Indian healthcare’s innovation imperative
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The world around us is changing at a pace unmatched in human history. Accelerating innovation and applying technology ideas to find new solutions for old and emerging challenges are critical imperatives—not just for India to address her own domestic challenges but also for it to build products and solutions for the entire world, and for the future.
Our curiosity, coupled with the tools and ideas that science and technology have given us, enables greater new possibilities with the potential to get around our traditional limitations in creating solutions and service delivery. We have much better medicines being developed because of our deep understanding of various aspects of biology. We have new tools like gene-editing that allow us to do amazing things across human, animal and plant health. We are investing in breakthrough new vaccines using technology to get them to those in need—safer and faster.
India has established itself as a credible, cost-effective manufacturer of medicines, supplying over 20% of the world’s generics and about half the vaccines sold globally. There has also been a significant improvement in the country’s health outcomes, coinciding with a period of higher economic growth and changes in health policy, both of which were triggered in part by the economic reforms of 1991.
India spends close to 5% of its GDP on health, and yet, on an index measuring country performance on health-related sustainable development goal indicators, It ranks poorly at 143 out of 188 countries. We are aware that the state of the current healthcare system does not always deliver for our citizens and faces significant systemic challenges. To overcome some of these, strategic shifts in the level of control that the government exerts on both the financing and provision of health are urgently required. India can build on core design principles from global experiences, including prioritizing resources for health within government budgets, pooling existing resources, and bringing in greater government control over the health sector. New thinking or technology solutions can only work if designed with a clear understanding of the current set-up’s lacunae.
While it is important to embrace innovation, it is also critical that innovation thinking is well grounded in the context of the social and economic evolution of the nation and its citizens, and any new technology intervention is flexible to the evolving dynamics of the ecosystem. The impact of coupling healthcare innovation with the prevailing socio-economic context can be explained with a few illustrative examples.
First, consider a diagnostic being developed for a disease of interest to public health. What features should such an innovation, which is driven by out-of-pocket expenses, have? High capital cost may be acceptable but per-test cost must be low—how does one design a product for this? Should tests be done in centralized labs or at point-of-care? What kind of technology tools can enable better delivery of diagnostic services?
Second, and more broadly, how does one scale up an innovation such as a new drug, vaccine or diagnostic test? What are the quality standards and user features that new products should have for the public market? What about pooled procurement to reduce cost per test? How would the government choose from a basket of available technology solutions—for example, multiple vaccines with different characteristics?
Third, consider a disease such as tuberculosis (TB)—one of the biggest killers of adults in India. The World Health Organization suggests that India had an estimated incidence figure of 2.2 million cases of TB in 2015. Only about 1.4 million cases are notified, while the rest have gone missing in the private sector. Part of the challenge comes from the isolated, disconnected way in which the private health system deals with TB. To help remove the scourge of TB, a long-term ecosystem of innovation must include an improved health system that casts a wide net of surveillance to identify and monitor cases.
In each of these cases, the use of technology across the spectrum, from supply to citizen preferences, could be helpful. New presentation of older products, novel manufacturing methods to increase productivity, mobile health, decentralized approaches taking advantage of tools such as the cloud to update health data in real time (ubiquitous in many parts of our economic and social lives), improved visualization of outcomes, transparent electronic regulatory approvals and digital supply chains—these could be employed to hurdle some of the older barriers. As a community, we must brainstorm on how such approaches could be helpful by bringing together people with diverse backgrounds, to draw on their unique resources and know-how.
Any new interventions within the health system need to be sensitive towards these issues and should be able to factor them in while designing a mechanism to identify potential patients, detect the disease early, and enable the full life cycle of the treatment—while all the time being responsive to the emerging and evolving requirements of patients and their ecosystem. ,
India’s healthcare system needs to harness technology and innovation—but also allow for a customized and flexible approach based on our current, and evolving, socio-economic and human contexts. Such an approach will allow India to deliver on quality healthcare and equitable health outcomes for all its people.
Harish Iyer and Nachiket Mor are, respectively, senior adviser, scientific programmes, India country office, and India country director, Bill and Melinda Gates Foundation.