The challenges of health care delivery in rural India are several and familiar: poor infrastructure, insufficient supply of skilled doctors, and dispersed poor populations, all of which make affordable care hard to achieve. Sameer Sawarkar, founder and CEO of Neurosynpatic Communications, says technology can bridge this deep divide.

In this video interview, he discusses ReMeDi—his low-cost telemedicine solution that aims to connect rural patients to urban doctors via the Internet. McKinsey’s Clay Chandler interviewed Mr. Sawarkar at Neurosynaptic’s Bangalore office in April.

Constraints of sustainable care

You see, traditionally, 70 percent of the people in India live in villages. The population has been slowly, steadily migrating to urban areas because of the facilities. But by and large, 70 percent—close to 70 percent—are still in villages where the infrastructure is not very good, the connectivity is not very good, the resources and linkages are not very good.

While you see many doctors available in the urban areas, where they’re easily accessible, you see that a villager—or even a pregnant lady—has to walk some five kilometers or ten kilometers to reach to the doctor for basic health care. The resulting fact is that not many people attend to their medical needs in the early stage of the disease cycle. And so, consequently, they reach the doctor only when things become very serious. That results in much more expenditure, and you find that about 20 million families get pushed below the poverty line every year because of health care expenditures alone.

What we saw is there were three critical problems. One was there is no electricity or there are various outages of electricity. Even in urban areas, you see something like two- or three-hour outages in a day. That’s routine. Whereas in rural areas, if you get something like 8 hours of electricity or 12 hours of electricity in a day, it’s considered very good. The second [problem] was really the skill set available. Now today, what we have in these rural areas is mostly either some sort of nurses who cater to the health care needs or some traditional health workers who have been practicing out of experience—also some doctors who have formal degrees in medicine, but not always. There are traveling doctors who come in on scooters and visit these villages one day a week. The third problem really is the technology aspect of it—which means unless there is bandwidth available or connectivity available, unless there is equipment and devices available that are cost effective, it wouldn’t be possible to provide these services at an affordable price point.

Technology-enabled solutions

Essentially, we started with a question in mind: can technology bridge this health care gap? You have a hugely disproportionate amount of doctors in urban areas compared to rural areas. So the first thing that we did was we said, “There is probably no point at this point in time to go and try to set up simply medical equipment there.” What we need is the right kind of reach into the village, which we identified initially as these village kiosk setups. A kiosk is a place where there is the necessary setup of equipment and a person to run it.

So, we ended up building what we call ReMeDi. That is, remote medical diagnostics. This technology comprises a device that runs on two watts of power. It’s a very, very low power-consumption device. What we did was, we actually integrated this device and software that has audio–video conferencing. This audio–video conferencing runs at 32 kilobits per second. You can simply run it over a telephone line, if it’s reliable, with the normal modems that we get; and you can have it over any form of connectivity. We also integrated a patient-record center. The patient records would help the doctor in recording all of the health-related issues that the patient came in with and in treating them.

ReMeDi: A remote diagnostics tool

The device came out of the need [for doctors to have] more information about the patient before making a decision. We started with an initial set of parameters. We said we need a stethoscope, we need a thermometer, we need a blood pressure meter, and, as specialty care, we also will put an ECG in. So those are the basic set of parameters that are there. It needs to operate in a very bandwidth- or power-constrained situation, so it consumes only two watts of power, which is even available in the USB port. And you need a webcam, of course, if you want certain pictures.

If you do not have connectivity, you can actually use “store and forward,” which means you capture all the parameters and then, whenever there is connectivity, a physical transfer is possible. In the other mode, if the real time bandwidth is available at more than 32 kilobits per second, then you can connect and transfer all the parameters in real time—so the stethoscope sound is heard in real time, while the chest piece is put to the patient. Actually, the doctor guides the operator to put the stethoscope chest piece at a particular place on the chest. There is a chart showing various positions of the stethoscope chest piece on the chest and on the back and [that shows the correct] breathing. The operator is trained in all of this initially. So we evolved these processes quite a bit as went along in the experimentation.

We have not yet initiated efforts where we directly tie up with hospitals and run the service, but we have taken a path of identifying partners—mostly those who are good at the delivery logistics.

Our strategy is always to partner with a more in-depth health care company that understands the health care issues much better than [we do], and we understand the technology issues much better—that’s the kind of synergy that will work.

Looking ahead

Now we are getting into much larger-scale experimentations from these understandings. We are partnering with various agencies now who have expertise in the health-care delivery part and working together with them to set up some really large networks. We have a very good acceptability [rate of our] solution: about 40 percent of patients actually come back. On any [given] day, of the traffic that we have—or of the people visiting the center that we have—40 percent have visited us earlier for their earlier episodes of illnesses. Also, we observe that about 75 percent of the people do not have to travel to the next town for their health care needs. Seventy-five percent of the needs get satisfied there and then. There’s a great amount of affordability, because the final model that we have allows them to get access to this health care for less than a dollar.

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