Abstract
As a multidisciplinary, dynamic and constantly evolving field, the global health sector has always adopted new modalities for the faster and more reliable delivery of healthcare services. After half a century, since the advances in the space sector began, the high technologies developed by various space agencies have made their way for finding various cross-domain applications. The potential of satellites to play a vital role in optimising and augmenting the global health sector though explored for decades now remains unassessed for its terrestrial applications, especially for its societal applications. This paper provides an overview of a range of applications of space technologies for addressing the challenges to global health. The paper further assesses India’s Telemedicine and Telehealth sector and attempts to identify prospects for using them as a tool for its foreign policy.
Keywords: Telemedicine, Telehealth, Global Health, India
Introduction
As a multidisciplinary, dynamic and constantly evolving field, the global health sector has always adopted new modalities for the faster and more reliable delivery of healthcare services. After half a century, since the advances in the space sector began, the high technologies developed by various space agencies have made their way for finding various cross-domain applications. The potential of satellites to play a vital role in optimising and augmenting the global health sector, though explored for decades now, has not been harnessed sufficiently, for its terrestrial applications, especially for its societal applications.
Various national and regional space agencies of the major space faring nations have initiated the programmes to leverage their outer space capabilities.The Expert Group on Space and Global Health identified four key technological domains that are applied or could be applied to global health, such as remote sensing, GNSS/GIS, satellite communications and human space flight.A range of subdomains that emerged with these cross-domain applications of space technologies can be listed as Telemedicine and telehealth, Tele-epidemiology and environmental health, space life sciences, Disaster and health emergency management. Despite the existence of the technology for decades, the potential of the existing space technologies still remains unutilised to its optimum level.
India, being an established space power for more than five decades now, has several indigenously developed technological capabilities and space assets that can facilitate the health sector directly and indirectly. There is a need to critically analyse the existing initiatives by India’s national space agency i.e. Indian Space Research Organisation’s (ISRO) existing initiatives in the health sector. There is also a need to identify the opportunities for further advances in the field of health and medicine using the existing and new programmes, especially with the entry of private players and a growing number of commercial activities in the space sector, domestically and globally.
This paper provides an overview of range of applications of space technologies for addressing the challenges to global health. The paper further assesses India’s Telemedicine and Telehealth sector and attempts to identify prospects for using them as a tool for its foreign policy.
Telemedicine and Telehealth in Global “Space for Health”
“The delivery of health care services, where distance is a critical factor, by all health care professionals using information and communication technologies for the exchange of valid information for the diagnosis, treatment, and prevention of disease and injuries, research and evaluation, and for the continuing education of health care providers, all in the interests of advancing the health of individuals and their communities”, remarks World Health Organisation (WHO).
As categorised in the table below, space technologies and their applications in health sector can be observed at different scales i.e. Individual, Community and Mass (population).
Telemedicine is a peculiar application of space technologies with direct societal benefits. It has the potential to play a significant role in improving health services. According to the health resources services administration, Telehealth refers to the use of electronic information and telecommunications technologies to support long clinical health care patient and professional health-related education public health and health administration. Telehealth includes non-clinical medical services while the term “telemedicine” refers to providing only traditional clinical services.
For several decades, not only state-space agencies but also international organisations like the United Nations Office of Outer Space Affairs (UNOOSA) and United Nations Platform for Space-based Information for Disaster Management and Emergency Response (UN-SPIDER) have also been promoting the use of space technologies for global health. This includes telehealth, infection surveillance and space cooperation for global health. A number of working groups on health plans have been established to facilitate developed and underdeveloped countries with access to and with capacity-building assistance in the field of space-based information to support the full disaster management cycle. The UNISPACE III conference concluded in 1999, with the theme “Space Millennium: Vienna Declaration on Space and Human Development” (Vienna Declaration), contained 33 recommendations as elements of a strategy to address new challenges in outer space activities which included identifying specific areas and actions through which space science and technology can help solve common problems of regional or global significance.
The Scientific and Technical Subcommittee of COPOUS (STSC) has established a working group on Space and Global Health. The group works on the domains of telemedicine, telehealth, disaster and health emergency management, and space life sciences to assess the question of space applications increase our ability to respond to global health issues. A multi-year Workplan started last year, national points of contact have been established, and a questionnaire has been sent to collect information about the development of a global platform to share information, best practices, and capacity building resources in the area of space and global health.
India in the Global ‘Space for Health‘
In India, 68% of the population resides in a rural area where the health care services are minimal and telemedicine can close the gap by overcoming distance barriers through joint efforts of government and private healthcare institutions. India had also participated in the 1999 UNISPACE III conference that aimed at promoting the use of space technology and help strengthen the capabilities of UN Member States, in particular developing countries, in using space applications for telecommunications broadcasting and navigation; agriculture and vegetation monitoring; protecting the environment; disaster warning; and space research for human development.
