C4S has enabled telemedicine service for the first ranked rural hospital in India and providing grassroot tele-healthcare to the remotest villages in the country. Under the leadership of Dr Jithendhranath, we have expertise in building the medical community around the village, developing ICT systems and making new inclusivity through community BOT based implementation.

Grassroot Telemedicine

Wireless telemedicine, also referred to as mobile health , which capitalizes on advances of IoT technologies to deliver health care and exchange medical knowledge anywhere and anytime, overcomes most of geographical, temporal, and even organizational barriers to facilitate remote diagnosis and monitoring, and transfer of medical data and records which can happen even without internet and cellular networks. Since its birth at the beginning of 1960s, the idea of telemedicine has offered a vision of healthcare for isolated people and communities, potentially reducing the cost of public health care. The case studies and research on the telemedicine practices says that, most of the telemedicine projects struggled to find its sustainability due to the vulnerabilities in technology. Given the progress of technology over the recent years, many advanced features become available for telemedicine. In particular, the latest technologies in hybrid wireless communication and networking, artificial intelligence and imaging are helping telemedicine system move to a new age of cure and care. Telemedicine can help increase rural access to healthcare and can be especially useful for developing countries like India.

The national telemedicine network of India covers up to the sub centre level in principle and paper. The project suffers many infrastructural gaps to be bridged with the support of local government and community. As per the national telemedicine policy , state government is entrusted to develop a sustainable PPP model to establish and maintain telemedicine units from medical college to sub centres. This document explores and explains a bottom up model to build ‘Tele Health Centres’ across hospitals and remote tribal settlements in Kerala with the support of Kudumbasree Mission.

Rural and Tribal Community Development Initiatives

Whether it is the Central Government or any State Government, to bring up the remote communities to the forefront of the society is always one of their primary agenda with various initiatives and development programs, where by establishing proper infrastructures, supply of water and electricity, education systems, health services and community benefit programs gets the priority. However, some of the benefits of these initiatives of health system either do not reach to the right communities or partially get implemented or sometimes fails due to poor surveillance. Poor awareness among the tribal people is also the reason of lack of response from the communities. Inaccessible remote locations like mountains, valleys, forests as their dwellings and inconsistent aid service networking are found to be the stumbling block in implementing these community health development programs efficiently.

As a result, people living in these settlements suffer from various illnesses, which could be cured if provided proper medical care, terminal illnesses, specialty medical treatments, skin deceases, and pregnancy and neo-natal care, mal-nutritious children, unmonitored adolescence & growth of children, all lead to reduced life expectancy of the remote population, even leading to extermination of certain communities from existence.

Grassroot Telemedicine and its Importance

Most of the health related issues can be ameliorated by timely and periodical medical care and surveillance. There comes the importance and overwhelming potential of Telemedicine. Telemedicine is the use of telecommunication and information technology to provide clinical health care from a distance. It has been used to overcome distance barriers and to improve access to medical services that would often not be consistently available in distant rural communities. It is also used to save lives in critical care and emergency situations.

The Telemedicine System establishes its Grassroot Health Centre (GTHC) at one of the remote villages or tribal settlements, where no basic infrastructure facilities available. These centers are then tele- connected to Primary Health Centres (PHC) or District Hospitals as required, where the doctors and nurses are available on a full time basis. Both GTHC and PHCs will have the video conferencing facilities and they get connected live without any hindrance through an appointed health service worker, who on the doctor’s prescription provides medical support to the patient. Technology beats the distance and helps underprivileged remote rural population a chance to survive with timely medical care. This connectivity and communication will be made in non-internet and internet scenario using the potential of long distance wireless communication.

Noolpuzha FHC - a success story from Wayanad

First of its kind in the Country: First Teleclinic @ PHC has been established in the Wayanad district of Kerala. The hospital is recognised by Govt of India as the best PHC in the country for the services including telemedicine. The Telemedicine connectivity with district hospital works without any intenet or commercial network provider. The video conference system and other software and hardware modules are developed in house by C4S.

Wayanad is one of the backwards districts in India due to poor socio-economic development index. Eighteen percentage of the population in Wayanad is from the communities, and some recent data shows that the tribal communities contribute as highest tribal rate of morbidity in the district since they live in the forests and no access to a proper health care system.

Identifying the wide scope of Telemedicine and its potential benefits in the remote areas and in tribal villages, C4S came up an indigenous technology to connect the tribal colonies and rural villages with Primary Health Centers (PHC) and District Hospitals. This became a huge success when the Noolpuzha District Panchayat decided to implement a full-fledged telemedicine clinic facility at the Noolpuzha Family Health Centre (FHC).

C4S helped Noolpuzha Panchayat to set up the Telemedicine facility at the Family Health Centre, and then connected the FHC to the District Hospital, Mananthavadi which is around 55km away from the Noolpuzha FHC. All specialty medical facilities like Ophthalmology, Orthopedics, Dermatology, Genecology, ENT and Psychiatry are available in the District Hospital are now available at Noolpuzha through Outpatient (OP) system through telemedicine. Computerization of the FHC with personal health data storage, token system and CCTV are additional support C4S implemented at Noolpuzha FHC to complement the success of this FHC winning the best Family Health Centre in India and the Model FHC of Kerala, all with the supports of the local people, Noolpuzha Panchayat and Hospital staff.

Going further in Grassroot Telemedicine Projects

Noolpuzha FHC Telemedicine unit is a golden feather in the history of Indian Telemedicine implementation. C4S is currently working with many other PHCs and Local Government Bodies of Kerala to implement a similar telemedicine system to connect to their respective District hospitals.

At the same time, C4S is constantly strives its efforts to reach out to the remote tribal villages of Wayanad to implement Grassroot Telemedicine, where even no electricity, phone network coverage or transportation exists. C4S has established connectivity in many such remote tribal villages, and the latest one to go live is at Manimunda tribal settlement , around 4km inside forest, where around 200 families of tribal people living scattered with no electricity or network. They have now GTHC inside their colony and could connect to the FHC and Specialty Hospitals with high quality video and audio streaming.

The wild clinic : Our teleclinic @ forest village in Kerala. The clinic is situated inside Muthanga Tiger Reserve Forest and serves for 700 people in the Manimunda tribal settlem.ent. The clinic is wirelessly connected to the nearest Noolpuzha PHC. The project is operated through our community ‘BOT’ system.

C4S Advantage

  • The grassroot telemedicine technology is indigenous, developed by C4S and implemented at various sites in Wayanadu, Technology accredited by Keltron, and hence highly cost effective.
  • C4S are using internet, wired LAN and wireless LAN as connectivity mediums to deliver telemedicine, moreover C4S are building its own wireless network in remote lands where no other network available.
  • C4S has built its own telemedicine software consisting of video and audio communication and other modules. C4S developed a new model for inclusivity which is called 'Community BOT'.
  • Community BOT takes the technology to the community and empowering them to build their own local wireless network to bring services in health and education.It works as ‘Build with communities, Operate through Self Help Groups (SHGs)and transfer of Know How’.
  • Highly reliable equipment in use, minimize down time, and very effective two-way communication, both audio and video.
  • Local trained personnel to operate, and to be supported by health staff, ensuring technical upskilling
  • The grassroot telemedicine and associated technology could be used for Tribal health monitoring, surveillance and monitoring of health statistics, accessibility to all specialty medical treatment for tribal people, personal tracking, community uplifting