Dr Vandana Sarda Blogs

Insights on DIAGNOSTICS AT LAST MILE By India2022, Authored by Dr. Vandana Sarda, @vandanasarda

Dr Vandana Sarda Blogs

EXECUTIVE SUMMARY

Our esteemed experts, Dr. Sreeram Sistla, Dr. Mirai Chatterjee and Dr. Shuchin Bajaj have pinned down the importance of taking diagnostics to the last mile, given that this is where it matters the most in terms of lessening the burden and cost of diseases such as Non Communicable Diseases (NCDs), for example. They have deliberated on the challenges in achieving this and have also taken a leaf out of their rich experiences, to suggest on as to how innovators can achieve this by aligning the incentives of all stakeholders. The speakers are unanimous in their belief that the indigenous innovations have it in them to be successful, provided they work at it. They came up with insightful observations not only on the technology front, but also on things such as HR interventions, the right mindset, efficient business models, etc.  All three have noted that the Ayushman Bharat scheme is turning the corner for preventive healthcare and that the MedTechConnect platform is doing its bit for the ecosystem. The key takeaways speak volumes about how much still remains to be done, lists the case studies on SEWA and Tata Trust models, as also the Cygnus story, which are all a pure delight to read, learn and get inspired from.  

This report was first published on the MedTechConnect Website, its been republished here with the author’s permission

INTRODUCTION

 “Diagnostics at the Last Mile” is the season 1 of ‘Diagnostics 4.0’, a webinar series hosted by MedTechConnect, featured Dr Sreeram Sistla, Senior Consultant, Tata Trusts, Dr Mirai Chatterjee, Director, SEWA and Dr Shuchin Bajaj, Founder & Director, Ujala Cygnus, in episodes one, two and three respectively.  This report on the insights derived from Season 1 of this Webinar series, is compiled by Dr Vandana Sarda, Principal at Xynteo India. The author thanks them for their views and insights. 

To support the Government of India’s goals, India2022 along with Cyient is working towards leveraging advanced technology to make high-quality healthcare solutions accessible, affordable and beneficial to as many people as possible. MedTechConnect, connects stakeholders with strengths in innovation, manufacturing and commercialisation of medical devices, through a collaboration between ecosystem partners. With the ‘silos to solutions’ approach, MedTechConnect enables scaling to the last mile, by leveraging each other’s strengths and experiences. The webinar series is an effort to learn from each other on a monthly basis, forging ideas and insights into partnerships such that the goal of making diagnostics affordable, available and accessible to all, is achieved together and faster.  Season 1 explored the various approaches towards efficiently addressing these issues.

THE LAST MILE 

The Need for Diagnostics at the Last Mile

People are increasingly becoming aware about health issues and actively seeking out productive and preventive measures to address them. Thus, preventive screening is gaining a lot of public attention, as observed by the Tata Trust team in their locations i.e. Vijayawada, Andhra Pradesh, Mathura, Varanasi and Vrindavan in Uttar Pradesh. People voluntarily showed up at their medical camps for screening, to get an early diagnosis. 

According to Dr Shuchin, the burden of non-compliances and not being diagnosed, are factors that none of us truly consider. He further explained using Diabetes as an example that if it isn’t diagnosed in time, the costs to treat its complications would significantly increase, than the direct cost of treating Diabetes, which is in fact the lowest.  If a patient with a diabetic foot comes in for treatment and his foot is amputated, the direct costs in Cygnus could be INR 20,000/- and in a reputed hospital in Delhi it could cost up to INR 200000/-to 300000/-.  This is a cost he would have to pay personally or he might be covered by some scheme. However, he might risk losing his career owing to his amputated leg. So the indirect costs of his disease are much higher- his lost wages/earnings for the next 10-20 years, which could run into millions of rupees. Moreover, being unemployed, he will most likely pull his children out of school and send them to work. Thus his future generation will suffer just because his diabetes was not detected in time, due to him prioritising his work and the initial costs of treatment over his own health, as also due to the lack of access to diagnostics in his village. 

