Visit to Comprehensive Rural Health Project, Tal. Jamkhed, Dist Ahmednagar

The SIIP team visited the Comprehensive Rural Health Project (CRHP) and its associated Julia Hospital in Jamkhed on 30 September 2015.We were introduced to the project by Mr. Jayesh Kamble, who, for the past ten years has been a part of various initiatives by CRHP — mobile health team, adolescent boys initiative, farmers’ clubs, women’s groups, village health worker training etc. He described the conditions in Jamkhed when the project was started by Dr. Rajanikant Arole and Dr. Mabelle Arole and the interventions by CRHP to improve them. For example, the infant mortality rate was brought down to 17 per 1000 from over 200 per 1000 by providing access to medical facilities and by educating mothers about nutrition, breastfeeding, adequate birth spacing etc.

CRHP has a three-pronged system:

  1. Village health workers from the local community
  2. Mobile health team, which generally has a doctor, a nurse, a pharmacist and a lab technician.
  3. A hospital – Julia Hospital in Jamkhed.

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In addition to the routine pathology tests, malaria detection is also done at the Julia hospital’s pathology lab. CRHP also has an international internship program for students who are interested in working in public health issues. In addition, they also have a pre-school for about 60 children upto 5-6 years of age, where the malnutrition related issues are also tackled in addition to preparing the kids for regular school. Children attending this pre-school are mainly from the slum areas and the poor socio-economic bracket.

 

One day Campaign workshop on “Anti-Microbial Resistance”

A one day campaign workshop on Anti-Microbial Resistance (AMR) was organized by Venture Center, Pune on Saturday, 29th August 2015. This workshop aimed to bring together clinicians, social innovators and technologists to facilitate discussion on needs and intervention priorities in the broad field of antimicrobial resistance. This workshop was supported by DBT-BIRAC and the Social Innovation Immersion Programme at Venture Center. The detailed report of this workshop is available at: http://www.venturecenter.co.in/campaigns/amr/events/

One Day Campaign Workshop on Medical Electronics

20 June 2015: One day Medical Electronics Campaign Workshop

| Outline | Report |

Venture Center hosted the Medical Electronics workshop, with the aim of creating a platform to allow stakeholders from the electronics, healthcare industry and industrial design and government grant disbursement agencies to interact and network. Entrepreneurs both young and experienced were introduced to ground realities in the field of government run healthcare sector. Potential need statements that can be addressed through applied electronics were discussed. Young product designers and engineers were exposed to typical product development cycle in field of medical devices. Some of the safety concerns and safety design constraints were put forth on the table. Senior designers and entrepreneurs shared their life experiences and insights into the nitty gritties that go into building a medical device and the possible mistakes that have taught them well. Finally members from government grant disbursement agency BIRAC shared new grant schemes (IIPME) in the field of medical electronics. Specific selection criteria were discussed, a Q&A round was particularly useful in understanding the funding mechanism of BIRAC.

The introductory session was opened by Founder of Concept Integration, Arvind Savargaonkar.

With 30 years of experience behind him, he shared his understanding of medical device landscape, do’s and dont’s of product development and overview of product development cycle.

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Mr. Savargaonkar started his talk by identifying growth potential in the field of medical devices particularly in India, which has large scale unmet needs in the healthcare sector. About 75% of India’s medical device needs are supported with imports, further emphasizing on the proportion of medical electronics and consumables import proportion.

Sharing his experiences of visit to China, and how their strategy of back engineering and robust manufacturing machinery provides the conducive ecosystem for innovators to productize sustainable out-of-the-box ideas. Assessing if India can build and evolve into such a device development hub, highlighting constraints and bold steps that India government machinery and industry can take towards building such an ecosystem would be useful.

He highlighted that innovation need not always come from the product or the process itself but may come from the delivery of the product itself. Citing the business models of uber, whatsapp, he warned young entrepreneurs about how innovations like these cannot be sustainable in the long run.

He talked about the 4 Challenges that need to be addressed during the innovation cycle: Myths, Methodologies, Scale and Speed, Mortality. There is one myth which believes that innovation equals product, which is totally wrong. The pipeline in this case is research to technology to products and then manufacturing. Some ingredients and recipe include:

  • Identify unmet and undiscovered needs
  • Work on the technology
  • Scale up

There is also a need to Identify technical needs. Rationale for existence of products should be thought about. One should also understand the dynamics of turning idea into business. In addition to this, other important aspects include: deal making, valuation, negotiation, communications and focus on excellence in delivery. As speed and size is important, he advised on building this into the research plan. Also, he advised to pay attention to the mortality rate of any product. Also, there is a need for collaborations with clinicians/users to identify unmet and undiscovered needs, clinical inputs and voice of customer. In this regard, he discussed about the need for home dialysis machines, as patient’s load is too much to handle in a regular hemodialysis unit in the hospital set up.

