Healthcare in rural India

Outlook carries a series of articles about doctors working in rural areas of India. The header article provides an overview of the kinds of efforts that are underway and the unique challenges doctors face in rural areas. This particular para caught my attention as I was guilty of this kind of thinking as well.

"What also angers doctors working in rural areas are misconceptions that are rife about the healthcare needs of "simple and hardy" rural people. Rural poor, they point out, are prone, not just to the worst communicable diseases, but all the so-called "lifestyle diseases" lazily correlated only with urban excess, and never with rural poverty and stress. For instance, the rural poor show up, far from obese, with diabetes so advanced that diagnosis and amputation happens in a single session. Yet, affordable access to insulin is a dream when even getting a basic malaria test is hard."

There are several short profiles (Chattisgarh, Tamil Nadu, Uttaranchal) of doctors who have given up lucrative careers in cities to go work in villages. Finally there is an opinion piece that makes the case that the rural medicine should be a separate medical specialization in itself as it requires some very specific and unique skills. The following quote from this article hints at just how imbalanced health infrastructure in India really is.

"Seventy per cent of our population lives outside the cities but eight out of ten doctors and a shocking 80 per cent of all hospital beds are urban. Every preventable malady, like tuberculosis, malaria, diarrhoeal diseases, is many times more prevalent in rural India; so are infant and maternal mortality."

Uses of internet in villages

Washington Post carries a long article about how internet access through cellphone (connected to a computer) is making life easier for the people of a village in Bangladesh. Here are some of the uses listed in the article

1. Making sure that a doctor will be available before making a long and expensive trip to the city
2. Make up for the lack of access to books
3. Call relatives abroad using VoIP at dirt cheap rates (11 cents vs $2)
4. Getting married on webcam !!!

These cellphone powered internet centers are being set up by Grameen Phone which is partly owned by Grameen Bank of Muhammad Yunus fame. To the best of my knowledge 3G hasn't arrived in Bangladesh yet. So that means the cellphone based internet can provide dialup speeds at best. I didn't know you could do VoIP or video conferencing over dialup!

Right now a number of initiatives are going on to make computers available at extremely low cost. Assuming atleast one of these initiative will succeed, this story illustrates how a combination of dirt cheap cellular rates and availability of computers can improve the quality of life of people.

Solar powered Wi-Fi

Uber tech blog GigaOm links to an article in news.com which talks about an effort to make internet access a reality in underdeveloped regions. This project named Green WiFi is being run by a couple of employees from Sun (one former and one current). They have developed a prototype with a grant from the $100 laptop project and are now getting ready for a field deployment in Uttar Pradesh.

At a very high level, enabling internet access comprises of 2 distinct challenges. Having a high bandwidth broadband backbone in place and getting people access to this backbone - the so called last mile problem. The wires that cable companies put, the phone lines that dsl providers use and the wi-fi access that hotspots provide all address the last mile problem. Simple WiFi won't be able to solve the last mile problem for Indian villages are they are usually no where near a broadband backbone. So the Green WiFi project is going to use a series of routers - each connected wirelessly through 802.11b/g (wifi) - to connect the end user to the backbone and hence the internet. Their innovation is that they are coming up with a cheap and robust solar power charged battery set in order to provide power to these routers and more importantly they are coming up with a way to do elegant degradation when the router starts running out of power.

""What we bring to the table is an intelligent charge-controller. We put the router on a diet," Pomerleau said. The controller sits between the battery and the router and regulates power to the router depending on the charge level of the battery and the amount of incoming sunlight."

Absolutely critical for this idea to succeed in Indian villages.

The pilot project in Uttar Pradesh would be able to flesh out the technical abilities and limitations of this model. But the possibility of widespread deployment would depend on how far the internet backbone is from a typical Indian village. The cost of the router has been capped at $200 (Rs. 9000). The news.com report says that the wifi router nodes can be 1kilometer apart. I am not convinced about that being true in real deployments. But anyway quibbles aside, greater the distance from the backbone more the number of routers that have to be used and more the cost. WiMax which has a longer range would be a better fit for this kind of an effort. But we won't be seeing commercial WiMax before late 2007. WiFi is already here. So if this model can bring high speed internet access to atleast those villages which are close to the backbone, that would be a great achievement.

Cell phones in Indian villages

Businessweek has this article about the growth of cell phones in rural India. Businessweek has a history of gushing over the latest fad in town and this article is part of the India, China series. Since I don't live in a cave I am well aware of the explosion of cellphones in urban India. The extent of this explosion can be gauged from this little statistic from the article.


“…India's mobile phone user base has exploded to 105 million today from 5 million in 2001…”

But the story, as always, had been different in rural India. Since the beginning of this year wireless circles have been abuzz with stories about the $4 billion BSNL mega contract. A chunk of the 60 million GSM lines that BSNL is planning to roll out are meant for underserved rural regions. According to this article other Indian wireless operators are also planning huge expansions.


"...Another major India telecom, Reliance Infocomm, is expected to invest around $550 million through the end of the decade, mainly outside of major urban centers.

Tata Teleservices will spend $214 million this year on infrastructure, network expansion, and transmission, according to CEO Darryl Green. On top of that, Bharti Airtel, India's largest wireless player, will devote $1.8 to $2 billion in 2007 on similar expansions...."

The good news is that call rates are so low in India (2 cents or 90 paise per minute) that wireless service will be within the reach of all but the extremely poor in rural India. Bad news is that handsets are not all that cheap.

"Nokia, for instance, sells about 45 models in India. Yet its biggest seller, accounting for 15% of sales in India, is the basic 1100 model for $44 that is turning heads in villages like Latur. Motorola will launch a handset for under $30 in October. "

Even $30 (Rs.1350) is not an insignificant amount of money. The monthly salaries of instructors at a school funded by DridSankalp are in the Rs.3000 range. So buying a cellphone even at these highly reduced prices would be equivalent to buying moderately expensive furtniture for an engineer in the US. Not something that can be bought on a whim. And these instructors would fall in the rural middle class category. For poorer people even a $30 handset would be extremely expensive. I hope some service provider will be smart and brave enough to provide phones on credit. I also wonder if it would be possible to recycle used handsets from Indian cities for around $10-15 dollars.

Ofcourse, having a cellphone or being able to make a call is not an end in itself. How beneficial will this access to communication be? Apart from the obvious benefit of being able to be in touch with friends and family, can this increased access give rise to new and novel applications completely unique to rural India?