This concern was also echoed by Dr Mirai that should primary care be ill-equipped, people at the last mile e.g. the informal workers in SEWA’s case, will end up losing their daily wages for which there is no compensation available. Thus in both cases, the importance of early diagnosis and preventive screenings are underestimated and people will keep ignoring it, till a hospital visit is unavoidable or becomes an emergency and by then, it is usually too late.  If we don’t detect these diseases early on, if the diagnostics are not available at their doorstep, if the point of care diagnostics and devices are not being deployed at the last mile, these non-communicable diseases can take an  extremely high toll on the patients. The only way to control costs is to ensure that people don’t have such diseases and make preventive health care extremely important and accessible.  Even now, preventive health care is allocated only about 9% of our budget [1]. 

Articulating a clear and compelling vision which ties up with the incentives of the various stakeholders; Once at the last mile, look at a mix of financing models including financing from government schemes, Pay Per Use, a subscription model, CSR funds, etc. 

The Challenges in Taking Diagnostics to the Last Mile

Medical technology innovators might be too focused on the finer details of finding solutions for the communities and thus missing out on the bigger picture- translating the critical changes into a large scale sustainable and effective strategy. In SEWA’s experience usually, when technology is developed in isolation in the lab, it may not suit the realities of the different communities of people in a country as diverse as ours.  There should be a consultative process set in at the initial stages- all the systems including the devices have to be developed in consultation with the users including the informal workers, in case of SEWA.  Another example by Dr Shuchin illustrates the problems faced by people who try to reach a city hospital in time, after suffering a heart attack. For e.g., an innovator may think of getting faster ambulances or getting them to Delhi quicker, rather than thinking about a solution like Cygnus hospitals (lined up across the length of the highway from NCR to Haryana). Some of our innovators are too much in love with their technology to see what the community actually wants.  They think of delivering the solution first and focusing on the problem and the community later. They think that they have the best ever solution in mind and they will offer it to the hospital.  Thus we need to talk to the healthcare community – the healthcare providers and the deliverers of healthcare, on how one can have the right business models to address the problem at hand.

Once deployed, technology usage from the users point-of-view has not been a challenge as per the Tata Trust’s experience, in fact it was much smoother. As far as the patients buy-in is concerned, their experience has been that the doctors do have to educate the patients about tele-consultation and explain its benefits being at par with a real-time consultation. From the clinicians’ perspective, it was observed that they actually spend more time with the patients during the former, trying to understand them as well as making sure that all their clinical information is gathered.  Regarding the nurses who are next to the patients along with the doctor consulting over a video, it was seen that once the protocol and clinical management was standardised, they were comfortable to treat the patients. 

Introduce a consultative process early on across all the systems including the technology, the devices to be developed in consultation with the users, the providers, the deliverers and the frontline workers, to point out the initial flaws – thus making them a part of the process; Innovators need to talk to the community on viable business models, estimate affordability for service providers and the paying capacity of the end user

Aligning Incentives At The Last Mile

Most important part of the technology deployment is getting the patient data, which has to be kept sacrosanct; if possible, it should be shared with the clinicians, the government and the public health system for better patient outcomes

The private healthcare clinicians, the providers and the innovators need to be on the same page as far as incentives are concerned and understanding the key factors is also important [2].  These will differ for private and public healthcare as well as for a not-for-profit NGO provider.  The incentives of organisations in public healthcare may be the bigger picture i.e. an innovation that prevents long-term expenses of the patient and brings down the intangible and indirect costs of the disease as well. Whether the private healthcare providers or clinicians will go for the technology and what really drives their incentive, depends on whether the innovation can be monetised, if it leads to short-term benefits and can actually show quick and tangible results to the patient. For a government organisation the incentive should be aligned for them to drive it more along public health and policy. For the innovators, it is critical to bring the technology and innovation to the market and articulate a clear and compelling vision which ties up with the incentives of these various stakeholders. 

Secondly, need to bring the technology to the stakeholders early on, when it is under development, thus making them a part of the process. Dr Mirai suggests involving frontline health workers like ASHAs and Anganwadi workers to work out viable plans and to point out flaws, as well as estimate the affordability and paying capacity.  According to Dr Shuchin, if you make somebody a part of your early prototype, you will get collaborators and champions for your device or technology; if you show them a finished product, you will get critics who will see only your shortcomings. As per Dr Mirai, workshops can be conducted including business and technology teams collaborating with the frontline workers to hammer out the requirements, instead of figuring out gaps later on which could be time, effort and money-wise cumbersome.  