Indian Space Research Organisation (ISRO) began its telemedicine programme in 2001 which has been connecting remotely located medical colleges and hospitals using Indian satellites to major speciality hospitals in cities and towns. The Mobile Telemedicine units of ISRO cover the areas of Ophthalmology, Cardiology, Radiology, Diabetology, Mammography, General medicine, Women and Child healthcare. Although the number of these units is as limited as 18 and only 386 hospitals have been connected as of now. Around 139 nodes in India’s Telemedicine network are currently operational on INSAT-3A and the remaining nodes on INSAT-3C and INSAT-4A satellites. Based on the existing coverage of INSAT and GSAT networks, ISRO has the potential to expand its existing Telemedicine Network not only within India but also across its immediate and extended neighbourhood in Asia.
Despite initiating the programme on telemedicine, two decades ago, the implementation of the technology by ISRO has remained limited. There is a still a wide scope for India to leverage its indigenously developed capabilities under institutions like ISRO and DRDO as a part of its science diplomacy initiatives and health diplomacy. The investment in R&D should be monitored to encourage the allocation of financial resources to projects with multi-domain applications.
The data gathered from satellites combined with other sources of data have been relevant for managing the COVID-19 crisis, around the world but especially in developing countries. As Mr Aravind Ravichandran describes, some specific uses of space infrastructure and its application to the current exceptional situation. Satellites help us identify human settlements and their density, which is particularly useful in places where this has not been documented sufficiently in the past. Segregated data can be useful in locating where to go to carry out testing, send help and medical equipment, or first responders. From space. Geolocation and EO can help in lockdown easing – those measures can be planned and monitored continuously.
As the COVID-19 pandemic scaled exponentially across the world, telehealth served as an innovative solution, clearly highlight unmet needs in the world healthcare system. Telehealth has shown its potential to address many of the key challenges in providing health services during the outbreak. Though Telemedicine has been used spottily in the Indian health care sector, the nation’s health systems were provided with an unprecedented opportunity to make a concerted effort to increase access and coverage.
Cancer, as one of the diseases with a high fatality rate, demands effective and efficient solutions. Systematic and effective communication between individuals at advanced oncology centres and those at remote or resource-poor centres can improve cancer care and enhance opportunities for continuing clinical education. Hence, disparities in cancer care can be reduced by developing resources, human capital and telecommunication infrastructure, that link institution with different levels of funding and expertise.
Access to quality cancer care is often unavailable not only in low- and middle-income countries but also in rural or remote areas of high-income countries, where India’s neighbourhood is an exception. Tele-oncology (oncology applications of medical telecommunications, including pathology, radiology, and other related disciplines) has the potential to enhance both access to and the quality of clinical cancer care as well as education and training. On these lines, the Ministry of Health in the Government of India can be seen to have taken up projects like Integrated Disease Surveillance Project (IDSP), National Cancer Network (ONCONET), National Rural Telemedicine Network, National Medical College Network and the Digital Medical Library Network.
The ISRO has been already been deploying a SATCOM-based telemedicine network across the country since that year. Various government agencies-Department of Information Technology and Ministry of Health & Family Welfare, state governments, premier medical and technical institutions of India-have taken initiatives with the aim to provide quality healthcare facilities to the rural and remote parts of the country. The Indian Government has planned and implemented various national-level projects and also extended telemedicine services to South Asian and African countries.
Way Ahead
As compared to other major space powers, India has been a late-entrant in terms of exploring medical and health applications of space technologies as a tool for its foreign policy. Although with its frugal innovation and cost-effective solutions, India can surely aim at providing cost-effective solutions that can help advance the medical field and help attain a number of sustainable development goals. The specialities in oncology, neuroscience and radiology have concentration only in urban locations, especially in developing countries.
A more coordinated effort between the health and space sector is required to create a well-networked telemedicine network for a better reach of these services, where India can definitely explore the opportunity to be a regional health security provider. The emerging private players in the telemedicine and telehealth domain, such as Apollo, Practo, DocOnline, Vidmed, etc. can play a key role in promoting India’s health diplomacy.
After the accomplishment of Vaccine Diplomacy, India can look forward to exploring its space power potential coupled with the expertise in the field of medicine, to facilitate the developing as well as developed countries with affordable as well as premium Telemedicine and Telehealth services. A well-networked Telemedicine and Telehealth platform can behelp the countries in need to bridge the access deficit and infrastructure challenges in the basic and advanced healthcare services by overcoming the geospatial constraints. With the expansion of nodes of the existing Telemedicine network in the immediate and extended neighbourhood, India can look forward to deepening its diplomatic engagement in the socio-economic sphere.
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