Lending a Helping Hand

Founded in 1992, Jiva–a non-profit R&D organization–works to foster sustainable development by producing innovations that improve practices of education, health and social welfare. It has offices in India, the US and the UK. In India, the Handy Vaid project of Jiva, now renamed TeleDoc, has been using PDAs in rural communities to offer affordable health services. Presented below are excerpts from a telephonic interview with Jiva director

Steven Rudolph:

l How does TeleDoc work? What are the salient features of the project design?



TeleDoc was initially launched under the name Handy Vaid. However, in view of its international relevance and acceptability, it was renamed to give it a global reach and understanding. Through TeleDoc, Jiva seeks to offer affordable healthcare services to underserved villagers in India using digital wireless devices. To start off, we conducted a pilot test for six months that covered needs assessment, measuring sustainability and usability testing. TeleDoc is based on a collaborative entrepreneurial model and besides offering much-needed health services, it also opens up employment opportunities in villages.

TeleDoc deploys wireless databasing and communications technologies to create economies of scale that lower the cost and increase the dissemination of essential healthcare services to the poor. Trained field representatives collect information from the villagers and the information is then transferred to the TeleDoc central clinic. Doctors at the clinic diagnose the conditions and prescribe medicines, which are then delivered to the village within one or two days.

Now, in its initial phase, TeleDoc offers only Ayurvedic treatment since it can be made available at affordable cost-points to the villagers. Later, diverse medical services–including emergency services–will be provided when the TeleDoc network becomes wide enough to make the offered services sustainable. The initial focus will be on extending the network.

l What kind of technology design does the project use?



In the initial phase, the prototype TeleDoc application was designed to run on the Windows CE platform and was tested using the Compaq iPaq and the Palm Pilot. However, we are now exploring the option of working with open source technologies and also with devices such as the Simputer. We are especially excited by the prospect of working with the Simputer. Although its potential has not been explored much, we feel that it can open up exciting possibilities such as remote sensing of vital signs, transfer of symptom pictures to doctors, video teleconferencing and much more.

l What is the current status of the project?



After completing the initial tests successfully, we concentrated on acquiring funds to launch the program. Jiva has received seed funding from the Soros Foundation to take TeleDoc through its first year of development. We continue to look for funds to support TeleDoc for up to three years as our preliminary tests show that it will become fully sustainable only after such time.

It is predicted that from the fourth year onwards, TeleDoc will be able to generate enough revenues to finance its own growth.

l How have the PDAs helped in health intervention for the village community? 



A quick survey of an average Indian village will confirm the fact that health services and authorized medical practitioners are scarce, if available at all. Villagers have to either rely on unqualified semi-doctors or take long trips to the city in order to get good medical services. This not only takes a toll on their health, but is also very expensive in the long run. Add to it the costs of loss in earnings and the situation becomes even grimmer. As a result, Indian villagers as a community are not sustainable.

Hand-held computers have made it possible to bridge the gap between villages and cities by connecting doctors to patients remotely. It is only through affordable mobile technologies that we can address such large-scale issues as otherwise the prohibitive costs of setting up health centers in every rural pocket across India makes programs unviable. However, now with new tools such as the Simputer, we can even develop a nationwide network without incurring additional costs for setting up a communications or power infrastructure. This will not only help us bring down the costs for services offered, but will also shorten the time frame in which these services can be brought to even the most remote corners of the country.

l How many villagers have been provided with treatment till date?



Before Jiva launched the pilot test for TeleDoc, it organized free health camps every fortnight to organize people and to spread awareness for the program. In all, Jiva organized some 10 health camps over five months and provided consultation and treatment to an average of 250 people in each camp. The pilot test for TeleDoc was conducted for three months with the TeleDoc representative gathering an average of 16 consultations per day. In all, some 800 patients (450 women and 350 men) were treated successfully during the pilot test.

l How has the community responded to the use of PDAs?



In our meetings and interviews conducted in the villages, a majority of them expressed a strong faith in the credibility of TeleDoc. The villagers were quite at ease with PDAs carried by the representatives and were keen on learning how to interface with the TeleDoc application.

l What are the challenges faced in implementing the project?



The biggest challenge faced by us is to make the TeleDoc program not just sustainable but also profitable in order to fuel its own growth. The initial challenge was to discover a price point where the service could be affordable to all sections of the rural society and, at the same time, cover the costs of bringing the service to villages. Our studies have shown that villagers are happy to pay Rs 70 for a week of treatment, which also covers the cost of consultation and medication. However, we feel that in order to develop an economy of scale within a specified timeframe for TeleDoc, it should generate substantial additional revenue. We feel that once we have established a widespread and stable network, this additional revenue can be generated from allowing other service companies to share this network. So, for example, insurance companies would be willing to invest a substantial amount of funds to reach the vast rural audience for their services.

The other slightly lesser challenge is to establish a strong brand recognition and credibility for TeleDoc. Ayurveda is a very holistic medical system and in many ways even better than modern medicine as it does not have any severe or lasting side effects. However, over the years, in the absence of publicity and advertising and a majority of the doctors adhering to the more lucrative modern medicines, people have gradually gravitated towards other systems of medicine. While in western countries Ayurveda is gaining popularity, in India an effort is required to make people revert to

Ayurveda.

l What are the futures plans of the project?



TeleDoc has a great future. In terms of technology, audio and video messaging services between the doctor and the patient will be incorporated. Once we have the network in place, we will be able to push any service through it. The biggest benefit of TeleDoc is that it is low-powered. And this makes it extremely scalable. We see TeleDoc as becoming a household name in rural healthcare. We are already moving in that direction. For a strong branding, we have created ads and brochures for the program’s publicity. Funding has already come from the Soros Foundation and more support is in the pipeline. This will help implement the project on a wider scale. The first priority is to widen the TeleDoc network and then when it takes off, franchise it and even weave in collaborative offerings like health insurance. TeleDoc is the solution to health problems not just in India, but in any developing country with inadequate medical services and a low per capita income.

RS