Telemedicine and Capacity Building Uptake of telemedicine within the public health system has grown in India.

However, wider uptake and use remains a challenge especially in the rural areas. Even the National Rural Health Mission does not have any systematic plan to promote telemedicine. The National Health Mission is in the making. It is high time to address important issues hindering large scale growth and use of telemedicine in Rural India. This document has put forth some important suggestions for the public health system to act on. Policy and Advisory support under Government Leadership Develop a supportive policy framework, programme guidelines, include it in national, and state level health plans to promote use of telemedicine Create an advisory body at state and district level to lead and guide implementation of telemedicine programmes Establish quality standards for the telemedicine services

Generate Awareness and Confidence Conduct focused campaigns (involving civil society organizations) using multiple media to raise awareness and confidence about telemedicine (not only technology), its use, cost and benefits to the rural community Collaborate with local organizations and associations to develop and implement awareness programmes on telemedicine Showcase value of technologies trusted and used by communities to access telemedicine services Use multiple technologies (mobile phones, voice based interventions, integration of voice with web and kiosk, etc.) to strengthen interpersonal relationship with community and to enable access to health care services Identify champions for the cause of telemedicine and seek their support

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Engage Community Involve community members/leaders in awareness and capacity building efforts Seek inputs from community members for designing and implementing appropriate telemedicine programmes Create mechanism to gather feedback on utility and quality of telemedicine services Integrate with Annual Health Planning Include telemedicine programme guidelines in district health planning processes Advocate for acceptance and inclusion of telemedicine guidelines in state planning In the plan define nature and type of services available through telemedicine

Capacity Building and Coordination Create a national resource group to support telemedicine efforts in India Establish a state level nodal agency for coordinating telemedicine efforts in the state and for leading capacity building programmes (development of training curriculum (in local languages), conducting trainings and offering support services (in a collaborating way) Develop a training plan for training of state, district, block and frontline health workers in use of modern telemedicine facilities to improve quality of health care services and integrate it with state training calendar Build capacity of state agencies (SPMU, SIHFW, Directorate of Training, etc.) to improve understanding, knowledge and skill to use and promote telemedicine Collaborate and build capacity of local educational institutions to offer courses (certificate, diploma, etc in classroom as well as e-learning mode) supporting use of technology in health

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Infrastructure: Coordinate with other development departments (transport, electricity, telecommunication, drinking water, etc) to roll out telemedicine services in areas where basic infrastructure is available Create basic IT infrastructure to facilitate use of low cost technology (like mobile phones, web-camera) to offer telemedicine services Establish a central telemedicine infrastructure at the state/district level only to reduce cost and ensure better technological support and maintenance services Financial Capacity Promote and build on low cost technologies which are in use at the community level Create a coordination unit to monitor state wide telemedicine efforts in the public health system to ensure integrated efforts and avoid duplication. Thus, reducing cost. Invite private investment in telemedicine through partnerships which are supported by appropriate policy framework

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