Mr. Prakash Khanzode handled the session on Design thinking. He highlighted the 4 dimensions of connecting and leveraging: Brand and business, Product and service, User and culture, Technology and trends. Some of the disconnects/problems could be how to make holistic decisions. Thus, design thinking enlarges possibilities and helps in joining the dots in your thinking process. There is a need for empathic enquiry, iterative prototyping, abductive reasoning (need to understand circumstances, build scenarios, propose hypotheses) and creative visualization (helps in putting things in perspective using some models or visualization packages).

Session 2 started with a panel discussion on some of the pressing needs and new developments in the healthcare sector. The panel consisted of Dr. Aparna Shrotri (formerly Professor at the department of Obstetrics & Gynecology, B. J. Medical College, Pune), Dr. Dnyaneshwar Shelke (Chief Operating Officer for the Maharashtra Emergency Medical Services project [MEMS / “108 Ambulance”] at BVG India Ltd.), Dr. Sujit Jagtap (neurologist with over ten years of experience and founding member of Jagtap Clinic & Research Center, Pune), and Mr. Prakash Khanzode (Director and Principal Designer at Onio Design Pvt. Ltd., Pune) and was moderated by Dr. Niranjan Khambete.

Dr. Aparna Shrotri started the discussion, focussing on cervical cancer screening. She highlighted how a relatively simple test of visual inspection of the cervix under acetic acid could help detect cervical lesions even before they become cancerous, and thus potentially save lives. She also pointed out the need to collect data about high-risk pregnancies and track low birth weight babies.

Dr. Dnyaneshwar Shelke spoke next about the Maharashtra Emergency Medical Service (“dial 108 to call an ambulance”). He invited participants to visit his central control room sometime and check out their real time tracking system for ambulances and their protocols for providing prompt medical attention. He informed the participants about some facts and statistics regarding the service. He said that around eighty percent of Indians have access to 108 emergency services. In Maharashtra, around 1200 people avail of this service every day. Of these, around 30% are trauma cases and around 30-40% are pregnancy related emergency cases. Typically, for such emergency cases in a hospital, multiple personnel work together as a team to  stabilize the patient. However, this is not possible within an ambulance and some tasks have to be carried out by semi-skilled personnel who have not been exposed to training as that of physicians or nurses. These people can be greatly helped by appropriate automated medical devices to help supplement their skills. Dr. Shelke gave some examples of devices needed on these ambulances. He expressed the need for a device that helps with tying of a tourniquet, to the appropriate optimal tightness, so as to minimize bleeding but also not cause necrosis by cutting off blood supply completely. He urged entrepreneurs among the participants to consider development of this and similar other such devices.

Dr. Sujit Jagtap expressed a need for devices of Indian make that meet international standards. He compared the cheap and expensive versions of several devices and enumerated the pros and cons of them. A common theme seemed to be that Indian devices, though cheaper, are often of poorer quality and sometimes do not help in the diagnosis at all. On the other hand, foreign made devices, though of good quality, are very expensive, and getting them serviced promptly in case of malfunction is often difficult. He also suggested improvements in existing devices which would make them more convenient to use. For example, to correlate EEG findings with patient activity, there is a need to record a video of a patient while their EEG is also being recorded simultaneously. There is a need for a version of this system where the camera automatically tracks the patient if the latter moves.

Mr. Prakash Khanzode concluded the panel discussion. He stressed the necessity for doctors and engineers to work together and exchange information, in order to effectively design good devices.

The next item on the day’s agenda was a quick presentation by Mr. Pradeep Kolankari, who heads the Solutions team at IGATE corporation as part of their medical devices and healthcare practice. He discussed the various steps involved in commercializing medical devices and taking them to market from the idea / prototype phase.

