Health systems in low and middle income countries continue to face considerable challenges in providing high-quality, affordable and universally accessible care – this is primarily evident in rural areas. As of 2014, approximately 876.1 million people live in rural areas within India with poor access to primary healthcare. This amounts to more than two-thirds of the total population.

As a result, programme implementers, donors, research institutes are investigating innovative ways to eliminate the geographic and financial barriers to health. From this, there has been an increased interest in the potential of e-health and m-health (mobile use of technology for health, a subset of e-health) in low and middle income countries.

E-health makes use of developments in computer technology and telecommunications to deliver health information and services more effectively and efficiently. The George Institute has developed a mobile based system, SMARTHealth, as a point of care, clinical decision support (CDS) tool. This tool has been developed to help primary healthcare workers improve optimal blood pressure (BP) control in high risk individuals and provide high quality healthcare by a low cost re-engineered workforce.

The mobile system will assist non-physician health workers such as accredited social health care activists (ASHA) and doctors in managing and assessing the risk of cardiovascular disease (CVD) within Indian rural communities. Furthermore, the capabilities of current healthcare workers will be broadened by providing them with the appropriate equipment to monitor and measure CVD risk within these communities.

The mobile system is able to show the patient their risk of CVD through a visual projection meter built within the app. The patient’s age, gender, cholesterol level, systolic blood pressure (BP), and behavioural risks is entered into the mobile system to estimate the patient’s risk of developing CVD. The mobile system transmits the patient information to a secure server for storage in a database that is accessible to local investigators and sites. Additionally, the system allows patients to access their personal healthcare information from their phone. This may encourage patients to change their behavioural risk factors of CVD (e.g. adhering to their medication, stop smoking and drinking).

SMARTHealth’s primary outcome is to determine whether the application of a mobile based system in rural areas will reduce death, disability and catastrophic healthcare expenditure. The mobile system has expanded over 50 villages in rural India – home to over 200,000 people. This system will incorporate new technologies designed to provide ASHAs with patient-specific information to guide their appraisal, referral and treatment.


In rural areas where there is limited resources, prioritising high-risk patients for a BP lowering treatment can be a highly cost-efficient approach. Over the next few years, the SMARTHealth application in India is expected to deliver major improvements in access to quality affordable healthcare for people with high BP and are at risk of CVD. Currently wireless networks now reach over 80% of India’s population; therefore, SMARTHealth has the potential to revolutionise the delivery of essential healthcare to those who previously had little or no access.