Home / Politics / Policy /  Challenging conventional constraints in healthcare

Despite its severe challenges (or perhaps because of them), the Indian healthcare sector could become one of the most fertile test beds for technology innovation around the world. Twelve disruptive technologies, deployed together, have the potential to fundamentally challenge the existing constraints and bring affordable healthcare to millions in the coming decade.

India’s myriad healthcare shortfalls are well known. Four facts are the most troubling.

First, India’s public spending on healthcare is low by all benchmarks—only about 1% of gross domestic product (GDP) in 2010, less than one-third of what Brazil, Mexico, and South Africa spend.

Second, the sector embodies India’s glaring inequality. About two-thirds of healthcare spending is paid for by households, but half of that is spent by the richest fifth of households. The vast majority goes without care or faces financial ruin when treatment is unavoidable.

Third, poor access to clean water and sanitation compounds the problem, as does a lack of awareness of preventive measures, which traps many in a cycle of debilitating malnutrition and disease.

Finally, affordability alone will not solve the problem. Healthcare operates through a funnel of awareness and promotion, prevention, diagnosis, treatment and compliance. Trained and appropriately incentivized human resources are required across the entire funnel, but India doesn’t have enough of them: the ratio of practising doctors and nurses to the population has fallen to 1.4 per 1,000 in India, far below the World Health Organization (WHO) norm of 2.5.

This means conventional solutions will not make a dent. Those who are trained and want to work are not willing to practise in poor, rural communities. And those who are willing are either not trained or not certified, or both.

In today’s education system, it would take the better part of a decade to boost medical college capacity and expand the supply of fit practitioners. And the fragmented healthcare delivery system in which they would operate is riddled with inefficiencies across both the public and private sectors.

The McKinsey Global Institute report, India’s technology opportunity: Transforming work, Empowering people, examines the potential impact on India of 12 disruptive technologies, including mobile Internet, cloud-based services, the automation of knowledge work, digital payments, verifiable digital identity, advanced genomics, and advanced energy technologies, all of whose costs are dramatically falling, and whose performance levels are exponentially increasing.

These technologies are enabling a set of healthcare applications that can bring health security to some 400 million people. Our estimates indicate the potential for additional economic value is $25-65 billion per year in India in 2025, representing the economic value of days of work saved, cost savings, and prevention of resource leakage. Many of these opportunities are already being piloted and can be scaled up nationally.

Community healthcare is seeing an explosion of technology-based innovation around the world. For instance, Mexico’s Medicall Home provides hotline-based medical services to more than seven million people through a centralized team of qualified doctors; users pay fees charged to their mobile-phone accounts, and more complicated cases are referred to a network of health service providers.

In rural Tamil Nadu, healthcare provider SughaVazhvu has equipped community health extension workers with low-cost tablets linked to a cloud-based health management information system. The system helps workers record patient data, geo-tag households, create unique electronic patient records, conduct health assessments, and recommend treatments based on certain protocols. Workers can be trained to use the system in eight to twelve weeks. Similar systems can be used to create a network of technology-enabled health centres and community health workers, leveraging the government’s existing physical infrastructure.

Hospitals are beginning to adapt advanced computing power and intelligent systems to augment human intelligence for disease detection and treatment. At Memorial Sloan Kettering Cancer Center in New York, IBM’s Watson supercomputer crunches data to formulate strategies for cancer therapy. Elsewhere, smart ICU computers are freeing up nursing capacity by taking on routine work, saving 60-80% of nursing time.

Innovations in mobile medical devices are improving access to affordable healthcare diagnostics. The Public Health Foundation’s Swasthya Slate, a $250-300 kit that attaches to an Android device, can conduct 33 diagnostic tests and stores data on the phone or on a cloud-based server for physicians to access. Netra, a $2 clip-on device that fits over the display screen of a smartphone diagnoses eye conditions and vastly reduces the cost of testing.

Wearables such as wrist monitors now have sensors that monitor blood pressure, temperature, and sleep patterns, and will soon have electrocardiogram and electroencephalography capabilities: they are helping healthcare workers monitor patients remotely—and helping patients avoid hospitalization all together. Linked to advanced drug-delivery systems, they can dispense medication before emergency personnel arrive. Advanced geospatial information systems, along with Big Data analytics, are helping track the spread of infectious diseases. The US Centers for Disease Control and Prevention mines data on pharmacy purchases and school attendance to plan treatment capacities for flu in different parts of the country.

While advanced genomics are at a very early stage in India, the rising speed and falling cost of gene sequencing makes it a promising technology to screen women for gestational diabetes and customize oncology treatments for individual patients.

At a more mundane level, several countries are adopting track-and-trace packaging to ensure that packages are not counterfeits. In Turkey, medical supplies are bar coded, and producers, distributors, and retailers are required to upload product data to a central database managed by the ministry of health. Pharmacists who dispense products that do not have the correct identification are not reimbursed. India could establish an even better system in the coming decade, assuming ubiquitous Internet connectivity, cloud-based services, and the Internet of Things become available.

As some of these examples (and there are many more) suggest, there are already pilots under way in India, with varying degrees of success and scale. But the challenges are many. New delivery models in healthcare are held back not by a lack of technology but by resistance to change in how care is delivered, the ways in which medical professionals and institutions operate, and how different stakeholders in public health work together.

The healthcare sector needs to be liberated from the institutional and human shackles that inhibit the transformative power of technology. It is time for the public and private sector to sit on the same side of the table to resolve India’s pressing health issues while managing the economic burden. We need partnerships across the value chain, and beyond it. Going it alone simply won’t work.

Anu Madgavkar is a senior fellow at the McKinsey Global Institute and is based in the Mumbai office; Mandar Vaidya is a principal in McKinsey’s Delhi office.

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