This was followed by a presentation on medical devices and diagnostic needs in India by the Social Innovation Immersion Program (SIIP) team at Venture Center. Dr. Mugdha Potnis-Lele, the program manager for SIIP, started by giving a brief introduction of the program and of the four fellows under this program. This was followed by a presentation by the fellows based on the needs identified during their clinical and rural immersions as part of the SIIP. Ms. Amrita Sukrity spoke about the disease burden in rural and urban areas, and introduced the participants to systemic and infrastructural challenges that need to be addressed. Mr. Sarang Kulkarni spoke about the problems of malnutrition and pneumonia and related device needs. Mr. DSS Chaitanya spoke about the prevalence of avoidable blindness and what can be done to help curtail it. Ms.Apoorva Bedekar presented the reproductive health issues and needs about non-communicable disorders like diabetes, identified during the immersions.

Dr. P.K.S. Sarma, Head Technical (Discovery & Product Development) at Biotechnology Industry Research Assistance Council (BIRAC) started the next session where he talked about the innovation cycle and role of BIRAC in the form of various funding schemes. This was followed by a presentation by Ms. Sonia Gandhi, Program Manager, Investments at BIRAC, where she introduced the participants to the  Industry Innovation Programme on Medical Electronics (IIPME), a joint program of BIRAC and the Department of Electronics and Information Technology, Government of India. More details are available online at http://www.birac.nic.in/news_description.php?id=169 . Ms. Gandhi and Dr. Sarma also answered queries from participating entrepreneurs about BIRAC’s schemes.  Mr. Paul Belknap, Investment Manager at Villgro Innovations Foundation spoke next about Villgro and their funding policies. He also announced a Social Innovation Immersion Program at Villgro and encouraged participants to recommend it to interested candidates.

This session consisted of a question and answer session as well as panel discussion with several entrepreneurs and innovators. Panelists included Mr. Vivek Mohile (R&D at Persistent Systems), Mr. Arvind Savargaonkar (Managing Director, Concept Integrations), Mr. Gautam Morey (founder and CEO of Sofomo Embedded Solutions), Mr. Siddharth Chinoy (founding member, Embryyo Technologies) and Mr. Aniruddha Atre (co-founder, Jeevtronics). The panel shared their experiences with the participants. Mr. Savargaonkar expressed that innovations should not be restricted to one’s technological background and comfort zone and lamented that perhaps a broader outlook is beneficial. Mr. Morey advised the participants to be well prepared before meeting doctors for their inputs, and to make it clear to them that you are not actually trying to sell them something but rather developing a new product. Mr. Atre spoke about the various risks entrepreneurs face, and how to mitigate them. Mr. Savargaonkar expressed the importance of a business model over the approach of addressing things only when they become a problem. He also pointed out that while several other sectors may seem easier to get into, medical devices is a sector where once one becomes established, one can survive a long time. He suggested that entrepreneurs should not be afraid to attempt to solve complex problems, rather than routine problems.

The workshop concluded with a note on thanking the speakers for sparing their valuable time and the participants for their active participation.

Visit to Gaganbawada Taluka

Among the twelve tehsils of Kolhapur district, Gaganba wada is a nature lover’s paradise. Home to Malabar pied hornbill Tehsil of Gaganbawada is 55 km from Kolhapur. The population of 32,545 (lowest in Kolhapur district) Gaganbawada is served by 1 rural hospital, 2 public health centres and 9 subcentres of which 4 are in Nivade and 5 are in Garivade. The tehsil sees an inflow of migrating population during the sugar cane cutting season.

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Gaganbawada experiences second highest rainfall in Maharashtra of about 4000 mm, causing a few villages to cut off from the central health facility and skilled man power to address health emergencies and arrange for medical supplies.

The fellows were given a warm welcome and insights were shared courtesy Mr. Vikas Bhalerao tehsildar and executive magistrate. First on the list was a stop at the tehsildar and executive magistrate’s meeting hall, where a group of asha’s, anganwaadi sevika and rural hospital nursing staff were invited to share their views, everyday issues, experiences on the field and comments.

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Next on the stop was the rural hospital at Gaganbavada. The fellows were given feedback from Dr. Shreyas Juvekar and insight into the world of clinical management of emergencies.

The rural hospital has been able to handle vasectomy, hystertonomy, tubectonomy, emergency deliveries. The hospital is equipped with IPD facility, 1 ambulance, There is a shortage of specialist therefore, sterilization surgeries are planned in advance. Immunization for newborns and toddlers is successfully handled, apart from emergencies such as dog bite, snake bite and wolf bite.

The next stop was a residential school for girls who drop out from primary school. A zilla parishad run school Kasturba Gandhi Balika Vidyalaya. The fellows meet and interacted with the girls understanding their backgrounds, motivation and aspirations. There are about 118 residents from 6th grade uptil 10th grade. They are taught vocational skills along with state approved curriculum.

