Month: October 2022

According to the National Cancer Registry, 1 in 8 Indian men and 1 in 9 Indian women will develop some form of cancer in their lifetime.

These outcomes rank cancer as the most frequent non-communicable disease in India. The mortality:incidence ratio of 0.68 in India is far higher than that in very high human development index countries (0.38) as well as high HDI countries (0.57). Major causes for increased mortality ratio are lack of awareness and illiteracy leading to an advanced stage of cancer diagnosis, limited access to quality cancer care and inability of patients to afford optimum cancer care.

The COVID-19 pandemic has severely affected cancer care services, with many oncology centres having been restructured to create COVID-19 units. It is estimated that approximately 100,000 cancer cases per month will go undiagnosed & delivering cancer care that complies with standard clinical guidelines improves cure, longevity, and quality of life will be further impacted.

To combat these disparities in standards of care and its availability, the National Cancer Grid (NCG) has the primary mandate of working towards uniform standards of care across India by adopting evidence-based management guidelines. However, an analysis of 21 cases at an AB empaneled hospital in a single day showed only 31% complied with NCG treatment guidelines, while 69% had treatment errors.

There are innovative solutions, like the one being piloted by Navya Care, that use the technology plus service model to empower patients with personalised, evidence-based cancer treatment plans. Navya’s AI-based intervention has three USPTO patents and functions as a sophisticated engine that requires trained clinical staff to operate. The guidelines engine matches a patient’s medical record with clinical guidelines from the National Cancer Grid (NCG) and National Comprehensive Cancer Network (NCCN).

• The Evidence Engine uses published literature from randomised control trials and global conferences, and matches new patient data with the most applicable high quality evidence.
• The Experience Engine uses case histories, treatment decisions of experts at tertiary care centres, and patient outcomes, to create an untapped source of experiential knowledge.
• The Expert App quickly converts a medical case into a structured summary, presents evidence and experience-based options (above), and patient preference considerations, and collects and combines opinions from multiple experts – online.

ACT is excited to support Navya in developing the Earthshot Engine for breast, lung and oral cancer and thereby enable savings by cutting overtreatment cost of ~30,000 per patient, improve patient outcomes by avoiding undertreatment and ensure 100% of the patients coming to Navya receive NCG compliant care.

A big challenge we see with universal health coverage in India is the financeability of care and the corresponding implications for health related poverty – there is an inability to access meaningful care, especially for the missing middle in India. Where insurance exists, it is often reimbursement based, involves significant fraud risk and is costly to process with long lead times.

Swasth is a multi-stakeholder health sector alliance that leverages digital technologies and healthcare expertise to drive healthcare inclusion & better health outcomes for India.

A key area of work for Swasth is the Health Claims Exchange (HCX) which has the potential to become a transformative factor in reaching Universal Health Coverage (UHC) in India.

HCX is a set of standards created by an open community of volunteers convened by the Swasth Alliance that is now being used to build a national claims routing network that can be interoperably accessed and used by all payers in the system – from private insurers to public and community payers.

As one of the core building blocks of Ayushman Bharat Digital Mission’s architecture, HCX’s construct is inspired by the recommendations of the 2019 Joint Working Group convened by National Health Authority (NHA) and Insurance Regulatory and Development Authority (IRDAI).

By enabling payer-provider interactions irrespective of who the payers and providers are, it focuses on improving the efficiency of insurance and other health benefit payments in India – both for those who are already insured (public and private) as well as for those who currently have no insurance (the missing middle).

The same infrastructure can support the transfer/exchange of any kind of health related information between health system participants – from doctors and healthcare providers to pharmacists, insurers and patients. The exchange can carry information on the services rendered, value delivered and the corresponding payments made or claimed for.

The immediate goal for HCX is to transform the viability and scale of cashless claims processing by:

Improving patient experience & outcomes: By decreasing the 6-24 additional hours spent by patients in hospitals waiting for payments to come through.

Reducing risk for payers/insurers by reducing fraud: By enabling reduced fraud, support the evolution and entry of new payers and new kinds of payers.

Reducing the cost of claims processing: Today, the cost of processing a claim ranges between Rs. 500-2000. This makes paying for small ticket items like primary care impossible. HCX will drive this cost down and enable payers to efficiently cover a wider range of services for the patient.

Reducing the time of claims processing: HCX will mean faster resolution of claims, therefore reducing the financial burden for insurance holders.

Enabling health benefits interoperability between all health stakeholders: Standardisation will lead to ease of information transfer & improve interoperability which will enable patients and policy holders to explore new, less expensive options.

Hence, HCX will act as the foundation of a wider health information exchange (HIX) that will eventually underpin universal value-based healthcare in India – in line with SDG 3.8, which is to ‘achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all’.

We believe that Swasth is uniquely positioned as the prime mover of foundational infrastructure – governance infrastructure, collaborative infrastructure, technological infrastructure – and we look forward to working with them in pursuit of our aspiration for a genuine population scale health for all goal!

