Governments can play an important role in influencing speed and direction of health innovations

With both the private sector increasing their investment share in R&D and innovation as well as the government looking to create a healthy innovation ecosystem, India’s healthcare sector is poised to be an innovation hub for the world. Priya Balasubramaniam-Kakkar, Senior Public Health Specialist and Scientist, Public Health Foundation of India and co-founder of the Innovations for Universal Health Coverage Initiative, speaks on various opportunities for India

What is the healthcare innovation scenario in India and how is it shaping?

The healthcare innovation space in India though nascent is both a vibrant and a rapidly growing sector. While larger more established health technology players continue to innovate around higher levels of healthcare, there are also numerous smaller innovators and start-ups that are providing innovations targeting the primary and secondary care sectors. These include innovations in low cost diagnostic tests, ophthalmic (vision) care and prevention of chronic diseases that include cardiac care and diabetes prevention. As this critical sector in healthcare provision develops, it is important to understand the need for innovations from both supply and demand side constraints. It is important, however, to embed thinking and strategy around healthcare innovations in the context of the country’s social and economic reform agendas that relate to health system strengthening. This will enable healthcare innovations and innovators to address long-term health outcomes and develop technology-based interventions that are adaptable to changing dynamics of complex health systems.

India has a huge potential for health innovation, however, sustaining scalable and replicable models is a tall task. Your comments.

Yes, many creative and innovative technologies that have been seeded and incubated often remain as prototypes which are unable to find markets and public health systems to scale and thereby achieve impact. This has led to a search for ways to overcome constraints to scaling up. As discussed in the recently concluded Innovations for UHC Conclave in Bengaluru, experience from diverse stakeholders suggests that it may take time for a combination of innovations and new types of partnership to become established and eventually reach a tipping point. Taking innovations to scale is likely to involve several organisations from within and outside the health sector (tech innovators, mobile phone operators, pharma sector) involving new kinds of partnerships between companies with different business models.

The government can play an important role in influencing the speed and direction of health innovations through its use of resources to support investment, purchase/contract-in services and also by enacting and implementing regulations. New regulatory arrangements in the health, pharma, medical device and telecommunications sectors will also influence capacity to go to scale. Recent analysis of ICT Innovations suggests that single health innovations, on their own, are unlikely to have a major impact on health markets and health-seeking behaviour. People need access to a bundle of services that include low cost diagnostics, advice on treatment and easy access to affordable and good quality medicines. In most health systems, this involves a mix of organisations in terms of their size, their business model and their relationship to the regulatory system.

What are the essentials to encourage health innovation in India?

India and other low-middle-income economies are definitely a natural hub for encouraging a spectrum health innovations. The democratic nature and complexity of India’s health system, governance and resource challenges and diversity of consumers have spawned new thoughts and new ways of improving healthcare quality and making it more accessible and affordable to those who need it the most. First, as mentioned earlier, health innovators often come from non-health backgrounds and need to be exposed to the challenges and opportunities and their place in country health systems where they can get a sense of context and scale and most importantly gauge demand for their interventions and models.

Second, health innovators need investment and the freedom to take risks. Government of India is playing an important role in investing and incubating health innovations through various initiatives like the DBT-BIRAC partnership, the Atal Incubation Mission and the Centre for Cellular And Molecular Platforms (C-CAMP), which is an initiative of Dept of Biotechnology, Ministry of Science and Technology, Government of India amongst others along with private sector investors.

Third, it is crucial for technology-based health innovations and innovators to be given opportunity to interface with key health sector stakeholders who will be using these interventions. These include physicians, allied health workers, community workers, civil society and patient groups. The ability to build trust and acceptance in the use of new models of healthcare access and provision is an important part of sustaining innovations.

Fourth, technology-based innovations and models especially relating to health need constant calibration, monitoring and evaluation on a constant basis, an environment that provides and demands these process ensures quality control and the ability to test the efficacy of innovations at scale beyond prototypes and pilots. Finally, research is the DNA of innovations in the pharma sector and affordable healthcare is inextricably linked with affordable medicines and it is therefore critical to foster an open, transparent and viable environment for drug innovation and discovery in India.