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The final destination on the agenda was a Public Healthcare Centre at Nivade. The PHC is well equipped to handle emergency deliveries, sterilization for men and women, temporary isolation of TB suspected subjects. The PHC reported 6 infants in the last year and 1 malaria patient.

Visit to KEM Hospital Research Center, Vadu

The SIIP team visited KEM Health and Research Center, located in Vadu (around 40 km from Pune). KEMHRC aims to extend healthcare to rural population through various means and collaborations. It is working in the field of health through various programs including: 1. Shirdi Sai Baba Rural Hospital, 2. Health and demographic surveillance system, 3. Vadu outreach program, 4. Pabal training center and a few others.

At KEMHRC, we met Dr. Juvekar who spoke to us about various aspects of healthcare and the day to day challenges faced by medical practitioners in given rural settings.

Neonatal health

KEMHRC is working towards the reduction of IMR and aims at reducing the rate to 2/1000 live births in coming years. The hospital is also doing a lot of data analysis to understand the various aspects of pediatric health and are also conducting vaccination trials for rotavirus and meningitis. They also have a plan for further vaccination trials for pneumococcal and RSV pneumonia. We spoke in length with Dr. Kawade on the topic of neonatal health who gave us insights on major hurdles and research priorities in this field. One of the major challenges faced at present is the prediction of birth asphyxia. Conventionally it is predicted through the measurement of optical density of amniotic fluid, however collection of the amniotic fluid is major challenge in itself. Also, in case the foetus passes meconium in mother’s womb, chances of survival of the foetus go down drastically. Another frequent cause of respiratory distress at birth is low amount of pulmonary surfactants in the lungs. This requires an artificial delivery of surfactants using the endotracheal tube, better methods are required in this aspect to reduce the IMR by large

Malshirus: An insight into community healthcare for women.

Malshirus, a village in the Purandar district of Maharashtra, is the field of work for MASUM. MASUM is a development group that is aimed at making women self reliant and aware of their rights, as well as to nurture their physical and emotional health.

We visited the village on 10th March 2015 and were escorted around and given an insight into the activities of MASUM by ‘Sadaphules’. We had an opportunity to observe the proceedings of village level samitis. There are three main samitis in function: 1. Jaagruk Mahila Samiti, 2. Aadhar Gath Samiti, 3. Aarogya Samiti. These samitis (each organised at the community level by local women of Malshiras) aim at creating awareness, financial independence and better health practices amongst the women. The Aarogya Samiti organises awareness camps for women on reproductive health, trains health workers to do initial screening of diseases and informs PHCs about pregnancies and ensure safe deliveries under skilled supervision.

There were several observations that we made while going around the village. Even though the maternal mortality and infant mortality rate of wasn’t high, the number of stillbirths in the village was alarming. The nurses (during our visit to PHCs) tried to convince us of a great decline in number of stillbirths but the opinion seemed to differ across different health workers. The PHC, well equipped with modern medical equipments and a pathology lab seemed in need of a little redemption. An obvious shortage of doctors, nurses, labour rooms and ambulances made us probe deeper into the availability and accessibility of health care to rural population. Although the government has done much in the field of community health, including diabetes and blood pressure checkup camps for elderly population and hormonal checkup camps for women, there is still a lot that remains to be done. The PHC had no working ultrasonography machine and patients were frequently being referred to the RH in Saswad for foetal health monitoring. The travel time between Saswad to Malshiras being more than an hour, or more depending on availability of an ambulance. Instruments in the neonatal department, such as incubator and phototherapy units, remained unused due to lack of skill and lack of proper maintenance. Further aggravation to these problems was provided by a load shedding schedule of 6 hours. The pathology department of PHC was well maintained and blood tests for various conditions such as pneumonia, malaria, sugar and anaemia were being carried out. However, a number of tests which required blood culture and analytical observations were not being performed.

There remains a lot more to learn about the health care area in Malshiras and we hope to do that in subsequent visits and observations during health camps.

(Opinions expressed here are author’s only and do not reflect the view of Venture Center, Pune)

Melghat: A region full of challenges and solutions

Melghat, a cluster of 320 villages spread over the area of 4000 sq. km is known for its scenic beauty, teak forests, exotic fauna and “malnutrition.”Our journey began when we reached MAHAN after crossing the sharp ghats in Satpuda ranges. MAHAN is an NGO, run by Dr. Ashish Satav. MAHAN works towards controlling mortality in the rural tribal population through its child care, deaddiction and nutrition programs. They also organize a number of eye care and surgery camps with the aim of bringing quality healthcare to inaccessible areas of Melghat.

