India faces many challenges on the road to universal health coverage, and a new public health approach to innovation has never been more critical. The problems facing the current public health system are many: a shortage of doctors on the supply-side, an increase in chronic disease on the demand-side, and ongoing challenges presented by infectious disease. India is unlikely to achieve universal health coverage relying on the West’s resource-intensive approach of building more hospitals and providing broad-based insurance cover—we cannot afford to spend 20% of our GDP on healthcare as in the US. A new approach is needed. There is great potential for public health systems to harness the technological advances and innovations of today. As the recently released report of the government of India’s Task Force on Artificial Intelligence (AI) notes, AI is likely to have a positive transformative impact on healthcare in India.
AI is not the only technology—drones, genomics, IoT, 3D printing, etc, all have the potential to improve outcomes while reducing costs in the long run. The government has to find ways to harness the best of these technologies The government has traditionally preferred doing things itself or partnering with the non-profit sector—an overhang from the days when the private sector was viewed with suspicion. This approach will not work in the future. Start-ups and private innovators are at the cutting edge of technology—and the public health system must find new ways of working and managing to maximise the benefit from these pioneers The transformation of public health systems is already underway elsewhere—and it is being led by China rather than the US or Europe. For instance, the Chinese government collaborated with PingAn (a private insurance company) to create an AI for detecting lung cancer (the most common form of cancer in China).
The system has broken records for detection of cancer nodes in CT scans, leading to a significant improvement in the early detection of the disease. China has outlined detailed plans to be the worldwide leader in AI by 2030. However, China is not alone. In Rwanda, for instance, the public health system is using drones, developed by the startup Zipline, to deliver medical supplies. The system now makes 50-150 daily deliveries of primarily blood and vaccines to 21 remote locations across Rwanda. In Nigeria, the start-up Ubenwa has developed a smartphone app to detect birth asphyxia, a critical public health problem. The app analyses the sound of the infant’s cries rather than using a blood-gas analyser, making detection easier and cheaper. In the UK, the NHS has turned to Babylon (an AI-based symptom checker start-up) to act as the first point of contact for primary care patients, reducing the demand for doctor appointments.
Another area that is being transformed is mental health. India has roughly 3,500 psychiatrists only, nowhere near enough for our 1.5 billion population. Unsurprisingly, mental health issues are under-reported and under-treated. This challenge has been taken up by a slew of Indian start-ups like Wysa and WayForward Health. Wouldn’t it be great if we could incorporate these services in our public health system? The public health sector has a duty to make sure it is making the best use of available technology. Specifically, public health systems should: – use their purchasing power strategically to accelerate the growth of the health technology sector;- provide a structured piloting process for the adoption of innovative new technologies across the health care sector (e.g., in hospitals, but also in home and long-term care settings); and- provide data and feedback to best support working prototypes (especially AI systems).
The eye-catching response is to announce funds for investments in start-ups. But that is only part of the solution. The much bigger opportunity lies in improving the commercialisation and diffusion opportunities for health-tech start-ups that create revenue. This means changing the procurement and adoption norms in clinics and hospitals across the country. This requires culture- and process-change, and needs to be managed accordingly.
The government must take the following steps to transform the public health system-
Create a secretary/additional secretary, health innovation: This office will provide the leadership to make India a leading centre for health-tech innovation. The secretary/additional secretary will work with the government and other stakeholders from across the country to identify health system priorities and population needs, which are best addressed by new and emerging technology. Creating a clear owner for innovation is international best practice.
Establish a pilot fund: A specific budget for piloting new health technology to pay for the costs of deployment only—not research and development.
Create a data capture and access policy: Access to data is the substrate on which next generation AI systems will be built. The vast and genetically diverse Indian population provides a rich source of data, but India is squandering the lead to China because the data is not being captured and made available via APIs to approved parties.
Setup a regulatory regime for AI applications: Who is responsible for the AI that reads your CT scan? AI applications will fall outside of current device, pharma and medical regulations. An appropriate regulatory regime should be established at the earliest.
Position India as the worldwide leader in frugal innovation for health systems: The government should develop, evaluate, and coordinate pathways for the adoption and diffusion of innovative health technologies across the Global South. We must ensure that policy, process and people move in tandem, so that we may maximise the impact of technology on the provision of healthcare and achieve Universal Health Care. The time to act is now.
Lov Verma & Shwetank Verma
Lov Verma is former health secretary, Government of India and Shwetank Verma is the co-founder and partner at the early stage VC, Leo Capital