Health workers travelled about 9 hours to reach Luguthang village at 14,000 feet in Arunachal Pradesh’s Tawang area for COVID vaccine coverage, claimed a report

This may seem extreme to some of us, but this is a usual day at work for a health worker in Northeast India and there are many stories of many health workers in Northeast India who are making healthcare accessible in their way. We know that the availability of a vaccine doesn’t translate into accessibility to a vaccine. Accessibility especially to healthcare depends upon a lot of factors like geographical barriers, financial and personal limitations.

So is the case of some parts in Northeast India which are remote due to poor road connectivity and topographical constraints. Difficult geographical locations can pose serious threats to healthcare accessibility and with COVID-19 imposed restrictions, the movement became more challenging. Against the backdrop of catastrophic damage done by the COVID-19 pandemic, it is important to understand the nuances of digital health and drones in particular for their potential to solve key challenges to healthcare systems with the case of Northeast India.

Digital health demonstrates successful convergence of different knowledge systems by combining technology and health for efficient healthcare delivery services. COVID-19 induced restrictions like distancing and travelling restrictions accelerated healthcare transformation with a major tilt towards digital health. Even though it existed before the pandemic in India but has received the required push during the pandemic imposed medical emergencies. Research suggests that the most impactful COVID-19 technologies include patient-facing tools, such as online symptom checkers, patient portals, remote patient monitoring tools and telehealth.

The WHO’s global strategy on digital health envisions digital health to improve health outcomes by adopting appropriate, accessible, affordable, scalable and sustainable person-centric digital health solutions to prevent, detect and respond to epidemics and pandemics, to achieve health-related Sustainable Development Goals and the triple billion targets of WHO’s Thirteenth General Programme of Work, 2019–2023. The World Economic Forum as part of its Digital Transformation Project has identified healthcare as one of the industries where introducing digital health services is imperative. This becomes all the more important to discuss within the sustained repercussions of the pandemic on already strained healthcare systems in our country.

The health systems in India suffers from a nexus of issues from affordability to accessibility to inadequate manpower on the ground. In either case, it is a symptom of a larger issue of insufficient public expenditure in the healthcare sector. Not only India but the South-East Asian Region performs abysmally low in expenditure on health. Another vulnerability is layered in terms of accessibility through long distances as there are travel costs, staying costs and loss of wages involved.

Tata Memorial Hospital’s Cancer heat map shows that despite it being located in Maharashtra, the majority of the patients travelled from Bihar, UP, Jharkhand and West Bengal which makes the argument of inequitable quality healthcare indisputable. As mentioned by WHO in their report, The Health Workforce in India, 59.2% of health workers were in urban areas, where 27.8% of the population resides, and 40.8% of health workers were in rural areas, where 72.2% of the population resides. This raises serious concerns over equitable healthcare, especially in rural areas. 

Digital health addresses the above-mentioned issues with technology and focuses on the citizen-centric model. With a majority of the healthcare services being provided by the private hospitals, digital health supported by the government can aid in health check-ups, monitoring and early identification which could save crucial time.

In addition to this, lack of timely or adequate HRH in rural and remote areas delay interventions which could be fatal in extreme cases. Delivery of medicines or collecting samples using drones to solve mobility issues could be life-changing for remote areas. Medical delivery drones have a real potential to resolve persistent transportation challenges, ensuring reliable access to medicines in areas not currently or consistently reached by ground transportation. From military use cases, in the past few years, the use of drones has expanded to commercial and civil purposes, including disaster management, photography and mapping. 

Relevance of digital health for Northeast India

The Healthcare sector is expected to increase three-fold to Rs. 8.6 trillion (US$ 133.44 billion) by 2022 but despite this, it faces challenges in terms of accessibility, affordability, awareness and availability of human resources. Simply put, these are health systems challenges that become exacerbated due to geographical locations such as hilly terrains and long travelling distances. National Cancer Registry Program has highlighted the rising cancer burden of north-eastern states and COVID-19 imposed restriction faltered the routine care required by cancer patients in the region.

The Bhubaneswar Borooah Cancer Institute (BBCI) in Guwahati serves as a cancer care centre in India’s NER and according to data, patients footfall declined by 50% during the lockdown period. Not only treatments were delayed, but the early-stage diagnosis was delayed which increased the possibilities of grave consequences. In such cases, digital health seems imperative to ensure equitable health.

Drones mobility overcomes challenges as posed by poor road connectivity in such difficult geographically located areas. Last year, a Rwanda-based NGO delivered cancer drugs to patients amid travelling restrictions during COVID-19 which proved to be lifesaving. Similarly, Western Isles are exploring the potential use of drones in delivering such medicines.