Working around Power cuts and poor connectivity

The villages in Melghat are sparsely populated and lack basic infrastructure and transport facilities. The fact that really struck us was that inner villages at Melghat had no connectivity or telecommunication networks and hence emergency communication or calling ambulances at time was not an option for them. Power availability in this region is also extremely poor, despite constant attention of government and several NGOs. This gets worse during the rainy season and accessibility to these regions is completely lost. Under such circumstances, it is a challenge to run surgical and opthalmological camps.

Mesh of Health workers

Given the economic background of this area, we could also notice a serious lack of proper education amongst the local tribes. The literacy rate in this area is as low as 45%. Yet, MAHAN has managed to work with low level of education and lack of skilled workers in this area. MAHAN trains a large group of village health workers every year, who are then made responsible for health check-ups, monitoring and tracking pregnant mothers, providing ante-natal care, assisting with labour and delivery, coordinating for home based child care programs, deaddiction programs and other initiatives undertaken by MAHAN. The VHWs are extensively trained to counsel the villagers and promote health awareness in the villages.

Maternal and Child Health at Melghat

A special focus is given by MAHAN towards maternal and child health. Melghat has been long known for its high infant mortality rate and large number of cases of severe malnutrition. At an average more than 500 children between age 0-5 years die due to malnutrition in Melghat. In view of this MAHAN started working with severely malnourished children. A weekly home based child care regimen was established where regular anthropometric measurements are done and children are categorized based on their height, weight and MUAC. After the categorization is over, they are recommended to the RUTF program, where nutritional food (based on UN standards) is provided to children at several locations in the village. The RUTF is made locally using easily available resources such as jaggery, peanuts and pulses. MAHAN also trains local women on preparing RUTF for domestic consumption.

Apart from tackling malnutrition, MAHAN has also been able to achieve significant progress in ante-natal care. Trained VHWs go from door to door to promote awareness of pregnant mothers. Pregnant mothers are tracked and monitored and fetal health is also recorded by the VHWs.

Anthropometric measurements: a challenge?

Constant data is collected from the village. This data includes anthropometric measurements and disease spreads for HIV, typhoid, pneumonia, malaria and diarrhea (among others). On interaction with these health workers and other doctors at Melghat, we noticed several discrepancies in collection and reading of anthropometic data. An urgent requirement, hence, in this sector would be to have automatic measurement systems with electronic readouts or data consolidation mechanisms.

 

 

International Conference on Social Entrepreneurship and Sustainable Development

Summary report on International Conference on Social Entrepreneurship and Sustainable Development

The International Conference on Social Entrepreneurship and Sustainable Development was organised by TISS and DBS Foundation with the purview of discussing and assimilating ideas on facets of social entrepreneurship and their effects on sustainable development.

The conference explored academic perspectives on social entrepreneurship; outlined stories of pilot, seed stage and established ventures in the social sector and discussed corporate governance issues towards social development.

The conference was a great networking opportunity where we met social entrepreneurs from all spheres including agriculture, animal husbandry, healthcare and education. There were discussions on several dimensions of social entrepreneurship which included not just pitching and commercializing a product or service but also highlighted the challenges in reaching the bottom of the pyramid. The conference was an excellent opportunity to learn from the real life field experiences about what we must know to take a leap into social entrepreneurship.

As a SIIP fellow, of particular interest to us were a few topics as enlisted here:

  1. Community mobilization of sugarcane growers through participatory approach. This study was presented by Dr. Rajula Shanth from Sugarcane Breeding Institute, Coimbatore. She discussed the conditions of sugar mills and sugarcane farmers in Coimbatore area and how both- technological and community based interventions were used to revive the dying the sugar factories. To deploy higher yields in the available farmlands for sugarcane, the institute did sequential trials with more than 20 plant varieties out of which two were selected for cultivation. The motivation for these experiments was to increase the yield by increasing height of sugarcane and sucrose content in the plant.The presentation led to a good learning on carrying out community based studies and on how to convince communities to accept and acknowledge technical interventions.
  2. Rural health initiative for Primary Centers and Eye Care Centers in East India. This study was presented by Dr. Sachin Ganorkar from Alchemist Hospitals, India. The presentation, as given by Dr, Ganorkar, discussed a hybrid model of PHC and eye care clinic established in West Bengal, Bihar, Jharkhand and Orissa. Alchemist hospitals are currently providing free screening for primary health and opthalmological issues. Dr Ganorkar listed some major issues with the industry which were:
  1. i) Lack of infrastructure to provide medical support through telemedicine initiatives.
  2. ii) Issues in transporting samples to distance path labs and tertiary care units and getting reports on time.

iii) Poor licensing norms in most of the Indian states which reduce the quality of health care.