Need to continuously explain to the doctors the importance of maintaining records, capturing objective data such that the electronic medical record developed will be of equal utility to patients during consultations;

The next step is very important- once innovation has been introduced into the system whether as a pilot or an installation in private health care clinic or in a hospital, there must be full energy, funding, staff and infrastructure provided on implementation. A pilot left hanging can lead to fatigue in the organisation.  Furthermore, planning it as a dedicated infrastructural project with a full funding and project plan works better than thinking of it just as an initial installation or a pilot, to be done at its own time and will. 

Of course, context is king. Dr Shuchin has really stressed on having the context clear- if a solution that is aligned to South Bombay or South Delhi is replicated in a rural place in Haryana, it will not work irrespective of how good it might be. 

Once you start the pilot or the installation, it is very critical to –  

  • Monitor progress on an ongoing basis, give timely feedback to one’s own and the delivery team 
  • Evaluate and demonstrate cost effectiveness, for which pre- and post- cost effectiveness of the innovation has to be monitored
  • Demonstrate that the unintended consequences are minimised
  • Evaluate competing and complementary innovations, rather than falling in love with one’s own ideas- start by understanding the needs of organisation
  • Realise that the onus for non-adoption lies with the innovators; employ design thinking- we are the champions of our own innovation, if we cannot have it adopted by an organisation it is not their fault, we have to sell it well

“Preventive health care is extremely important, early and timely detection of diseases is the only way to control costs- if we don’t detect these diseases in time, if the diagnostics are not available at the doorstep, if point of care diagnostics and devices not deployed, non-communicable diseases can take are extremely high toll.”

The important part of the technology deployment is the patient data received- it should be sacrosanct since it reflects the health status of the population.  The data also helps form an understanding of the actual requirements at the last mile, its population’s needs down the line, the disease burden and what needs to go into its policy.  We could even make a disease conditions database, for e.g. of skin conditions that are very common in villages, and this information can be shared with the dermatologist, the government and even the public health system, to train the young medical graduates.  If these turn out to be (dermatological) conditions frequently encountered at a primary level, this would be valuable for pharmacies as well as diagnostic companies, who can come up with new innovations, new medications, medical protocols and new standard operating procedures.  Nonetheless, there is a need to continuously explain to the doctors the importance of maintaining such records and capturing as much objective data as possible, such that the electronic medical record developed will be of equal utility to the patient during their consultations.

Financial Pain Points at the Last Mile

Financing is a pain point for everyone working at the last mile [3].  Here, the increasing gap is that the doctors want more compensation to go and work at the last mile and the community pays less for their services. One of the solutions for this is to increase the volumes of production and deployment, such that the innovation is accessible to a critical mass of people.  According to Dr Sreeram and Dr Shuchin, there is a lot of funding support available for innovators, provided they do their preparation and groundwork to ensure that the unit economics works well and know how to access it. 

There are five parameters of healthcare at the last mile- accessibility, availability, affordability, appropriateness and accountability. Usually affordability is left to be worked upon.  At the last mile, one needs to look at a mix of financing models. Innovators should definitely look at financing from the government schemes abundantly available for healthcare implementation, which is second only to software and innovation funding.  Secondly, going for Pay Per Use decreases the initial capital outlay, as does going for a subscription model in the form of lifelong subscriptions.  CSR funds for health care is another funding model available. At the Tata Trust, both the models are possible viz.  a grant or the purchase of the equipment. On the start-up side, one of the critical criteria is to demonstrate clinical utility including the end use, how is it going to benefit users and ensuring that it has been tested very thoroughly and that the results are as good as or better than a similar kind of device already being used.  With this data, many organisations and funders would readily come forward to fund and support them [4] [5]. 

