Tag: Public Healthcare

India faces a daunting healthcare challenge with an estimated 270 million people experiencing vision loss. Among them, 9.2 million individuals are burdened with irreversible blindness and shockingly, 90% of these cases are preventable. The lack of access to quality eye care, especially in rural areas, has exacerbated this crisis, leaving millions without the opportunity to see the world around them. This has huge implications on quality of life and the overall economy of the country.

We strongly believe that there is a pressing need for Point-of-Care (PoC) devices in peripheral settings that can be easily operated by any frontline health worker with minimal training. That’s why we have decided to support C3 Medtech’s eye screening solutions to help bridge the gap on quality ophthalmology care for underserved communities and facilitate wider adoption of the solution in primary care settings. C3 Medtech’s solution plays a crucial role in the early screening of conditions such as cataract, corneal opacity, glaucoma, and diabetic retinopathy, which are the major causes of blindness in India. By doing so, it significantly contributes to the fight against preventable blindness.

Traditionally, both slit lamps (used for anterior eye inspection) and fundus devices (used for retinal examination) have been bulky and expensive, requiring trained ophthalmologists to operate. However, C3 Medtech has developed a portable slit lamp and a fundus imaging device, which are powerful eye screening solutions that empower primary care settings to conduct efficient screenings, facilitating early detection and timely treatment for various eye conditions. The best part is that these innovative devices can be easily attached to smartphones, allowing healthcare providers to capture high-quality eye images and receive remote consultations from qualified ophthalmologists.

They are simple to operate with minimal training, making them ideal for use in primary care settings in remote regions. They effectively address the challenges faced in reaching underserved communities and offer a cost-effective solution for resource-constrained environments, where access to advanced eye care technology has historically been limited.

ACT For Health will support the deployment of 30 sets of C3 Medtech eye screening devices within our implementation partner network and charitable institutes operating in low resource settings. Our support will help them in getting real life market feedback and pathways to scale in peripheral settings and we’re excited to collaborate with them on enabling better access to quality yet affordable ophthalmology care!

In India, research indicates that almost 50% of the prevalence of mental disorders are observed in transgender communities and that there is a visible reluctance to access support due to the real as well as perceived inaccessibility and stigma. In fact, transgender people face a 4x higher risk of mental illness along with unhealthy coping mechanisms due to:

• Stigmatization, oppression, cis-sexism, discrimination, violence, poverty as well as issues such as gender dysphoria and trauma
• Lack of spaces that are sensitive to the needs of the community
There’s a clear need for comprehensive and targeted mental health support for trans communities that is effective, preventative, private, and accessible.

ACT For Health has partnered with MITR Trust to support Adagio VR in delivering a 4-week program for the LGBTQI+ community in India. Adagio VR, an innovative startup co-founded by a British psychiatrist and a serial entrepreneur, offers a preventive wellbeing and behavioural change solution that leverages Virtual Reality (VR) to create impact. The program integrates this technology with cutting-edge clinical techniques, with a 97% success rate in addressing issues such as stress, anxiety, depression, trauma, addiction, and more. With researchers from renowned institutions like Cambridge University, PGI Chandigarh, and the London School of Economics, the solution’s design is backed by expertise and empirical evidence.

Adagio’s users are able to identify and overcome the root cognitive processes that create stress, anxiety, depression, trauma, psychological addiction, sleep issues etc. quicker and more effectively than any other non-clinical intervention in the world. With immediate relief in the first 30-minute session, there is observed systematic transformation in just 4 weeks of regular use. Delivered in Virtual Reality, the user experience is powerfully immersive, uniquely private (does not require users to disclose the details of the issue they are experiencing) and highly engaging.

Our grant will impact 70 individuals, with an additional 70 acting as a control group for research. Participants will be those dealing with distress, mild-moderate trauma, and chronic issues, excluding severe mental illnesses. A community member will be recruited to ensure program delivery is rooted in lived experience, trust, and empowerment. Beneficiaries will receive specialist consultations, VR program tests, educational workshops, access to VR programs, self-led and community exercises, and online support if needed. This research aims to help Adagio VR in establishing clear outcomes for the program to enable scalability in the future.

Overall, this collaboration hopes to bridge the gap in mental health support for transgender communities in India. By leveraging VR technology and expertise, the program strives to provide effective and accessible solutions that address the root causes of distress and disorders resulting from successive trauma.

In September 2022, ACT For Health conducted a Needs Assessment study with medical professionals to understand their perspective on the healthcare innovations landscape. This study helped us identify and understand the broad categories of challenges faced by healthcare providers and assess where technology-based innovation can potentially play a role in improving healthcare delivery systems. A key insight that emerged for us was that the most critical need is to strengthen primary care centres with high-quality screening and diagnostic facilities along and to build the capacity of general physicians. This is how the idea of the ACT Implementers Network was born.

With 13 partners on board – eGov Foundation, Transforming Rural India Foundation, CureBay, Last Mile Care, Ambuja Cement Foundation, Mahan Trust, iKure, Karuna Trust, Parinaam Foundation, Swasti, Dvara Health Finance, FPAI & Clinikk – the network aims to strengthen the healthcare ecosystem by matching the tech needs of such social enterprises working among underserved communities with ACT supported innovations and launching pilot projects to address identified need gaps. Such pilots are co-designed with our partners based on their needs and our goal is to demonstrate evidence-based deployment models which can be further contextualised by other stakeholders in the healthcare ecosystem.