  1. iv) Expensive equipments for eye care facility.

At present Alchemist Hospitals have set up around 9 centres in East India at a cost of around 112 Lakhs INR/unit. Out of this around 50 lakhs per unit is the cost of equipment for eye care divisions.

During our personal interaction with Dr. Ganorkar he further explained that a major need for standardised and portable instruments are required in the field of refractory testing, CBC measurement, lipid profiling and thyroid testing. Other medical professionals present at the conference also agreed to the fact that portability of medical equipment is of major concern especially for needs of rural area.

 

Indo-UK joint workshop on Affordable Medical Diagnostics and Devices

13 Feb 2015: Indo-UK Joint Workshop on “Affordable medical diagnostics and devices: From ideation to commercialization”

| Outline | Report |

A joint workshop was organised by Venture Center, NCL Innovation Park, Pune, UK Science and Innovation Network and Association of British Scholars, Pune with the motivation of understanding various aspects of technology commercialization for medical devices. The workshop also aimed to explore potential industry, research and medical fraternity partnerships towards technology development and evolution.

Opening Session

An opening session provided a brief introduction to Venture Center, NCL Innovation Park and Science and Innovation Network, UK. This was followed with an introductory note from Dr. Sourav Pal (Director, National Chemical Laboratory) which outlined the importance of frugal innovations in Indian context and the importance of designing easy, reliable and non-invasive diagnostics. Dr. Sourav Pal called upon entrepreneurs to understand the regulatory framework involved in reaching the market and increase the fraction of ideas which get commercialized to sustainable products.

After the opening session, a brief background of the workshop was provided by Dr. Mugdha Lele which outlined the mission, objectives and agenda for the same.

Session 1: Affordable Devices and Diagnostics- UK Trends

The workshop started with initial panel discussion on UK landscape relating to medical technology innovations, chaired by Dr. Ramesh Paranjpe. As an opening remark, Dr. Paranjpe briefly spoke of the need of technology innovations in field of medicine and healthcare and talked about huge expectations of the market such as TB diagnosis test for INR 2-5 only. Ms. Sue Dunkerton gave a brief on the UK landscape and a broader overview of KTN (Knowledge Transfer Network). The life sciences sector in UK is worth 52 billion Euros and is fast growing in terms of funding and manpower resources. The emerging trends or hot research areas in life sciences from the UK perspective, include affordable medicine, personalised medicine, targeted treatments, minimally invasive surgeries, regenerative technologies and digital health management. There is also a major focus on rapid and Point-of-Care diagnostics for diseases such as TB, COPDs, sepsis and antimicrobial resistance. Currently KTN is bringing along people from interdisciplinary sciences and working across sectors to provide know-how, multi-stage fundings and to increase entrepreneurial spirit. Strength of the KTN group lies in Chemistry and Materials Sciences and Biotechnology. Ms. Himangi Bhardwaj then spoke of available opportunities in the healthcare sector by UK government  She talked about 4 broad areas of funding:

  1. Newton-Bhabha fund. This option focuses on individuals, research entities and foundations and has joint research calls in Maternal and Child Health, Mental Healthcare and substance abuse, Affordable Healthcare and Antimicrobial resistance.
  2. Industrial Research and Development fund. This funding is provided in partnership with GITA and InnovateUK with a major focus on affordable healthcare.
  3. Affordable Healthcare Axis-Wellcome Trust.
  4. Longitudinal Prize. The longitudinal Prize focuses antimicrobial resistance research.

Apart from these the UK government is also exploring possibilities of collaborations with Ministry of Health to fund several exchange programs for researchers and doctorates.

