Madhav Joshi, CEO, India Health Fund, Tata Trusts explains the impact of the tools validated, adapted and deployed by IHF in the fight against infectious diseases ranging from the present COVID-19 pandemic to TB and malaria
What is the mandate of India Health Fund?
Tata Trusts, in a strategic partnership with The Global Fund to Fight AIDS, Tuberculosis and Malaria, announced the launch of India Health Fund (IHF) in 2017. Their aim was to create an organisation which could collaborate with the private and public sectors to develop and scale up innovative solutions, business models and financing mechanisms to improve outcomes in diagnosis, treatment, prevention and eventual elimination of infectious diseases. IHF’s primary objective is to identify, support, and ensure the sustainable scale-up of innovations in the domain of infectious diseases, where market failure has limited investments in research and development. This is done through grant funding, with the grants managed by IHF. We aim to ensure all solutions supported by IHF are globally relevant and accessible around the world.
What are the resources, not just monetary but in terms of expertise, contacts etc., that IHF provides to portfolio companies?
In addition to grant funding, all organisations which are supported by IHF, receive the following support:
- Ongoing guidance on aspects including technical advice, project management guidance, developing and improving financial systems and process, governance, and business planning.
- Periodic technical assessments and advice from independent subject matter experts to help enable and improve technical aspects of the solution.
- Market access support through IHF and its partner organisations, which develop implementation projects and raise external funding. These initiatives enable solutions which are ready for deployment to be introduced in the public and private health are systems, demonstrate impact, enter new markets and raise funding for deployment.
How does the IHF select the companies/products to fund?
All projects which are received at IHF go through a rigorous three-step assessment process, comprising:
- Internal assessment at India Health Fund to determine how well the proposed solution addresses a need gap identified by IHF, to what extent it will improve outcomes when compared with currently available solutions, the potential to implement at scale in India and internationally and the capabilities of the organisation.
- Shortlisted solutions are vetted by two external panels to assess their technical and commercial potential.
- Due diligence of shortlisted organisations to assess their financial and governance processes.
How have these innovations functioned in real world scenarios?
This can be illustrated through the following two examples.
Example 1: Deployment of IHF supported innovation AI-driven solutions for the prevention of COVID-19
Project location: Mumbai, multiple sites
Project period: May – October 2020
Project purpose: Demonstrating the impact of Qure.ai’s artificial intelligence (AI) driven software qXR COVID, developed with IHF support, in screening and triaging of suspects among general population in Mumbai, in partnership with Brihanmumbai Municipal Corporation (BMC). The project goals were:
- Reducing turnaround time for identification of COVID-19 suspects: By detecting radiological signs of COVID-19 in under a minute, qXR aids early identification of suspects as they can be swabbed immediately (versus in a few hours in a conventional setting that is dependent on radiologists)
- Optimising for RT-PCR testing capacity: qXR serves as an effective tool BMC’s frontline healthcare staff to triage and prioritise testing for the individuals most likely to be positive for COVID-19 based on lung conditions, especially in scenarios where the number of suspects exceeds the testing capacity.
- Detecting asymptomatic cases: Since qXR provides a COVID-19 Risk Score based on radiological manifestations of COVID-19 within the lungs, it is useful for ruling in cases that are asymptomatic, especially in mass screening settings; such individuals would have been missed otherwise and contributed to higher community transmission
- Empowering frontline health workers: Given the paucity of specialists, having a reliable decision support tool such as qXR is critical for empowering healthcare staff to proceed to the next step in patient management immediately, including directing suspects for swab testing/quarantine (as needed) within a minute of taking the Chest X-Ray.
- ensuring early diagnosis of COVID-19 cases –
o resulting in zero to minimal loss to follow-up cases,
o improved clinical outcomes of co-morbid patients
- Detection of asymptomatic cases – that continued to be one of the key challenges in preventing the Covid-19 transmission
- Strengthening the capacity of MCGM’s healthcare system – reducing the burden on the healthcare workers
Example 2: Deployment of a molecular diagnostic platform, developed in India in collaboration with support from IHF, to strengthen testing capacity for TB and COVID-19
Problem: COVID-19 and TB share similar clinical presentations and are both transmitted through respiratory droplets and aerosols. Patients with TB are at greater risk of contracting COVID-19. TB notifications have dropped ~50 per cent in the last year owing to a greater focus on COVID-19. A combined strategy to tackle both diseases is in line with the Union Health Minister’s recent pledge to build on private and social impact efforts to fight TB. It also bolsters the government’s approach to address both diseases with the same focus.
Ramping up testing in Mumbai to meet the dual challenges of COVID-19 and TB includes implementing recent bi-directional screening guidelines (i.e. to conduct COVID-19 screening in all people diagnosed TB, and screen for TB all those who are COVID-19 positive), issued by the Ministry of Health and Family Welfare (MoHFW), Government of India.
Solution: Truenat is a molecular diagnostic platform, developed in India in collaboration with support from IHF. It uses reverse transcription polymerase chain reaction (RT-PCR) to test for multiple diseases including TB, and delivers test results in under 60 minutes. It is being used extensively in the National TB Elimination Programme, and the Indian Council of Medical Research (ICMR) validated Truenat as an assay for COVID-19 before in May 2020.
This project involves the deployment of Truenat machines, test kits and lab technicians at five hospitals run by the MCGM to strengthen testing capacity for TB and COVID-19 in the city. It is the first large scale implementation of bi-directional testing for TB and COVID-19 in India. 200,000 patients will be screened under this project. MCGM will take over bi-directional testing in the long term, using the infrastructure and knowhow developed through the initiative.
Project period: December 2020-June 2021
Some of IHF’s portfolio of innovations
- Qure.ai – TB and COVID 19 – A smartphone app linked to AI algorithms that analyse an analog chest X-ray to enable faster screening and diagnosis of TB adapted to COVID-19, without a trained technician.
- Hemex Health – A one-minute, accurate rapid diagnostic test for malaria, at a targeted cost of $1 per test. The test device, Gazelle also enables automated reporting of case and patient details to the national and state malaria surveillance systems.
- Centre for Health Research and Innovation (CHRI) / Molbio Diagnostics– Truenat is a compact, battery-operated system with test results at the point of care within 1 hour enabling same day reporting and initiation of evidence-based treatment of tuberculosis, reducing the risk of infection spread.
- Sensedose Technologies – Product design, Internet of Things and cellular technology combined to improve adherence and surveillance for patients’ TB medication regimes, enable remote patient monitoring and focus on critical patients.