We are self-sustainable since last five years.

With this context, the most important innovation Neurosynaptic brings forth, and which differentiates it from similar other initiatives, is the end-to-end linking of various ecosystem components, capturing of processes and entities through its ReMeDi solution, which makes actual affordable service delivery possible on the ground.

Having said that, we are happy to note that there are now several upcoming initiatives for the rural e-healthcare segment. It would also be important at this stage of this nascent and growing segment, to consider commonalities amongst various initiatives like Neurosynaptics’ on the ground, to evolve basic guidelines / accreditations and systematic inclusive policy approaches, so that the 70% of the population gets maximum benefit towards the access of healthcare.

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Bhattiprolu Mohan krishna profile img
Sat, 07/20/2013 - 15:57

Your statement of 70% people live in village and 74% doctors live in urban, after reading this i laughed for 15 minutes. i live in a town due to power cuts i purchased invert-er. I understood that you need power to charge your invert-er. In rural villages now every week city doctors visit is there. We need to solve the basic needs to implement this.What i feel is your total invention invented by our elders in terms of R M P doctors.This is my opinion only . Indians are touch and feel type people. I feel your idea will take lot of time for us to adopt. As i know villages people are not poor now. We all are doing the same mistakes like what our government is doing,Government gives crop lone to the farmer, latter they ask them to pay only half of it,latter they give total reduction. We are indirectly encouraging farmers to be lazy. This point should be noted. In your explanation to one of the question raised by Sharma you have told that you are making good profits since 5 years. The 74% doctors loosing their income because they live in urban?.