Despite progress in bridging urban ruralhealthcare divide, most Indians continue to bear the brunt of inadequate healthcare system. Subash Deb, ENN,writes a treatise on Telemedicine in India 

The thought that doctor is a second God and medical is heaven on earth is utterly true. However, in India there is an acute shortage of doctors with 1 doctor for every 1,000 population”a sordid reality which India has been reeling under since a long time.
Doctors may not be the panacea for all problems, but the fact remains that they definitely can provide cure for all diseases. Doctors view that patients suffering from several life-threatening diseases can be saved by early detection and timely intervention. However, a large chunk of Indias population, which still resides in rural India, has been deprived of such medical facilities and infrastructure. India, with its grotty health care network and dearth of doctors, faces a daunting challenge of providing quality health care to its citizens. More to the point, doctors coyness to serve in the boondocks is actually creating a blot on Indias health care landscape. A total of 74 percent of the qualified doctors inhabit urban areas, serving only 28 percent of the national population, while the rural population remains mostly neglected.
Besides that, the public health care system is not only pathetic, but also under-utilized and bungling. There is a need to increase our spending in the health sector. Public expenditure on health in India is 1.2 per cent of the GDP, which is lower than four per cent in Australia, Britain, Norway and the US, President Pranab Mukherjee was quoted as saying in many national dailies. As per the Planning Commission of Indias Report (2012-13), public health care expenditure has increased from 1.27 per cent in 2007-8 to 1.36 per cent in 2012-13. On the contrary, private sector is quite prent in Indias healthcare system. Nearly 80 percent of total spending on healthcare in India comes from the private sector. However, accessibility and availability of these optimum medical facilities is largely skewed towards urban areas which make up only 28 percent of Indias population. The remaining 72 percent who live in the hinterland continue to bear the brunt of insufficiencies in public healthcare services as well as higher costs at private hospitals.
teAs a matter of fact, there is a high degree of disparity in quality and access to health care service between urban and rural regions. The quality of patient care and access to healthcare services are disproportionately low in rural areas. In such a scenario, telemedicine has come as a boon for all”to improve the countrys healthcare system.
Telemedicine, in simple words, means use of Information and Communication Technologies (ICT) to provide medical services from distant locations.

“India is an ideal setting for telemedicine activities. Here, telemedicine is not only trumpeted as a bucolic boon but also as a boom sector for various stakeholders”

Telemedicine in India
In India, telemedicine activities started in 1999. It was formally launched on March 30th, 2000, when Bill Clinton, the then president of the United States, commissioned the first telemedicine unit in the village of Aragonda in Southern India.  Telemedicine has been increasingly making strides in the country with the vigorous involvement of both the public and private sectors which have initiated various path-breaking steps to bring a sea change in the rural healthcare statistics of the country. Telemedicine is a desideratum considering the fact that a large chunk of Indias population live in difficult to reach, inhospitable terrain and have to travel long distances and also incur additional expenses to have access to super-specialty medical care.  The advantages of telemedicine are multifold. It virtually takes doctors to regions where there are no doctors. It has made medical help a reality in areas where no help existed before. Tele pathology, teleradiology, teleophthalmology are some ways of accurately diagnosing diseases from a distance.
With the objectives of extending quality healthcare facilities to the rural and isolated parts of the country, various government agencies like Department of Information Technology (DIT), Ministry of Health and Family Welfare, state governments, premier medical and technical institutions of India have taken various game-changing and utable initiatives in recent years. The Indian Space Research Organization (ISRO) is also delivering health care services to the remote, distant and underserved regions of the country through a satellite communication- based telemedicine network. The Government of India has initiated and uted various national- level projects and also taken telemedicine services to South Asian and African countries. A number of institutions which have been actively involved in telemedicine activities are also running curriculum and non-curriculum telemedicine courses.
In order to shore up telemedicine activities within the country, the Department of Information Technology has set the standards for telemedicine systems and the Ministry of Health and Family Welfare has formed the National Telemedicine Task Force.
There are various government and private telemedicine solution providers actively engaged in creating awareness about telemedicine within the country. Some private players who are also in play include the Asian Heart Foundation, Apollo Hospitals, SGRH, Fortis, Max etc. It is estimated that 1.5 lakh people are benefited from telemedicine every year.

Market
India is an ideal setting for telemedicine activities. Here, telemedicine is not only trumpeted as a bucolic boon but also as a boom sector for various stakeholders. With the sudden spurt of telemedicine network within the country, the market for medical diagnostic, healthcare providers, drug manufacturers, telecom equipment manufacturers, software has increased manifold. According to a study by Technopak Advisors, the Indian telemedicine market is valued at $7.5 million and is expected to grow at a CAGR of 20 percent over the next five years to around $18.7 million by 2017. A London-based market intelligence firm, Infiniti Research in its report published in 2009, titled Global Telemedicine Market:2008-2012, pegged the size of the global telemedicine market in 2008 at US$9 billion. As per this report, Asia is the fastest growing region for the telemedicine market with India and China leading the growth.

Key growth drivers
Inadequate disease management framework
Derisory healthcare facilities in far-off regions
Low technology cost and availability of qualified technical personnel
Paucity of qualified medical professionals
Governments vision of healthcare for all
Disparity in medical services between urban and rural areas
ISROs dedicated satellite for health communication
Development of ICT as a sector

Challenges remain
Despite the fact that telemedicine deployment is moving at a steep rate in India, it hasnt yet gone on a giant scale. Around 75 percent of our rural population are reeling under poor infrastructure and lack of computer knowledge. For the implementation of telemedicine one must be computer literate. Moreover, rural India faces power cuts of 12 to 15 hours a day, where even a battery backup system does not work out.
Language and communication is another impediment. In India with over 22 officially recognized languages and over 1,600 mother tongues, linguistic diversity is a major hurdle for patients living in one region being able to talk to a doctor in another region.
Though telemedicine technology advantages and benefits are well recognized but still many healthcare professionals are unenthusiastic to engage in telemedicine practices due to unsettled legal and ethical concerns. Last but not the least, most of the government and private doctors are not willing to participate in telemedicine activities since they view it as a direct challenge to their livelihood.

Conclusion
In spite of the progress, there is much to be done on the policy front. Even as Government of India has made attempts to set guidelines and standards for telemedicine, the country doesnt have a proper policy in place.
India deserves kudos for setting up the Pan Africa Network and South Asian Association for Regional Cooperation (SAARC) telemedicine network, but the public expenditure on health which is counted as one of the lowest globally cannot be ignored.  While the Indian medical community and private hospital networks may take pride in countrys medical tourism and rare surgeries that save precious lives, but the fact remains that rural India is prodigiously deprived of this very advantage.

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