According to Dr Mirai, few parameters to be considered for a revenue model: 

  • Important to align the project with government priorities and plans 
  • Consider the scattered populations at the last mile – figure out a way to reach the scattered hamlets and far-flung and communities. For e.g. the northern and western parts of Gujarat are patchy and covered by deserts, whereas southern Gujarat has a thick forest cover, with some very inaccessible areas and low internet connectivity; for such practical issues, only local people can guide on viable plans
  • Local people are ready to pay for doorstep services as it saves them from spending extra time in reaching to a public/private hospital; however, it is important to test out the revenue model early on, otherwise the entire business plan could be based on wrong assumptions and premises 

“Many of the diagnostic tools and medical equipment and cutting edge technology in the sub-centres and primary health-centres dotting our country can be put in the hands of the frontline workers with proper hand-holding and capacity-building all along, even for backup support and maintenance.”

INDIGENOUS INNOVATIONS

Scope for Indigenous Innovations

With numerous brilliant companies based on indigenous innovations proliferating across sectors [6], the concept has truly come of age. As per the experts [7], funding, scope and demand is endless. However, it is up to the start-ups to think innovatively and make the right kind of technology available to the population.  Medical technology companies should also contribute significantly, to enable reaching out to the masses [8].  The devices which are cost-effective and add a great deal of clinical utility, in due course of time, will be the one most sought after. 

One of the critical criteria is to demonstrate clinical utility including the end use, benefit to users and ensuring that it has been tested thoroughly; For a robust revenue model, it is important to align with government priorities and plans, to consider practical ways to reach the scattered and far-flung populations at the last mile and test out the revenue model

Scaling Towards Market Access

While it is a massive achievement for any innovator to get their devices implemented in private settings and more importantly, to have clinicians disengage from the current practice and embed the new technology, it is still difficult to lay down the key factors that might have supported the successful scaling of the innovation. 

The process of innovation begins with adoption by the organisation, implementing it, sustaining it and then active diffusion and spreading of the innovation, active dissemination of the innovation and then finally scaling it up. All these steps interplay in a complex situation at all times, influencing each other on a continuous basis. One has to make sure that all these steps are delivered in an integrated manner so that the innovation spreads rather than dying out very quickly. Sometimes one may need to change the model as they go along. Also, it could be more about how well the team is placed to take setbacks, how well they are equipped to pivot, how diligent and persevering are they because flashes of brilliance disappear quickly and perseverance is the only thing that takes them along, as per Dr Shuchin. He advises to just keep working at it, rough it out in the initial phases and if they can survive for 2-3 years, most indigenous companies do go on to do well and would be very successful, in his opinion.  

Furthermore, according to him, innovations can be divided into three types:

  • Consumer-focused: these change the way consumers buy and use healthcare
  • Technology-focused: these are new products, treatment and plans of care using technology such as wearables, digital devices or the ones that help the doctor/deliverer to access healthcare in a different way
  • Business models: these horizontally or vertically integrate separate healthcare organisational activities

Define innovations as one of the above three types and then figure out forces influencing them positively or negatively and thus assess the situation correctly, to build a scale-up plan – 

  • Players/stakeholders in the implementation process: be it healthcare provider, managers, patient, or the innovator team itself
  • Funding available for scale up: either to innovators or to providers for technology usage, the latter could also be from end users or patients
  • Policies that influence either uptake or abandonment of your vision: are they clear and in favour of or against the innovation?
  • Technology and its benefits: is there a better technology available?
  • Final customer and their readiness to uptake: is this clearly defined?
  • Innovation should take into account the outcomes for the end users: is accountability built into the system giving the clinicians the confidence about the uptake?

“The devices which are cost effective and going to add value to clinical utility, will be the ones most sought after; it is up to the start-ups to think innovatively and make the right kind of technology available to the population.”

Many of the diagnostic tools and medical equipment gather dust in sub-centres and primary health centres dotting our country.  This cutting edge technology can be put into the hands of frontline workers with hand-holding and capacity-building all along, as per Dr Mirai.  Similarly, Dr Sreeram stressed on bringing the right team into the system, making sure that they have the right attitude and are supported by on-the-job training, where they are thoroughly trained on new requirements that haven’t existed before. Since an important part of any technology deployment is the backup support and maintenance, Dr Mirai pointed out that capacity building of the local workers and members can be done for these aspects, as part of an innovative business model. 

