Given the low entry cost, ready availability of trained talent & the goal of scaling up manufacturing in India, start-ups can thrive.
By S Ramadorai & Arvind Singh
The novel coronavirus pandemic is shutting the lights off for the global economy. The health crisis has morphed into an economic catastrophe for the entire world. Covid-19 is likely to have serious and long-term economic consequences around the globe. While most economies are in a state of shock, the impact of this crisis could be more severe than the 2008 Global Financial Crisis or the Great Depression in the early 20th century. Amongst all sectors, one sector where the impact of such a pandemic could have been anticipated was the healthcare sector. Even countries such as the US and the UK, which have conducted exercises in planning for an epidemic, either did not anticipate such devastation or did not learn lessons from those exercises.
Hence, once the pandemic was underway, some of the major shortages were intensive care beds, ventilators and personal protection equipment for caregivers of those infected by the virus. In countries with state-funded healthcare systems, the response to the virus was the most effective. Singapore, Taiwan, New Zealand and Japan are some of the countries that were able to have some control on the pandemic. These countries had the advantage of uniform access to healthcare. People were able to access testing either for free or with significant state subsidy. In times of economic hardship, the cost of accessing healthcare becomes of vital importance.
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In the last few years, there has been a significant increase in start-ups addressing different aspects of healthcare delivery in innovative ways. Connectivity across the country has also been helped by the rollout of GSM technology and support from the Indian Space Research Organisation (ISRO) in the form of free satellite time where GSM signal is patchy. Institutions like Aravind Eye Care System, Sankara Nethralaya and LV Prasad Eye Institute have used this technology to communicate with their mobile units sent to rural areas for provision of screening services, particularly for diabetic retinopathy. Saving and restoring vision, through early screening for diabetic retinopathy and diagnosis and management of cataracts and glaucoma, have demonstrated the effectiveness of innovative solutions in the domain of healthcare.
If India is to leverage the advantages of a thriving Health Tech ecosystem, both for its domestic needs and to export this technology to other countries, then certain steps must be taken. We remain convinced that India can actually learn from the experience of dealing with challenges brought about by Covid-19, both in India and in other countries. This would enable us to put in place systems that will not only take care of the needs of the population in ‘peace time’, but also enable us to cope with additional demands placed on the healthcare sector in times of an epidemic.
Primary healthcare spans across multiple aspects of care; preventive, promotive, curative, rehabilitative and palliative.
The present structure of the primary healthcare system originated in the 1940s as an outcome of the Bhore Committee, headed by Sir Joseph William Bhore and set up by the Government of India in 1943. The 80-year-old system has several limitations: it is not accessible, is personnel-intensive, is expensive with limited returns, does not provide required services and does not address the cause/determinants of disease. Universal Primary Healthcare can be achieved when AI-based primary healthcare can be delivered at a person’s home continuously and comprehensively. This can streamline the rest of the healthcare system as well.
To prepare for a future pandemic, we should build a specific ‘ring-fenced’ funding provision to support the ecosystem for innovative healthcare devices. Given the high percentage of Indians living in rural areas, primary care is the most important need for the population. India has its share of corporate hospitals providing world-class healthcare to those who can afford it. Every effort should be made to make such care accessible to all.
While meeting the healthcare needs of our population, we must also build strategic reserves of critical medical equipment like testing kits, personal protection equipment like masks, and gowns; and lifesaving medical equipment, like ventilators and CPAP (continuous positive airway pressure) devices. Some of these are currently being imported. A culture of local manufacturing and export substitution will also benefit the Indian economy and stimulate manufacturing.
Epidemic preparedness must enter our policy and health delivery language. We must scale up manufacturing across the country so that all our innovations can be brought to market quickly. Other countries with requirements very similar to those in India will offer great export opportunities for all such innovative products.
Strategic planning with appropriate allocation of funds aimed at self-reliance is a sure step towards actually reaching self-reliance. Such projects, in the long term, will become self-sustaining with export revenue coming in.
Covid-19 and the opportunities thrown forward by this pandemic show that many start-ups have come up with innovative ideas to cope with or fight the pandemic. Covid-19 containment efforts have shown that tracking and testing were key to “flattening the curve.”
Effective use of Personal Protective Equipment (PPE), mass communication of quarantine measures, effective quarantine monitoring measures, as well as digital solutions to regulate essential logistics also played a vital role. Several start-ups rose to the occasion by providing quick solutions relating to each of these areas.
However, a majority of the funding calls primarily focused on molecular research, drug discovery and vaccine development, even though our country lacks the ecosystem to deliver on any of these. Our country’s expertise is in reverse engineering cheaper solutions.
Pure software-based solutions and newer concepts in personal and mass protection were often overlooked for funding. The focus of funding seemed to be based on novelty and following the West, rather than appropriateness and requirement of solutions on the ground in India.
Even successful solutions ran through regulatory roadblocks. Thoroughness of regulatory approvals must be a feature of healthcare service, and justifiably so, as healthcare directly relates to life and death. It does seem that the process of regulatory approvals has become globally centralised and we have ended up being caught in a warp where we are following other nations’ regulations when we actually need to understand our own country’s requirements and support our own localised solutions.
Beyond existing traditional regulatory or certification agencies, appropriate academic, research and innovation centres at the forefront of innovation should be made part of the regulatory screening process. Simpler testing processes should be identified for solutions that focus on simpler requirements, like a mask worn by any person on the road. Decentralisation of decision-making would help support more rapid deployment of Covid-19 containment responses.
Some of the notable start-ups that have been of prominence or who have been able to create due to the opportunities given by Covid-19 are:
Calligo Technologies: Applying AI algorithms to analysis of medical images to help with the diagnosis of diabetic retinopathy, cervical cancer and cancers of the oral cavity.
Fourth Frontier: Inventors of a device for remote, non-invasive monitoring of cardiac strain (oxygen demand/supply balance) in exercising amateur and professional athletes. This enables athletes to optimise their training while staying within safe limits.
O2Matic: Have developed (patent pending) a highly portable oxygen generator, which provides uninterrupted 99.7% pure oxygen, without the need for power. This may well be the game changer in the post-Covid-19 scenario, where supplemental oxygen is vital.
Niramai: Have developed a non-invasive AI-based diagnostic solution for breast cancer screening, which is operated on a lightweight portable device.
The Ministry of Health and Family Welfare initiated the creation of several Health Technology Assessment (HTA) centres across the country. These centres should take an active role in assessing and evaluating newer concepts proposed by start-ups, and provide some validation of their efficacy and recommend utilisation of the product. These efforts would help raise resources for start-ups.
India takes its responsibility of innovation and implementation of cutting-edge technology seriously. Speaking at the Royal College of Physicians and Surgeons (Glasgow), the Director General of the Indian Council of Medical Research (ICMR), Dr Balram Bhargava, who is a cardiologist by training, said, “We see our task as creating a climate of innovation in India, supporting it financially and ensuring that the entrepreneur is adequately rewarded by retention of fair equity in his/her innovation.”
We remain convinced that given the low entry cost, ready availability of highly trained talent and a commitment to scaling up manufacturing in India, we can make the best use of our innovative thinking and set up a thriving start-up culture. It now remains for our political leadership to strategise, motivate and inspire our talent to go forth and claim our rightful place on the world stage.
Ramadorai is former CEO & MD of TCS, and former chairman, Skill Development Agency. Singh is a retired eye surgeon, and now the CEO of Eternitii PLC, a devices and processes consultancy
(Reprinted with permission from the Observer Research Foundation; www.orfonline.org/expert-speak/post-covid-19-health-and-technology-opportunity-for-india-67689/)