Basic Healthcare Services (BHS) is an NGO that was born of the realization that rural India still struggles with a lack of access to proper healthcare.

With the aim of ensuring dignified healthcare for vulnerable communities, a group of public health & development professionals came together to set up a network of high quality, low cost primary healthcare services in Rajasthan’s tribal areas.

Tribal communities have a high prevalence of tuberculosis but existing XRay diagnostics are expensive & unavailable in rural PHCs. Patients have to incur huge expenses to travel to the nearest city for the XRay and often drop out of treatment; which can be fatal.

As an ACT For Health grantee, BHS is setting up light and inexpensive XRay machines across 3 AMRIT Clinics in Udaipur and 1 PHC in Dungarpur district to enable timely and effective diagnosis of TB. They’ll install a reader in one of the nodes to capture data from all machines; leading to an estimated cost reduction of 40%.

We are proud to play a small part in BHS’s journey & look forward to the wave of change they’ll bring to underserved communities healthcare needs!

If you’re a healthcare entrepreneur working on an innovative solution to address the access to affordability gap for Bharat, get in touch with us here.

Because we believe that everyone can be a co-founder of social change!

Cervical cancer is the second most common cancer among women in India; accounting for 18.3% of new cases in the country. It is touted as the ‘disease of inequity’ because of the lack of access to modern advancements that have not equally benefited people living in LMICs like India.

Many studies prove that early screening and treatment reduces the overall incidence and prevalence of the disease. But for women living in rural India, low awareness about early detection and scarcity of healthcare resources often leads to the cancer only being diagnosed at an advanced stage; which leads to death.

Pap smears have been used for cervical cancer screening since the 1940s but the methodology is plagued with multiple issues. Pap smears require a complex infrastructure – experts to collect the sample / develop the slide, careful transportation of the slide to the laboratory and expert analysis by a pathologist for the final results. This not only makes this technique cost intensive but also increases the turnaround time for getting the results – which prevents the patient from getting immediate treatment, in case the results are positive.

And while WHO recommends naked VIA tests for LMICs, they also have a major limitation w.r.t. the subjectivity of test results as the accuracy is dependent on the experience of the professional conducting the test.

Taking cognizance of all these issues, ACT For Health has decided to support Periwinkle Technologies which has developed Smart Scope® CX – a handheld device that enables health workers to detect cervical cancer at an early stage, thus, reducing the morbidity and high mortality caused by late diagnosis.

Smart Scope captures images of the cervix with uniform illumination without the need for electricity, space, or other infrastructure. Its AI component analyses the images to provide a risk stratification thus reducing the need for extensive training and experience for the existing personnel to conduct the screening tests. The sensitivity of the test is around 88-90%, which is quite high compared to a pap smear, and the test results can be obtained within 10-15 mins.

ACT Grants is supporting Periwinkle in conducting an operational study in Chhattisgarh, by screening 2500+ women, to establish the benefits of Smart Scope® CX against the current prevalent naked eye VIA test.

Cancer, often dubbed as the ’emperor of all maladies’, is one of the leading causes of death globally. Among all prevalent types of cancer, breast cancer continues to account for the largest share of cancer cases globally.

The prevalence of breast cancer in India has sharply increased, primarily as a result of demographic changes and lifestyle modifications. A study found that the overall survival rate for breast cancer is 95% for stage I patients, 92% for stage II patients, 70% for stage III patients, and just 21% for stage IV patients.

According to the WHO, early detection is the key to improving patient survival. In fact in countries like the US and UK, the early stage screening program has led to 30-40% reduction in the mortality rate of breast cancer patients.

However, 60% of breast cancer patients in India are diagnosed only at an advanced stage (stages III and IV), which impacts both healthcare outcomes and the financial burden on patients.

Currently, mammography is the gold standard for screening breast cancer patients. However, it is ineffective for women with dense breasts – which is a dominant trait in the Indian subcontinent. This often results in false positives and over-diagnosis. Moreover, there is a lack of adequate mammography machines and trained manpower which limits widespread cancer screening across the country.

Innovative tools like the one developed by Niramai, a Bengaluru based deeptech startup, shows promise in addressing these limitations. Thermalytix, its proprietary product, is a low cost, portable & radiation-free AI based engine that objectively analyses images to detect thermal signatures for abnormalities. Many clinical studies have demonstrated their superior performance and as a result, Thermalytix has been approved by both the CE and FDA as an adjunct tool for breast cancer screening.

In one of their multicentric clinical investigations for instance, the sensitivity and specificity of their solutions were comparable to mammography while the accuracy being greater for participants with dense breast tissue – making them ideal for women from the Indian subcontinent.

This non-invasive technology has the potential to be socially and culturally more acceptable in countries like India and would therefore, accelerate mass screening of breast cancer in India.

ACT For Health is assisting Niramai in conducting a breast cancer screening in Andhra Pradesh with the goal of enhancing early stage cancer detection and treatment. This program will help 5,000 women in the state and create useful data to aid the replication of such programs across the country.