Mindset towards market access 

Last but not the least, Dr Shuchin talks about the attitude with which an innovator should work towards creating market access.  First of all, the present journey has to be enjoyed without focusing too much on the end, because flipping, pivoting and changing the model might be required throughout as is the case with most business models, according to him. Next, if one is in the healthcare sector only for the money, he advises them to get out right now because this is a very difficult path and there are many easier paths to make money.  He emphasises that this journey is more about ‘Saraswati’ (knowledge), following one’s passion and innovation and that ‘Laxmi’ or money will come in on its own.  Finally, since the process of building the innovation may not last long, soon each one may have a large company set-up, talking to investors and dealing with them, which may not be as enjoyable as the start of the voyage. Nonetheless, it is  important to have fun, enjoy it and not worry too much about the outcomes.

The devices which are cost effective and going to add value to clinical utility, will be the ones most sought after; it is up to the start-ups to think innovatively and make the right kind of technology available to the population  

AYUSHMAN BHARAT

The Ayushman Bharat scheme is totally viable and is a scheme that can be arranged for and adopted by most of the healthcare providers; hospitals that have been trying to work in the small towns should look at it as they could benefit immensely from it.

Champions to Deliver Innovations to the Last Mile

Dr Shuchin alluded to issues in accessing treatments at private tertiary facilities in urban settings viz. affordability and the limited capacity of the city hospitals. Secondly, the struggle is to match quality vis-a-vis pricing.  Hence, in his view, for hospitals like Cygnus that are trying to work in small towns, the Ayushman Bharat scheme is immensely beneficial.  The Comprehensive Primary Care, conceptualised as part of the Ayushman Bharat scheme, stresses on evidence-based care, as stated by Dr Sreeram Sistla and begets a primary healthcare model encompassing medical devices and technology, as well as tele-diagnosis and telemedicine.  Dr Miraiben Chatterjee also underscored the need for the two important pillars to work together- the Pradhan Mantri Jan Arogya Yojana for secondary/tertiary care and the Health and Wellness centres at the primary and sub-centre levels in the rural and urban areas.  According to her, ideally people should go to a well-functioning sub-centre/primary health centre in the rural/urban areas to be screened using diagnostic tools/equipment for early detection and only then, go on to the secondary and tertiary levels, if required.  The tertiary providers can then work smartly through technology interventions, to transfer the patient records and diagnosis from the primary level, thus benefitting patients with a ‘connected care’ approach.  For this to happen, there must be a full complement of services, human resources and diagnostics at the primary level.  In due course of time, the patient or rather any citizen of this country from even a remote place, should be able to walk into a Health and Wellness Centre and be able to enjoy the best of healthcare facilities.  Unless this happens, there will be far greater hospitalisation rates, resulting in escalating healthcare costs and thus making it unaffordable for most in the long run, as per Dr Mirai.  Dr Shuchin felt that the Ayushman Bharat scheme is totally viable and can be arranged for and adopted by most healthcare providers.

Ideally, well-functioning sub-centres/primary health-centres are to be set up with diagnostic tools and equipments in the rural and/or urban areas for early detection; people should be coming here to be screened and only then should they be going on to the secondary and tertiary level facilities using the PM-JAY card.

ECOSYSTEM PLAY

Role of ‘MedTechConnect’ at the Last Mile

According to Dr Shuchin, the platform MedTechConnect is one of the most important initiatives taken up in the last few years to take innovations to the last mile by connecting innovators, providers and policymakers [9]. Even though the alignment of incentives for all stakeholders is very difficult at the best of times, it is on the right track. The Tata Trust would like MedTechConnect to foster its collaborations further, by getting partners together and interacting more often via online and offline sessions and summits.  SEWA would be very keen to explore further with the MedTechConnect platform, its team and other partners who are working on new technologies, forge partnerships to test out the models at the last mile when technology is put into the hands of the frontline workers and women with proper backup support, maintenance and capacity-building.

CONCLUSION 

Scaling innovations is to understand the innovation process, position the innovations (three types) and overlay the forces (six types) to figure out a plan such that the innovation spreads rather than dying out quickly

The ‘Diagnostics 4.0’ Season 1 ended with clear insights through first-hand shared experiences of the last mile like never before. Throughout the three episodes, we heard exclusive perspectives on taking diagnostics to the last mile.  While the speakers threw light on many notable areas, some critical imperatives for the last mile success could be agreed upon as follows: 

  • Technology for best patient outcomes 
  • Training of local resources to bridge the urban-rural divide
  • Assessing needs of population for design innovation
  • Fathoming incentives for technology usage in different settings
  • Opting for a mix of financing models as available
  • Defining and utilising the process for innovation 
  • Comprehending the user context to deploy products

With the hope that the above are useful to our the partners to not only accelerate their work, but also discern transformative ideas and contribute to building an efficient ecosystem, we are committed to bringing this exclusive webinar series over many seasons. 