How can strategic partnerships be utilised to build health innovations for India? What kind of partnerships are essential to do so?

The issues of health innovation and access are inevitably intertwined, cutting across distinct policy areas, in particular, public health, medicine, the private sector, technology, intellectual property (IP) and international partnerships. Strategic partnerships to build health innovations in India and other LMIC settings will involve convening multiple stakeholders across the health sector, medical professionals, academia, devices, diagnostics, and pharma as well as non-health sectors, investors, engineering, information technology and design to create interventions that can be integrated and adapted to local health systems with long-term health outcomes in mind. Low-cost health technologies have tremendous potential to be scaled across geographies and regions.

Identifying and landscaping innovations across regions and helping create multi-stakeholder innovator networks that build on health system reform is an area that the Innovations for Universal Health Coverage Partnership between Amref Health Africa, Institute of Development Studies and the Public Health Foundation of India is focussed on. Central and state/ local governments play a key leadership role in the formulation and implementation of strategies for making progress towards healthcare reform. They will need to adapt their approach in order to promote rapid technological innovation.

Government regulation of healthcare and its allocation of public funds for basic health services can either aid or hinder innovation. It is important for innovators to understand the extensive network of regulations that may affect a particular innovation and how and by whom those rules are enacted, modified, and applied. It is also important that government officials have access to information and evidence on health system innovations to enable them to make informed decisions on how to regulate this space as well as consider the type of innovations that can be adopted at scale.

How can governments, innovators, researchers and funders of innovation work together to create a supportive ecosystem for the same?

A supportive health innovation ecosystem is created over time. It involves the ability to incubate and pilot great ideas, the infrastructure to be able to prototype those models and ideas and most importantly the freedom to interface with the multiple stakeholders who inform, implement interventions and utilise healthcare service. For this to happen, there has to be access, communication and support within these multiple actors who are invested in innovating for health systems and good health outcomes especially for vulnerable populations.

Digital health has the potential for transforming access to effective and affordable health services, but it also could reinforce existing inequalities. The role of research in supporting innovation and in formulating and implementing strategies for taking the innovation to scale has to re-thought.

Experience of the past few years has demonstrated the need for an iterative, learning approach for translating technological and organisational innovations to health system transformation at scale. This will require a new approach to health systems research and learning that is truly interdisciplinary.

A supportive innovation ecosystem will ideally bring together people who are involved in the design, investment and implementation of healthcare innovations, which have the potential to be taken to scale and transferred between regions and countries.

The aim is to recognise and encourage healthcare innovators and serve as platform for public and private sectors to explore the potential for new kinds of partnership to take low-cost technology solutions for improving healthcare delivery to scale. It will provide an opportunity for dialogue between public and private sectors, between health and other sectors and between innovators and government officials from to:

• Share evidence on early stage and more mature innovations that can inform decision making and policy formulation
• Discussing ways and means for regulations and regulators to enhance and support innovation in low-cost healthcare
• Public and private sector collaborations that accelerate the adoption of innovations
•  Understand pro-innovation business models and how this works for bringing down healthcare costs.

How can these innovations bring in the much needed pill for improved health economics of India?

I do not think technology-based health innovations and new models of healthcare services will be a single pill or silver bullet to reform health systems in India. But they will definitely be part of India’s future in creating a stronger more transparent and equitable health system. It is critical therefore, to see how these new technology-based players in healthcare provision can be integrated in the roll-out of UHC mandates within the country. What role can they play? Can they be aggregated to primary and secondary care to provide a much needed care continuum? What is the best way to establish confidence and trust between these newer actors, the medical profession and the state in terms of improving the quality and bringing down the cost of healthcare. These are important areas of consideration that need to be factored, factors in charting a newer and nimbler path to health system reform where good quality healthcare can be brought to the most vulnerable users without causing financial impoverishment or compromising on quality.

Several donor agencies and private investors have become increasingly interested in potential markets for low-cost health services. Experience in other sectors suggests that it may take time for a combination of innovations and new types of partnership to become established and eventually reach a tipping point. Governments can play an important role in influencing the speed and direction of health innovations through its use of resources to support investment, purchase services and also by enacting and implementing regulations.

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