icegov2012 proceedings

2. HEALTHCARE IN RURAL INDIA
Healthcare system in India is still in a nascent stage. Though the
urban population have some access to healthcare at a higher cost
but studies indicate that healthcare in rural India is still a
neglected sector. This is largely due to lack of infrastructure and
specialist doctors in the rural areas. Even the ones who study
medicine prefer to work in cities rather than going back to their
own villages to serve the rural people. Private players have
succeeded in providing the best of the medical facilities in cities
but they have shown little interest to invest in the rural areas. This
is because the private investors are skeptical about their return on
investment as the rural people have limited paying capacity.
Therefore, whatever healthcare is available in the rural areas is
only because of the government initiatives.
There is a great demand for healthcare in the rural areas. Patients
need to be treated for malaria, polio and other typical diseases
normally seen in rural areas because of lack of proper sanitation
and unhealthy environment. Leave aside the treatment; even there
is little facility to diagnose dreaded diseases like AIDS, cancer,
and tuberculosis. Child care and regular checkups during
pregnancy is again a neglected subject in the rural areas. Of
course, over the years the Government of India has focused on
reducing the burden of illness and mortality among women and
children through a number of development and public health
programs such as the Integrated Child Development Services
(ICDS). Awareness generation among the rural mass,
infrastructure development and evolving mechanism to ensure
that various healthcare programs introduced by the Government
are implemented to perfection is of paramount importance.
A typical healthcare system infrastructure in India is depicted in
figure 1.
NATIONAL LEVEL
Ministry of Health & Family Welfare
PROVINCIAL LEVEL
Department of Health & Family Welfare
RURAL AREAS
Community Health Centre
Primary Health Centre
Sub-Centre
Village Health Guides
DISTRICT LEVEL
District Hospitals
URBAN AREAS
Hospitals
Dispensary
Figure 1. Healthcare System Infrastructure in India
The doctors in the primary/community health centers in the rural
areas are mostly inexperienced. Therefore, when a patient arrives
for treatment the doctors try to diagnose the disease and carry out
preliminary investigations. If the disease is minor doctors treat the
patient but if it is beyond their capability they send the patient to the
nearest district hospital. Depending on the seriousness of the disease
and availability of facilities to treat the patient the case is further
referred to the next higher level hospital with better medical
facilities. In such cases, whenever a serious patient is taken to
another hospital, invariably the same medical tests are conducted
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due to unavailability of proper reports and patient history from the
lower level hospitals. Therefore, there is an obvious delay in starting
proper treatment and in many cases there is further deterioration of
the patient and in some cases even the patient succumbs to death. If
the required information would have been available at the right time
proper diagnosis could have been possible and treatment could have
been initiated immediately.
2.1 Patient Information Management
Information management in hospitals, dispensaries and healthcare
centers particularly in rural areas is a difficult task. Today High
quality healthcare depends on extensive and carefully planned
patient information processing. Many of the rural healthcare units
still depend on paper-based record-keeping system wherein
patient information is maintained in pen and paper. This results in
difficulty in accessing patient information.
2.2 Medical Infrastructure
The quality of medical infrastructure deteriorates as one move
down the hierarchy in figure 1. Even if certain medical
instruments are available but in many cases those are not
operational for lack of maintenance. This becomes a hurdle for
proper diagnosis. Moreover, there is no way to analyze patient
data both due to unavailability of expert doctors and necessary
computer-aided diagnostic tools in the rural healthcare centers.
2.3 Disease Control and Monitoring
Certain rural areas are prone to specific type of diseases, for
example malaria, filariasis etc. Similarly, there is seasonal
outbreak of epidemics, flu or diarrhea because of certain local
factors. Such cases are to be monitored carefully and must be
brought under control at the earliest. Unless the Government gets
the right information at the right time about the affected areas,
remedial measures cannot be initiated immediately to deal with
the situation. Many-a-times lack of communication of the ground
realities becomes a bottleneck for the Government to respond
quickly.
3. PROPOSED CLOUD BASED SYSTEM
3.1 Cloud based System
Cloud based systems are being developed to deliver hosted
services over the Internet. These services are broadly divided into
three categories, namely, Infrastructure-as-a-Service (IaaS),
Platform-as-a-Service (PaaS) and Software-as-a-Service (SaaS).
The basic aim here is to provide a virtualized environment so that
a client can make use of state-of-the-art resources such as servers,
software, storage etc. instead of buying those resources rather pay
based on usage. Such a notion is quite appropriate for developing
healthcare system for the rural community. This is because it is
not possible to build infrastructure at each and every primary
health centre considering the cost, unavailability of experts to
operate the equipment and even from the maintenance point of
view. Thus cloud can provide an innovative and cost effective
solution to modernize healthcare information management in rural
areas. Once patient data is collected and stored in a cloud it can be
easily accessed by expert doctors for analysis and further action.
Thus medical staff from one institution can monitor patients
located at another distantly located hospital.