CASE STUDIES: Models for Taking Technology to the Last Mile 

SEWA – Putting Technology in the Hands of the Frontline Workers.

From the early days, SEWA [10] has been introducing healthcare albeit in basic measures, for women and their families to help alleviate poverty and move towards economic empowerment and self-reliance [11].  According to them, both are deeply intertwined such that in all SEWA healthcare programs, there is a livelihood and economic component and vice-versa. 

The other article of faith in SEWA has been about putting technology in the hands of the poorest of citizens especially the women of our country. This emerges from the strong belief and the deep faith in the insights, ability, experiences, and commitment of the women of this country and knowing better than anybody else what they need, including how to use technology to reach the last mile.  Members are actively serving on the government’s health committees in the rural and urban areas, as well as carrying out a bottom-up grassroots campaign to push the government on the road to universal health care.  Putting technology in hands of the frontline workers by providing diagnostics and tools will be critical in the slow march towards universal health care.

Since there is very little preventive focus on primary healthcare, there is a strong need for promoting comprehensive primary health care, including occupational and mental health with a strong focus on women’s health, which is often missing.  Similarly, early detection and screening at the grassroots level and the last mile is important, which according to SEWA, can be achieved by putting medical technology in the hands of the frontline workers.  The guiding principle has to be a tailor-made approach, keeping in mind the diversity in the country and using decentralised planning and implementation and a ‘doorstep’ approach, through frontline workers and the local people. 

SEWA initiatives in healthcare include – 

  • The Lok Swasthya Health Cooperative, set up on demand by members, aimed to help reduce costs as it was felt that in spite of greater access to financial services and savings and higher livelihood opportunities, whatever they earned was spent on healthcare.  Also, the co-operative focusses on health education & awareness about primary health care and diseases & conditions experienced by women, girls, young children and their family members, so as to guide members on preventive healthcare.  In the last 10 years, increasing focus has been on non-communicable diseases including its early diagnosis and screening.
  • The Shakti Kendras have been a more recent innovation within SEWA to take care of the information asymmetry. These centres are an information and empowerment hub for members on public health services and entitlements ,as well as to navigate the healthcare system.  These kendras are set up both in urban and rural areas in Gujarat and other states. 
  • A social health enterprise created by SEWA has become one of their major revenue earners.  It consists of  low-cost pharmacies to help offset the major healthcare costs of medicines for members.  It was found that for every hundred rupees spent on healthcare about seventy was spent on medicines and other equipment.  The model includes buying medicines in bulk from large companies and wholesale pharmacy bazaar, with a very low mark-up to cover costs and benefit the members.  As of now, four such pharmacies are running round the clock, three of which are outside large public hospitals.  From the surplus profits generated, the enterprise took up manufacturing its own brand of Ayurvedic medicines and wellness products which are cheaper, green and with less side effects. This has further helped to make the co-operative viable and sustainable. 

Tata Trust – A ‘First Contact’ Healthcare System

Tata Trust [12] chose two sites, one in Andhra Pradesh [13] and the other in Uttar Pradesh, to extend a well-equipped ‘first contact’ medical healthcare system for the underserved in the form of a primary level ‘e-health’ platform.  

In order to prove that the conceived concept works, 20 clinics in Vijayawada distributed over two parallel lines, far removed from each other but fortunately well connected, were chosen.  Even though the geography is quite vast, there was a public health system already in place.  In order to complement the public health system it was made sure that the clinics were well beyond five kilometres from where the public health centres are established. Instead of getting medical doctors to relocate to rural areas to operate these clinics, it was decided to choose the local nurses and train them on a video conferencing application, following which they would examine the patients, document the records and then connect them with the medical doctors for consultation. Fortunately, Tata Trust was able to employ and get a very good telemedicine experience.  The next step was to be able to collect as much evidence as possible, by introducing medical devices that are connected to the application, to avoid any biases from the nurses. So far the team has been able to conduct up to one lakh consultations. 