Even in the case of vaccination, it can prove to be advantageous in such locations. As of 19 July 2021, Northeastern States (except Assam and Tripura) have the lowest vaccinated populations among all states barring UTs.

These six states clubbed together account for a total of 47,84,026 total doses of vaccination which is lower than many states. It has been reported from various parts of the northeast that healthcare workers had to travel dangerous hilly paths, slippery and non-functional roads to provide vaccination.

One such case was of Meghalaya where teams from Community Health Centre in Meghalaya’s South West Khasi Hills had to travel through mountains and dense forests with heavy backpacks comprising of AEFI kits, anaphylaxis kits, stationeries, packed food, vaccine carriers among other essential items provided by the Meghalaya health department to a remote village. As reported by EastMojo, a few dry runs in the states revealed bottlenecks related to internet, road connectivity and lack of facilities which are expected to get worse with the monsoon season.

The Wall Street Journal covered the overwhelming 1500 mile journey of vaccine to Nunsury village of Mizoram. The local health workers had to drive, walk and row down the Khawthlangtuipui River on a wooden boat to reach the village where they would prepare a make-shift vaccination centre. There are many similar stories from remote areas of the northeast yet untold, however, digital health can make it comfortable. 

Collaborative efforts for accessible healthcare

Teams from the Public Health Foundation of India (PHFI), World Economic Forum (WEF), NITI Aayog and several state governments have had deliberations in an attempt to truly realise accessible healthcare using digital health and drones for remote and rural areas. In early 2020, a delegation from WEF and PHFI visited four key states (Assam, Meghalaya, Manipur and Arunachal Pradesh) in the northeastern region to explore the possibility of drones in enabling primary healthcare access to isolated areas.

Their visit concluded that the region will benefit immensely using drone technology that can connect primary healthcare centres to sub-centres and sites of administration of healthcare seamlessly while ensuring higher levels of primary healthcare coverage. The state of Arunachal Pradesh partnered with the initiative in June 2020. Based on the situational analysis conducted by the organisations, the state faces severe last-mile delivery challenges but to ensure the sustainability of the initiative, a local based ecosystem needs to be created.

Specific innovations at PHFI have catalysed the efforts in providing accessible healthcare. Hi rapid Lab at PHFI, SKY BRIDGE program aims to improve access to vaccines, lab samples and medical products in rural, remote, and hard-to-reach areas.

SKY BRIDGE is based on a heavy payload, long-range drone paired to a custom developed modular temperature-controlled box (patent pending) platform that can safely and reliably deliver multiple medical payloads simultaneously and improve access to vaccines, lab samples and possibly on-demand medical products to primary health centres and subcenters in rural, remote, and hard to reach areas. A team from IIPH-H (Indian Institute of Public Health- Hyderabad), health informatics and technology innovations vertical of PHFI is leading an initiative for a drone delivery system for medicines with a temperature-controlled payload box, which would surmount terrain hurdles and cut delivery time.

The pilot program is being run in selected districts of Telangana. To cover long distances, the project envisages a petrol-powered drone as against battery-operated ones and these particular characteristics could be beneficial for NER. 

PHFI developed MITH.AI (Mass Modular Integrated Transformational Health Care through Artificial Intelligence) to address healthcare-related challenges proactively by comprehensively taking several modules of primary health care service directly to the doorstep of the point of need.

It includes Home including vaccination; pregnancy risk assessment; including antenatal care and diagnostics, nutritional evaluation and management. MITH.AI can go beyond proactive home service and even provide precise and personalised service with Artificial Intelligence. This concept offers several advantages like universal health coverage; focus on primary and primordial prevention; provision of comprehensive and continuous care; granular and longitudinal generation from source and high accuracy prediction. 

Northeast India presents a unique case for drones in futurising the distribution of healthcare essentials to the last mile. In addition to the advantages mentioned above, it provides avenues for local skill development such as coding classes, MRO – maintenance, repair and overhaul technical courses, drone pilot programs.

This will result in job creation and economic activities in the partnering states. Digital health in the face of drones and mobility is a potential game-changer for healthcare, especially in rural Northeast. Such initiatives must be supported by community participation in awareness generation and improving digital literacy. Youth can play a key role at the community level for this. Also, with rising demands for quality healthcare, realigning the regulations of the drone industry will be catalysed with the timely support of the government. Further, seeing this in association with central- policies like Aatmanirbhar Bharat can boost domestic growth of the industry and especially at local levels.

This author is Health Transformation and Advisor- Digital Health, Drones and Mobility at the Public Health Foundation of India.

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