Health!Public 2014 kicked-off with the panel on the emerging health innovation ecosystem.Â Panelists discussed the approaches to health innovation emerging in India, which included innovation spaces within hospitals, hackathons, and Health Innovation Labs among others. The aim of the panel was to address questions around the success of the various models.
Prashant Jha, Postdoctoral Fellow at Stanford India Biodesign, began by commenting on the complexity of India’s healthcare system which functions like its counterparts in the UK and USA. He said that ‘the future is already here, but it is not evenly distributed.’ However, individuals in the framework have now started discussing approaches to solving problems through inter-disciplinary methods. There is a widespread change in mindset and the government is supporting it well. He then commented on how technology in medicine is at least ‘ten years’ ahead of the USA, because there is low regulation.Â However, even the poorest technology is not available to the poorest in society. Innovation is required for malleability and accessibility is key. A kit that might be life-saving exists, but is not distributed. Innovation can not just be coming up with new, ‘cool’ technologies, but around business models, re-engineering and also starting from scratch.
Jessica Seddon, founder of Okapi, took the discussion further by suggesting that the level of government innovation had deep access and the level of granular detail in delivering services was immense. She continued by saying that the ecosystem of invention and large-scale innovation requires more attention in terms of funding, the focus of which seems to be on service-delivery models. New devices in India are not getting adequate funding and a lot of the technology is borrowed from the USA or Europe. There is lack of transfer from homegrown institutions like IIT Kharagpur. SheÂ suggests that if participants could develop structures of how to facilitate that at Health!Public, it would be a great start.
Divya Datta, Director-Innovation at the Bihar Innovation Lab, adds to the debate by saying that the technology ecosystem Â is very fertile and is ‘booming’. There is, however, a gaping hole in capacity building and service delivery and therein lies the critical problem with the public healthcare system.Â Integration into public health systems becomes a problems, which deliver wide scale services.
Chakrapani Dittakavi, Director at the Centre for Innovation in Public Systems, takes the discussion further by saying that there is a lot of effort by the government and private organisations into emerging innovation in healthcare. He says that inspiration needs to be drawn from the optic fibre network initiative that connects all gram panchayats – a very strong integration of IT infrastructure to sensitize the ASHAs and ANMs. If there is high speed optic fibre, he says, it is possible to link up sub-centres through a PPP model. He cautions by saying that the unmistakable emergence of corporate has led to the exclusion of the public sector and it is not desirable. In AP, the corporates have totally pushed out the public health expenditure. He goes on to add that 70% of the expenditure on healthcare is borne by the individual – which begs innovation in cost reduction. . A lot of fake drugs are in the market, to the tune of 40% need to be eliminated. Unfortunately, there is not enough recognition of the fact that there needs to be a second-layer of public health layer/cadre at sub-centres to spread awareness and take care of health departments. Doctors, however, are resisting this attempt. 50% of US states require health assistants. Assam has done this. Rural Medical Practitioners have done excellent work.Â Institutional deliveries have increased, but the cost of diagnostic tools needs to come down drastically. He cites the example of Jammu and Kashmir that has done well in this sphere.
Aditya Dev Sood, CEO and Founder of the Centre for Knowledge Societies, suggests that there is a tension between products and systems. He asks the question of who is responsible for innovation. How do Indian doctors start demanding protocols and tools that are in use in the UK or US? Is that a major hurdle – from labs to medical practice?
Jessica, moving the debate forward, said that a lot of focus has been laid on the supply-side of innovation and there is a need to look at the demand side. There are potential forks in the road.Â Public health expenditure is going to go up, but it is interesting to see how this will happen. She asks whether it will be completely funded by public money, because then it is bound to struggle. Questions around whether public money is going to flow through household demand determining where money is spent or through entrepreneurial reform and capacity building of people engaged in the supply of services are then raised. Â Divya continues by adding that there is an ecosystem of healthcare around the individual. Only going through systems is myopic. A lot of investment goes into strengthening service delivery. Who is responsible for the health of citizens – informal support system? Formal? Can we empower and design for that instead of looking only at the system?
The debate then took a different turn when Prashant highlighted the fact that our healthcare system was set-up during the first World War.Â We are confused because our healthcare system is not universal. We are a socialistic system but our healthcare is most corporate – an extrapolation of capitalism. People are reliant on paying out of their pocket or depending on insurance. Until we have a system that works in a certain way, we can’t come up with a policy. Mixed policies won’t work.Â Given the expenditure on healthcare, going forward, he thinks that it is unlikely that we are suddenly going to become richer and start spending more. The US, for example, is upset about how much they spend on healthcare. Per Dollar, the US spends the most on healthcare. In terms of quality derived, it ranks much lower than Western Europe. More money does not mean healthier citizens and we cannot invent something for only 10% of the population. The last point, he says, is to take a step back in terms of innovation and maximise innovation happening around services Questions are then raised around how we have different models of healthcare. What is the market that for innovation? There are some where only the government is the buyer. There are presumably ecosystem challenges. The question really is: Given our brief review of the health innovation ecosystem, how can the Bihar Innovation Lab contribute, insert itself to find solutions?
An important input at this stage suggested that ‘small is big.’ For the Lab, rather than being all over the place, it needs to choose one or two interventions. No ordinary human can handle no more than three things. If is is focusing on the Vaccine Delivery Kit, ensure that it reaches the end-user. Nobody cares for something that never showed up. Pick up something that is small and requires small intervention. Further,Â questions around who has the economic and social incentive, and motivation to carry out preventative health work were raised. The lab can demonstrate the value of preventative care, in a way that other people can draw on it. TheÂ public sector, it was suggested, is not a bad market for med-tech products. It is the best market for a diagnostic tools and has the potential to roll out consistent and widespread services. The Lab can integrate itself with the national and state government around supporting and working with entrepreneurs. The Lab could then build a tender recommendation in the way of a policy piece, which could really serve the innovation ecosystem well.