In this project, Tata Trust is working very closely with the Government of India in the mass screening for NCDs across the country as their technological partner.  They train the ANMs and ASHAs to correctly use the app, to enter the data and use standard operating procedures.  The latter involves connecting every patient who walks in, to the monitor such that all health indicators are recorded and reflected in the medical record.  The moment the doctor logs on remotely, he is able to view the vitals (oxygen saturation, pulse rate, blood pressure, etc.) in the electronic medical record and if required, the patient can be connected to other devices e.g. portable ECG and the doctor is able to consult on it remotely. 

The success story has been the actual impact on the population, e.g.: using an ophthalmic device, the doctors were able to give early diagnosis of diabetes, predict potential retinal damage and impress upon the patient for a proper check-up, so as to restrict the progression at the earliest.  The next step was to very diligently follow-up with them to come in for an examination every six months and subsequently connect them to a retina specialist. The seamless work-flow of an early diagnosis, using technology, training local nurses, with a doctor closely monitoring and then following-up for further referral, is a success story in itself. 

The Cygnus Story – Factors for Success at the Last Mile

It is awe-inspiring to know why does Cygnus [14] do what it does and so passionately while at it. In Dr Shuchin’s own words, ”Because it’s been a passion for me throughout. Cygnus was formed because of some personal experiences. I had completed my MD and I was working in a prominent hospital of Delhi, one of the most prominent and biggest hospitals, with the latest technologies. So I used to get a lot of calls from families- somebody had an accident or a heart attack and they wanted me to help them get beds and treatment. On one hand, it was a very nice feeling for me to help them but on the other it was always a problem that they had got very expensive treatments and private hospitals had limited capacity to help them on the financial front. It has always been a struggle to match quality versus pricing and that is the reason this whole thing was set up”.  

He explained about importance of preventive healthcare.  Despite being a tertiary care physician running a group of hospitals focused on saving lives in emergencies such as heart attacks, head injuries, trauma, critical care, etc., for which they are equipped with Cath labs and trauma services capable of performing neurosurgeries, at heart he truly and strongly feels that as a primary care physician, the only way to control costs is to make sure that people do not fall sick and that early and timely detection of diseases is extremely important. 

Even when Cygnus started out, they had solved most of the last mile criteria except one. Out of the five- accessibility, availability, affordability, appropriateness and accountability, they had yet to tackle accountability. They were appropriate, accredited by an NABH, accessible and available to the doorsteps. Affordability was a factor that had to be solved and being a private company, they had to sustain. Even though they became very affordable, they were not free. So the community had to spend some money to access them.  With the Ayushman Bharat scheme coming in, it turned out to be a blessing for hospitals like them because for the people who were not able to pay anything, at least now the government was paying on their behalf. 

Quoting him on mindset and persevering, “But I just persevered for many years. It’s been eight, nine years of the journey now. I feel that we’ve gotten out of very bad situations where we didn’t know where the next salary for our employees would come from. It’s now a stable enough company.  We are expanding our footprint in UP, so we’ve just opened a hospital in Varanasi about two weeks ago and we aim to be in most towns of UP districts.  I think we need to just persevere for a long time.” 

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[6] “Innnovations in Healthcare Laying Foundation of New India,” [Online]. Available: https://ehealth.eletsonline.com/2018/12/innovations-in-healthcare-laying-foundation-of-new-india/.
[7] “From idea to reality: The funding landscape for healthcare innovations in India,” [Online]. Available: https://www.expresshealthcare.in/strategy/from-idea-to-reality-the-funding-landscape-for-healthcare-innovations-in-india/382999/ .
[8] “How startups are solving challenges plaguing Indian healthcare,” [Online]. Available: https://www.biospectrumindia.com/views/17/13719/how-startups-are-solving-challenges-plaguing-indian-healthcare.html.
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About Diagnostics 4.0 

Diagnostics 4.0, an exclusive webinar series and latest offering of MedTechConnect, is designed to connect the platform partners with experts, medical professionals and key opinion leaders from the MedTech space, to discuss challenges, advancements and opportunities and unravel the latest transformative ideas and leader perspectives for accelerating medical technologies in India.

