The commencing plenary for Health!Public 2014 discuss new models of and approaches to health innovation emerging in India: from Innovation Spaces within Hospitals to Self Organizing Hackathons to Med-Tech-Incubators, to Academic and Co-Creation Labs, and Health Innovation Labs. It will address key questions around the success of these various models and how do they work, to the kind of integration of efforts, new approaches and routinization of innovation is required to maximize impact on health outcomes. Panelists includeÂ Chakrapani Dittakavi, Director at the Centre for Innovation in Public Systems,Â Â Jessica Seddon, Founder at Okapi,Â Divya Datta, Director-Innovation from the Bihar Innovation Lab, and Dr. Prashant Jha,Â Postdoctoral Fellow-Stanford India Biodesign. The Panel is moderated by Dr. Aditya Dev Sood, CEO and Founder of the Center For Knowledge Societies.
10: 00 Aditya Dev Sood asks all panelists to introduce themselves and talk a little about Â their work in public health innovation.
10: 01 Chakrapani Dittakavi, is Director at the Centre for Innovation in Public Systems that works to document, replicate, enhance public service delivery across various public sectors, and one of their core target areas is health.
10: 02 Jessica Seddon, is an economist and founder of Okapi, an Insitutional design research group, where they recently worked on a Health Horizons, 2021 report in conjunction with Dhoopa Ventures, HTIC, Villigro, and CIRM Design Research, to highlight emerging opportunities in the health care system for low income India. Jessica will talk a bit about possible futures, that can be drawn from knowing what it is that we are innovating into, and the potential roads we would take going forward.
10:02 Divya Datta, is Director-Innovation at the Bihar Innovation Lab, that looks at indetifying the needs and challenges of the public health system, and bringing systemic level changes through an integrated and holistic approach to innovation at multiple levels.
10:03 Prashant Jha is and Entrepenuer, and a Postdoctoral Fellow at the Stanford India Biodesign Programme. He has developed significant experience in being able to well locate, identify and define problems in public health before tackling them for change.
10:05 Aditya proceeds to ask each panelist to share their initial thoughts on the health innovation ecosystem as it stands today.
10:05 Prashant Jha, is the first to respond, throwing light on the fact that India has an extremely complex health system, that functions a lot like many other countries across the world. In the past five to six years, however, people have come out of their disciplines and begun to have conversations to support one another in solving grander challenges. Today, an initiative connecting technology students to contribute to public health projects is something that is well supported, which was not necessarily the case a few years ago. However, conditions aren’t perfect. Prashant refers to the technology used by Indian doctors, and the regulatory restrictions that govern their use. Maybe technological products have been transplanted in to a system where they do not fit, which warrants innovation. Perhaps innovation needs to also look beyond technology to create business models and paths for access, that may be facilitate integrated service delivery.
10:08 Jessica adds to this, by saying that organizations like C-camp and the Ananya Project, are exemplary of the conversation between public and private health players. The level of granular detail in identifying required change in delivering services, and identifying needs is quite robust. The second level is that drawing on technology, and research, is going into service delivery models, as opposed to wide spread distribution and scaling up of new devices in the Indian market. A lot of these devices that actually are coming up are from the US or Europe find Indian corporate leadership, as opposed to actual innovation and devices coming from technological institutes in India, such as the IITs, among others. Another, area that requires innovation is that details of service delivery do not feed in to invention around improving them. Jessica suggest that if we could develop structures of how to facilitate that at Health!Public, it would be a great place to be at the close of today.
10:11 Divya suggests that in terms of technology, the innovation ecosystem is thriving, across private players and academic institutions, but the gaping hole lies in capacity building, training and sensitizing the system, and service delivery, which presents a clear direction for innovation. This will also target public institutions that actually roll out these technologies, and in a way targeting this would eventually facilitate the other.
10:12 Chakrpani echoes these concerns, and adds that innovation needs to draw on ICT infrastructure and optic fibre networks that are soon to connect gram panchayats, to sensitize the ANMs and ASHA workers to deliver better services. The gradual but unmistakable participation of the corporate sector in public health decisions, resource allocation etc, is something that must be addressed. Unfortunately there is not enough recognition of the fact that we need to put in place a second level of public cadres at the sub-centers, to spread health awareness and take care of 50 -60% of the health requirements at a village level. If 50 states of the USA have enabled health workers in providing legal health care, there seems to be no reason why we can’t. This has successfully happened in Assam, where they have developed a cadre of rural health workers and effectively institutional delivery, vaccine delivery rates have gone up. ,
10:17 Drawing from comments from panelists, Aditya elucidates an overhauling challenge of a disconnect between ‘product’ and ‘system’. He invites panelists to return to this question to address who is responsible for service delivery, and who for med-tech innovation, and whether they are in conversation with one another, and in the likely event of a communication gap, how can these be addressed. A wider, upstream problem, Aditya points out, is one of Indian doctors have no idea of how to demand devices and protocols that had not been validated in other countries across the world.