(Details of funding programs are as in the given link: https://www.h2020uk.org/funding-calls )

The session moved further to other aspects of the technology landscape such as collaborations in eHealth, obstacles in scientific developments and potential areas for research and development. Mr. Mario Giardini briefed about his projects and collaborations in opthalmic screening solutions developed for low-income countries and inaccessible regions. Dr. Richard Black further discussed on his work biomedical materials, their processing technologies, development of scaffolds and surface treatments of these materials. He cited that the major obstacles in development of biomedical materials lie in sourcing of these materials along with the required cells and antibodies (from the perspective of ethical considerations) and understanding surface topographies, bio-reactive technologies and the complete mechanism of interactions between biomaterials and living cells. The major focus of Dr. Black’s group lies in rapid fabrication of biomed materials and gel-based systems for better drug delivery. Dr. Bachmann focussed on concepts of personalised medicine and stratified medicine and highlighted that most areas in healthcare need to mimic and build upon the developments in oncology for providing better solutions.

Session 1: Questions and Comments

In India, as opposed to UK, the problem definitions in large-scale diagnostics transform based on availability of products, level of awareness, access to infrastructure (such as electricity and manpower). A key to tackling this problem would be to co-create solutions along with medical practitioners and health workers at the ground level. The medical devices to be developed must incorporate ease-of-use and should be accessible to most through minimal training. Along with co-creation, it is also important to horizontally deploy the proposed solutions in other sectors such as animal husbandry and agricultural technologies.

Another issue in developing a robust healthcare landscape lies in gaining the trust and feedback of patients where around half of patients don’t return for results after . This makes patient monitoring and adherence to drugs and therapy a major issue in healthcare market. The panelists discussed and debated on the definition of affordability, deployment of existing solutions to rural environments and sustainable technology models. Also, there was an unanimous agreement that affordable doesn’t necessarily mean low-cost and a target price must be given and roadmaps should be derived wherever necessary. Affordability can be brought in healthcare by early and effective diagnosis techniques which help lower the cost of treatment and drugs.

Session 2: Affordable Devices and Diagnostics- Emerging Needs in India.

The second panel discussion chaired by Dr. V Premnath focussed on needs and priorities for medical technology in India. The panel constituted of veteran medical practitioners, biochemists and biotechnologists and also new-age entrepreneurs working in the field of affordable healthcare. Mr. Nikhil Phadke (Founder, GenePathDx) explained the challenges with design and manufacturing of microfluidic kits and elaborated upon modular and low risk strategy of his enterprise. Presently, GenePathDx focuses on molecular diagnostics and aims to monetize each step in molecular diagnostics rather than manufacturing of complete kits.  Dr. Prasad Rajhans, intensivist at DMHRC elaborated on the urgent need to localise a number of low to high technology medical devices and consumables ranging from CPR mannequins to MRIs.  The panel also discussed about need of investment and innovations in technologies which are peripheral to healthcare, such as water sanitation and immunization processes. It was agreed that we as a country still need to collate a huge amount of medical data on Indian demographics, especially in the field of NCDs.

Session 2: Questions and Comments

Medical tourism has been a buzzword in the Indian healthcare market, since long now. People have from neighbouring regions have been visiting India for low-cost and affordable medical procedures. Market analysis of medical tourism does pose India as a favorable location. However, there is a difference in opinion on whether the diagnostic and medical device industry see a sudden growth in demand due to medical tourism. Though, a uniform opinion on this matter couldn’t be reached, it was agreed that coming years will see more competitors in the healthcare industry which will lead to reduction in prices. A number of labs in India are already accepting samples from other countries for conducting diagnostics tests and providing results via electronic means. This system needs to be made more robust and labs must be certified and standardised with international systems to encourage this trend. It is also important to look at innovations from process viewpoint rather than the viewpoint of manufacturing to further boost growth of medical devices industry.  On the other hand, medical tourism may also lead to increase in cost of healthcare in the long run due to better buying propensity of the market.

During the discussion, Dr. Niranajan Khambete (Clinical Engineer, Deenanath Mangeshkar Hospital [DMHRC]) pointed out that we are presently at the center of a huge mesh of problems and a major difficulty lies in prioritising them while developing solutions. This difficulty is enhanced due to the non-uniform structure of Indian market. The fragmentations in Indian healthcare industry pose a big challenge in developing diagnostic devices. this reduces scalability of solutions and also increase the cost of delivering the solution to masses. There is a need of policies by the Indian government that enables the marketing and distribution of low cost diagnostics and medical devices through government hospitals, laboratories and health missions. There was also a suggestion to try out the open source model for developing diagnostics where each innovator can benefit with the developments and advancements of another.

Session 3: Stories of tech developments and commercializations in diagnostics and devices.