About the Speakers

  • Dr Sreeram Sistla, Senior Consultant, Tata Trust on “Diagnostics in public health: scope and opportunities” in S1.E1. Dr Sreeram is a clinician with four decades of experience in clinical care and practice. He is an ardent practitioner of clinical decision support systems and digital health platforms and adept at technology in clinical medicine.  Dr Sreeram has diverse experience in clinical practice in Africa and India, actively participates in public health, has done administrative stints as CEO for Sankara Eye Care Institutions of India and as vice president for Aayush Hospitals as well as passionately involved in EMS in India
  • Dr Mirai Chatterjee, Director, SEWA, on “Innovative business models for taking diagnostics at last mile” in S1.E2.  Dr Mirai is the Director of the Social Security Team at Self-Employed Women’s Association, (SEWA). She is responsible for SEWA’s Health Care, Child Care and Insurance programmes. She serves on the Boards of several organizations, including the Public Health Foundation of India (PHFI), Save the Children and PRADAN. She is in the Advisory Group on Community Action of the National Rural Health Mission and was also a Commissioner in the World Health Organization’s Commission on the Social Determinants of Health.
  • Dr Shuchin Bajaj, Founder & Director, Ujala Cygnus Hospital on “Role of private providers for taking diagnostics to the last mile” in S1.E3.  Dr Bajaj is the Founder Director of Ujala Cygnus Hospitals and is a highly qualified medical scholar with a Doctorate in Internal Medicines (MD) from Dr S N Medical College, Jodhpur.  He is recipient of numerous recognitions, accolades and awards including Chevening Gurukul Fellow (King’s College, London), IHT Fellow (INSEAD, France), Aspire Fellow and Cohort Stanford Seed and on the board of a number of national prominent NGOs as Advisor-Health Programmes.  Shuchin is also an avid healthcare investor and is associated with multiple health tech companies as investor, Board Member and mentor.

About MedTechConnect

MedTechConnect is a collaborative healthcare ecosystem led by Cyient and the India2022 Coalition. It’s a platform to catalyse affordable medical diagnostic technologies. Working with partners in innovation, development/manufacturing, start-ups, incubators, academic institutions, and private and public market access, the aim is to support and bring to market high quality healthcare solutions that are affordable, available and accessible to all to ultimately improve early diagnosis. 

About Cyient

Founded in 1991, Cyient provides engineering and technology solutions to the global industry leaders. It delivers innovative solutions that add value to businesses through the deployment of robust processes and state-of-the-art technology and works across multiple industries, from aerospace to communications, transportation and energy. It has also been active in the medical technology space for the past 10 years and it’s one of their fastest growing industries.  

About India2022

Xynteo is a platform for galvanising leaders, catalysing ideas and fusing them into new projects for new growth. India2022 coalition, powered by Xynteo, is a business-led coalition, that was conceptualised in the late 2016 and launched in March 2017 with the support of its partners – Hindalco, an Aditya Birla Group Company; Baker Hughes; Cyient; Hindustan Unilever Ltd, Shell, State Bank of India; Tata Trusts, TechnipFMC and WPP.  It aims to leverage the power of collaboration to unlock a new kind of growth in India.  The coalition is taking forward its vision to tackle some of the most pressing challenges facing through its fours impact tracks Waste to Value, Energise, Sustainable mining and Healthcare. In the Healthcare track, led by Cyient, it is looking to make affordable diagnostics accessible to as many people as possible.

Get in touch with us

Twitter: @MedTechConnect_

Email: medtechconnect@xynteo.com

Dr Vandana Sarda
Dr Vandana Sarda

Dr Vandana is a Healthcare /Lifesciences /Biotech, mainly Pharma/Healthcare, consultant, mentor, and business development professional with 17+ years of experience in this domain.   She has extensive commercial experience in business facing roles to enable scale and market growth of businesses in these domains. 
She is currently Principal based in the Mumbai office, India as part of the India2022 – Healthcare Impact Track supporting Cyient. She has also been mentoring medtech start-ups at IIT-Bombay and Swissnex and has been an expert evaluator on BIRAC programs.

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