The India-Russia agreement on healthcare, medical education, and science, signed on December 5, 2025, during President Putin’s visit to New Delhi, deepens institutional collaboration and facilitates the exchange of knowledge and personnel between the two nations. Among several key areas of collaboration, we will be advancing digital technologies in healthcare, including telemedicine, strengthening the regulation of medicines and medical devices, and sharing quality standards. This is a significant step towards making India not just the “Pharmacy of the World,” but the healthcare provider of the world, through vaccines, drugs, medical disposables and equipment, telemedicine, telemonitoring, and health tourism. India has a robust national telemedicine service, and e-Sanjeevani has served millions of patients and offers a successful model for implementation, particularly in rural areas. Russia and other large nations like Canada and Australia can leverage this expertise and experience.
LEGAL HURDLES IN RUSSIA
A major historical barrier in Russia was the legal prohibition on doctors making an initial diagnosis or prescribing treatment via a remote consultation alone; a face-to-face visit was required first. In 2023, an experimental legal regime (EPR) was introduced to allow doctors in participating clinics to adjust treatment and prescribe medication online, even for patients in different regions. In May 2025, the Russian Ministry of Health approved a new order allowing the use of artificial intelligence (AI) to support medical decision-making during delayed telemedicine consultations. Telehealth services require precise identification and authentication of both patients and healthcare providers through state-approved IT systems, such as the Unified System of Identification and Authentication (ESIA).
HANDICAPS
Legal hurdles exist in many nations, as mentioned earlier, with reference to Russia. Significant gaps exist in specialized digital skills among some healthcare professionals, and a low level of trust among some patients regarding data security and remote care. Personal touch, encouragement, and solace are often the most important parts of healing and may be difficult to provide, especially in the native dialect and cultural mores, by remote healthcare workers. While private insurance is starting to cover some services, a universal, unified mechanism for reimbursement within the compulsory health insurance system remains a challenge.
GLOBAL TELEMEDICINE NETWORK BY INDIA
India has the best telemedicine network among large nations in the world. The largest nations, area-wise, are Russia, Canada, the USA, Brazil, Australia, and India, in that order, each with more than 2% of the world’s land area. Nations like Indonesia, Malaysia, and the Philippines have less area, but their land is widely distributed. Nations like Algeria, Saudi Arabia, Libya, Mongolia, and Namibia have extensive desolate areas. These are nations where Indian expertise and technology can help set up telemedicine networks, including mobile units. India has already helped nations like Kazakhstan and North Korea set up telemedicine facilities. India’s Pan-African e-Network Project connected 48 countries across Africa to super-specialty hospitals and educational institutions in India through a satellite and fibre optic network, providing tele-education and telemedicine services, through government-funded projects (MEA, ISRO) and private hospital networks like Apollo and Narayana Hrudayalaya. The success of this project is now being replicated to cover all Central Asian states and extended to help Iraq, Yemen, and Malaysia. The Indian SAARC Telemedicine Network established a telemedicine network for the member nations of the South Asian Association for Regional Cooperation (SAARC). India chaired the Global Digital Health Partnership (GDHP), a collaboration of government agencies and the World Health Organization, in 2020. India’s e-Sanjeevani platform was added to the India Stack as a global digital public infrastructure platform during India’s G20 Presidency in 2023.
TELEMEDICINE IN OTHER LARGE NATIONS
The US has sophisticated infrastructure but faces challenges in setting up a national telemedicine network due to regulatory fragmentation, overemphasis on strict privacy (HIPAA), and detailed insurance reimbursement. Most of the telemedicine services are managed by multiple, for-profit private companies like Teladoc Health, American Well, Philips Healthcare, MDLive, and Epic Systems Corp. China accelerated telemedicine adoption during the COVID-19 pandemic to address significant urban-rural healthcare disparities. It provides extensive specialist services via 5G-enabled platforms and hospitals, but significant internal disparities in access persist. Chinese national e-healthcare rules of 2018 facilitate large-scale commercial platforms. The National Health Service of the United Kingdom rapidly expanded telehealth services during the COVID-19 pandemic, with support from major telecommunication companies to facilitate remote primary care and chronic disease reviews. “Rute” is the Brazilian telemedicine university network connecting 124 universities and teaching hospitals, facilitating peer-to-peer consultations across a wide region. Russia’s national digital health strategy for diagnosis and treatment is limited in its coverage of this vast nation. While all nations use telemedicine for primary and specialty care, some have unique focus areas, like Japan uses it to manage its aging population, and Brazil uses it for inter-hospital networking. The “clinician-to-clinician” segment is currently the largest in terms of revenue in most nations, but the “clinician-to-patient” segment is the fastest growing, driven by increased patient acceptance and the push for home healthcare. In contrast to all these nations, India has a unified national guideline that provides legal protection for practitioners and is integrated with national health missions, thus avoiding the spread of funding over similar parallel projects.
EXPORT OF TELEMEDICINE EQUIPMENT AND DIGITAL HEALTH PLATFORMS
The Russian telemedicine market is projected to grow at a Compounded Annual Growth Rate (CAGR) of 17.8% from 2025 to 2030. There is significant potential for Indian companies to export diagnostic, monitoring, and telemedicine equipment, and digital health platforms to the Russian market, with an ambitious goal set to triple overall medical device exports to Russia within five years. Russia is actively seeking technology collaborations and joint ventures with India, especially in satellite communication, as pioneered by ISRO, as it faces the challenge of providing healthcare across vast areas and remote regions.
India is actively incorporating AI into its healthcare ecosystem, using tools for screening conditions like tuberculosis and supporting clinical decision-making. AI is particularly useful in the analysis of medical images, such as CT, MRI, and X-rays, to detect pathologies faster and more reliably. The India-Russia agreement on healthcare explicitly mentions advancing digital technologies in healthcare, which includes telemedicine and remote patient monitoring.
The agreements foster technology exchange, potentially leading to joint ventures in developing and manufacturing relevant medical devices and software needed for effective telemedicine systems. A dedicated Indo-Russian Centre for Biomedical Technology is also planned. By promoting information sharing and standardizing quality, and aligning regulatory frameworks for digital health services, cross-border collaboration and service provision will be easier in the future. India’s exports of medical equipment to Russia and the rest of the world have been increasing, and the new pacts create significant opportunities for exporting portable diagnostics, at-home monitoring kits, and other tech essential for remote consultations.
India is a major manufacturer of cost-effective drugs, medical devices, and consumables. If operation Sindhoor enhanced export of Brahmos and other military equipment, a global operation e-Sanjeevani can enhance export of digital platforms, telecom and medical services, and equipment, drones, satellites, mobile telehealth units, diagnostic kits, medical disposables, vaccines, and drugs, and lead to increased medical tourism to India. It will enhance demand for Indian professionals and training. In addition to telemedicine, the growing adoption of personal health monitoring devices (wearables, smart tonometers) has made telemonitoring feasible.
With one-sixth of the world’s population, we already have one-sixth of the world’s medical and surgical experience. Indian doctors and nurses are already the backbone of the health services of many nations globally. With the trust and goodwill earned by Vaccine Maitri during the pandemic, and by providing prompt disaster relief worldwide, India can eventually set standards of international cooperation in healthcare and training, and become the healthcare provider of the world.
Dr P.S. Venkatesh Rao is a Consultant Surgeon, Former Faculty CMC (Vellore), AIIMS (New Delhi), and a polymath in Bengaluru, drpsvrao.com.
