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Telemedicine Provision Centers and Reproductive Age Women in Rural Uttar Pradesh, India


World Health Partners (WHP), a New Delhi based non-governmental organization, began establishing telemedicine provision centers (TPCs) in rural areas of three districts in northwestern Uttar Pradesh, India. Communities in rural Uttar Pradesh, the most populous state in India with nearly 200 million people, lack access to qualified medical physicians and have a large unmet need for family planning. Through a live streaming audio/video Internet connection, rural communities were able to consult with qualified physicians located elsewhere in India. This large "pilot" project of 116 TPCs provided health services to 1293 villages with an estimated population in excess of 6 million. TPCs were specifically marketed to reproductive age women with the goal of increasing their access to healthcare and family planning. The TPCs were also established as social franchises. These telemedicine franchises generated revenue for their entrepreneurs in the form of consultation fees and drug sales, and in return, they had to provide family planning products and services in their rural communities.

From April 2009-December 2010, 28,970 telemedicine consultations occurred with a mean of 19.7 (s.d.=20.3) per 30 days of TPC operation. The telemedicine consultations, however, rapidly decreased after the start dates of the TPCs either due to the actions of the rural entrepreneur or decreased patient demand for telemedicine services. Despite the decrease in consultations, TPC entrepreneurs still fulfilled their family planning obligations. Overall, from the family planning services and products sold, the couple years of protection (CYP) was 288,119 (MSI/DKT calculations) which corresponded to a cost per CYP at USD$5.84.

Spatial analyses demonstrate that the 90% catchment area for TPCs for reproductive age women was approximately 4.9 kms. Location-allocation models in Bijnor district comparing an optimal configuration of TPCs to their actual resulted in a locational efficiency of 0.84. Twenty additional TPCs would be needed to achieve a population weighted mean distance equal to the catchment distance for women. Semi-structured qualitative interviews with reproductive age women indicated that while acceptable, telemedicine was being tested by women, and it provoked feelings of fear of how to communicate through the computer as well as how to interact with the doctors. Ultimately, it was judged by its ability to provide relief since these women needed to be healthy to fulfill their household and family responsibilities.

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