10:19 Jessica believes that a lot has been said regarding the supply side of innovation, and draws our attention to examining the demand for the same. A lot of things are changing, including private expenditure on public health. Public health expenditure is going to go up, but it is interesting to see how this will happen. Something has to change to see that if it is purely funded by public money, in which case it will struggle. She raises questions around whether public money is going to flow through household demand determining where money is spent or through entreprenueral reform and capacity building of people engaged in supply of services. There are also two ends of the spectrum where the intelligence of health lies. The big visions of health being driven by statistics and data analytics, that are technologically driven, brings with it a key challenge of where this data should go. There is a disconnect in where data is directed – doÂ you direct it to empowering people and beneficiaries, or do you guide them toward training semi trained health care para-professionals.
10:23 Divya agrees that addressing merely service delivery is a myopic, and overly specified approach to health innovation. However, public health needs to be viewed from the wider lens of sensitizing communities in to strengthening service delivery. She raises questions of whether there is a way of capacity building communities as opposed to limiting innovation to only strengthening service delivery.
10:25 Prashant poses a different view on this. NHS is the most holistic, public health system that is based on a strong social welfare model, that has a well thought out channels and processes for service delivery. However in India, people pay through insurance, and sometimes out of their pockets. Therefore systems need to be standardized, in order to form policy. His second point highlighted that it is not necessary that higher health expenditure means better quality healthcare. Exemplified in the fact that the USA spends the highest healthcare expenditure, but is much lower down in the list of quality of service in comparison to many western European countries. He proposes a model of ‘More for less for More’ – Giving better quality services, for less money, covering and serving larger populations. It is also important to understand the attitudes of private investors and venture capitalists, and how this determines their investing behaviours. They want a quick turn around, with quicker timelines and forseeable results. Their choice of what they invest in, and what type of projects they classify as government responsibility, is largely dependent on quick turn arounds and outcomes.
10:30 Aditya shares that there is no institutionalized space for certain types of innovation. It is a strange scenario for a private sector to invest in a product for which there are limited markets. There is a considerable challenge toward institutional funding and support, from the private and public sector, which the Bihar Innovation Lab is also encountering. Aditya raises a concluding question to the rest of the panel – Given the current health ecosystem, how can the Bihar Innovation Lab position itself to contribute further.
10:33 Divya clarifies at this point that it is important to differentiate between clinical care and health and well being. The lab is looking at inside institutional care, outside institutional care, and enabling the system to solve inter dependent problems.
10:34 Prashant shares his mantra of ‘small is big’. He suggests that the lab should focus on small challenges as opposed to being everywhere. So if the lab develops a Vaccine Delivery Kit, it should ensure that it leaves the design studio and reaches the ground. Unless it interacts with the user, its impact will never be recognized. Innovations must radically changing small things, take up small challenge that require actionable interventions, and take it to end users, that brings recognition and credibility. Lastly, a systemic change around diffusion of self-responsibility among citizens, and attributing basic health practices as government responsibilty, needs to be brought about. Basic, preventative health care, along with healthy pregnancy, is a life skill, not a medical problem, which should be included in primary education.
10:35 Jessica points out that preventative care is essential to reduce the burden on clinical car, but hard to scale up because ‘who really cares?’. She raises questions around who has the economic and social incentive, and motivation to carry out preventative health work. However, the lab can demonstrate the value of preventative care, in a way that other people can draw on it. The second point Jessica raised was one around the misconception that the public sector is a bad market for med-tech products. It is the best market for a diagnostic devices, it is huge, and has the potential to roll out consistent, widespread services. If there is something the lab can do, it involves jumping on a bandwagon that is coming from national and state government around supporting entrepreneurs. The lab could potentially build a tender recommendation in the way of a policy piece, which could really serve the innovation ecosystem well.
10:40 Chakrabarty says that the lab can attempt to bring in corporates in a significant way, to facilitate capacity building around IT skills of para-medical staff. How do you link these efforts with the common service center, as it is the widest point of dispensing services. The model of the common service center may disappear in future, but Prashant understands that it will hold good for the next 10-15 years. Â The last of this, could be a three and half year rural health service degree of bachelor in community health, that has scaled up delivery in states of Assam and Chattisgarh. China produces 1.4 lac doctors in a year, that may not be the best in the world, but they are ready to be deployed to rural areas, unlike in India, where para-medical staff are interacting with rural beneficiaries. Therefore capacity building, digital literacy of FLHWs must become a considerable focus.
10:45 Aditya opens the floor to questions and thoughts from the audience.
10:45 Neelima Grover responds to question around what the Bihar Innovation Lab can do, and mentions that it is essential to create a feedback loop. It is important to feedback learnings into programme development. There are some lessons learnt in other parts of the world that can be applied in the lab setting. These should be incorporate into the broader framework of what the lab does.
10:46 Hanimi Reddy shares that in terms of public health, we are in a state of confusion. There is public health system and a private system that work exclusively and there is no effort being made to merge these two. The Indian health system has been devised to reduce to life threatening demographic markers, such as infant mortality and maternal mortality, which we have succeeded to. So most of the public health problems are curable which puts pressure on developing strong diagnostic techniques, and public health experts.
10:51 With no responses from the panelists, the panel concludes, and Divya Datta takes the stage for her Key Note on the outcomes of the recent Landscaping study conducted by the Bihar Innovation Lab.