During the third session, delegates from India and UK presented their stories of tech commercializations in medical technology. Dr. Bachmann presented his work on rapid diagnostics for infectious diseases with major focus on molecular in vitro diagnostics, biochip technology and medical microbiology. The Bachmann group are working on biosensing platform project, chronic wound care program and EIS (Electrochemical Impedance Spectroscopy) techniques for PoC devices. Several devices and IPs were developed as an outcome to these programs such as electrochemical sensors, detection platforms and handheld machine for wound care detection. Another technology developed by Bachmann group was ePCR which utilizes intercalation techniques for DNA denaturation. This technology provides an edge over PCR which is a relatively slower and complex process. Following Dr Bachmann, Dr Prodromakis also spoke about integrated bio-sensing technologies and the key challenges in achieving them.  Some of these challenges are sensitivity of the chemical sensing processes, encapsulation materials and finding appropriate bio-markers. He emphasized that contrary to popular belief, it is futile to integrate nanoelectronics with microfluidic devices as these add to the cost of fabrication and processing. Dr. Prodromakis’ group has developed several solutions such as hybrid chemical sensing platforms, disposable diagnostic prototypes and Lab-on-PCB devices. The Lab on PCB device uses a cartridge concept wherein trenches are etched in the PCB which are then stacked together to design the required channels. this system incorporates microfluidic sample delivery network, electrochemical biosensing reagents and reference electrodes. A key challenge for this technology lies in minimizing the drift of these reference electrodes. In future, his group intends to design customised user interfaces and integrate primitive logic to disposable cartridges. They also want to exploit the ossibilities of deploying these solutions to alternative markets.

Dr Black from the Department of Biomedical Engineering, University of Strathclyde elaborated on his team’s work in rapid manufacturing of tissue scaffolds. The rapid fabrication was achieved using electrospinning of PU dispersions and later functionalizing them through various means. His current research focusses on coronary artery diseases and development of artificial arteries which can be used as grafts; biomaterial surface functionalization for developing blood vessel substitutes, vascular bioreactors and perfusion bioreactors

The session on stories of tech development continued with stories of Indian entrepreneurs: Mr. Aniruddha Atre, Mr. Nishant Kumar, Mr.Sachin Dubey, Mr. Dhiman Sarkar, Mr. Mandar Gadre and Mr. Jayant Khandare, all incubated at Venture Center, NCL.

Session 3: Questions and Comments

There are a large number of adoption barriers in the Indian medical devices industry which include lack of a regulatory framework, lopsidedness of the market for imported devices, mistrust in new and cheaper technologies and clinical history based decision making systems. A good way of overcoming this hurdle will be to involve opinion setting customers early in prodcut development stage and co-create a prototype which is suited to the needs of medical practitioners.

Session 4: Collaborative technology development and taking ideas to market – Experiences and opportunities

This was the last session for the workshop and focussed mainly on collaboration opportunities and challenges.  An opening remark during this session was given by Mr. Satya Dash who gave a brief background of BIRAC, its focus areas, funding opportunities and programs. Major paradigms at BIRAC include affordability, quality and localisation. Mr. Dash also briefed about the recently started SIIP program grants available at PoC stage. After the opening remark, Ms. Sue dunkerton again emphasised on collaborative funding programs provided by UK government. She elaborated on InnovateUK which supports innovative businesses with a goal to improve wealth of the UK and provides funding for themed calls, technology inspired calls, industry academia partnerships and small industries. Ms. Sue also introduced to the audience H2020 programs that are more SME specific. The H2020 programs include Eurostars, SME instrument and FastTrack to Innovation. Mr Vishy Chebrol outlined the importance of finding the right customers to have sustainable developments. As an example, he quoted that most medical diagnostics can target low scale private clinics and doctors who cannot afford to invest into full-functioned high end equipments due to budget or space constraints. Mr. Chebrol also suggested to backlink the innovation happening in industry to academia so that research can take it further and frugal innovations may mature into advanced science. The panelists also discussed and debated on hurdles in collaboration which included difference in opinion between industry and academia, lack of interest in high risk solutions and challenges of IP protection.

 

Welcome to the Collaboratorium on Affordable Healthcare

Welcome!

This blog attempts to catalog and compile problem definitions relating to the most pressing and widespread healthcare needs of the masses in India. The initial emphasis and focus shall be on maternal and child health in India.

The hope is that if we can compile accurate problem definitions, “solvers”  from anywhere in the world can contribute solutions.

Join us in this effort.