An example of such a pilot is the one we catalysed between ACT For Health grantee Medprime Technologies and Mahan Trust – an NGO that works in the remote Melghat district of rural Maharashtra and serves the tribal communities in the area. With 70% of the region’s mortality rate attributed to treatable infections, a key challenge that emerged was the lack of trained microscopy technicians who could enable timely diagnosis.

“Currently, local lab technicians can only prepare the sample slides, which have to be transported to a pathology lab 4 hours away in Amravati. In fact, even the onus of transporting the slides is on the patients themselves – which often results in them refusing to go because of the costs involved. Even if they do go, it takes 4-5 days for results to come in – which often delays timely diagnosis. So more often than not, patients are treated on the basis of their symptoms which may not be accurate,” says Dr. Ashish Satav, Founder – Mahan Trust.

The Mahan Trust team leveraged the ACT Implementers Network to collaborate with Medprime, who is piloting Cilika – a digital microscopy solution that allows pathologists to remotely analyse test reports for patients living in low-resourced areas without the hassle of transporting or storing the sample slides. Ever since the introduction of the Cilika device in February 2023, physical samples are no longer needed to be sent to Amravati and they are able to get 5 samples a day, which are diagnosed by the pathologist remotely from Amravati.

“Thanks to ACT providing Cilika to us free of cost, we’re able to diagnose many poor tribal patients who would otherwise have received empirical therapy. This will improve patient management and reduce morbidity and mortality. Its successful implementation in MAHAN Trust will also help develop replicable models in other tribal areas of India.” Dr. Ashish concludes.
A similar pilot that we are currently running is with the Family Planning Association of India (FPAI), Bidar to establish their women’s cancer detection centre. ACT For Health matched their needs with Niramai and Periwinkle from its portfolio – Niramai’s affordable breast cancer screening device is portable, radiation free and non-invasive while Periwinkle’s AI-led Smartscope solution helps detect cervical cancer without the need for electricity and can be used by healthcare workers without extensive training.

Since the inauguration of the cancer detection centre in early May 2023, the FPAI team has been able to screen more than a hundred women for cervical cancer within their first month, and are slowly starting to screen for breast cancer as well.

As we explore more pilot engagements with other partners in our Implementers Network, an important learning for us has been the need to develop robust M&E frameworks and mechanisms to help measure the success of each such intervention. Simultaneously, we are also trying to engage with state governments to introduce such innovations in the public health system at scale.

Our hope is to create scalable models of interventions that use the power of technology and collaboration to improve health outcomes in our country.

If you’re a grassroots public healthcare organisation who could benefit from being a part of the ACT Implementers Network, download our Implementers Guide to know more.

Recognised by the UN as the world’s 50th Digital Public Good, the Open Health Care Network (erstwhile Coronasafe) has been supported by ACT For Health since the early days of the Coronavirus pandemic.

At the time, the solution enabled the National Health Mission to manage 355K patients through 130K ambulance shifts and 200K tele-medicine calls between March 2020 to May 2022.

Last year, ACT expanded its support to help OHCN develop tele-ICU capabilities – a solution that’s being institutionalized in 7 states to cover 200 district hospitals. Today, our focus is expanding to enable their journey from tele-ICUs to Smart ICUs as a way to enhance its ability as a Digital Public Good that’s integrated with national healthcare programs.

What are Tele-ICUs and why are they important?

When the nation ran out of oxygen during the Delta wave, it was also realised that around 300 rural and remote districts out of 766 overall districts in India don’t have ICU beds with oxygen capabilities.

The 10BedICU project was born to fill this need with a goal to set up 3000 ICU beds in 300 district hospitals, and the original CARE platform was adopted as the solution to build the necessary tooling.

In rural and remote hospitals, there are barely any healthcare professionals who understand how to use critical care equipment and so, along with the supply of physical medical equipment, ACT For Health supported the development of tele-ICU capabilities which could ensure that medical professionals in rural areas could remotely leverage the expertise of critical care specialists anywhere in the country.

How did OHCN develop this tele-ICU capability?

36 engineering students, who were selected and trained in a full-stack industry curriculum, worked under 2 senior software engineers at eGovernance Foundation to build the tele-ICU Capabilities. These students worked with Srikanth Nadhamuni, the founding CTO of Aadhaar, as well as intensive care doctors from Kerala to scope out the design requirements and engineer the feature set – which was piloted at KR Hospital in Mysore.

Today, the solution is deployed to manage 410 ICU beds in 41 district hospitals and has supported 4498 patients as of May 2023.

The road and the vision ahead

The most significant difficulty in creating Digital Public Goods has been the availability of software engineers. The full-stack developer curriculums supported by ACT are now approved as the National Model Curriculum. 18 institutions from 13 universities across 6 states have now adopted the curriculum that is creating a direct path for the industry to get highly skilled talent. The top students from this talent pipeline are being inducted to build and upgrade Digital Public Goods, post which they graduate into the industry.

Thus, by creating a scaling pipeline of high-quality engineering talent, the capability to build and upgrade digital public goods is being directly institutionalized into the nation’s higher education system.

The OHCN software has also completed 2 of the 4 milestones in integration with the ambitious Ayushman Bharat Digital Mission (ABDM) program. Once completed, partner hospitals will have the ability to create unique health IDs for patients, deliver care and get reimbursed under the PradhanMantri Jan Aroya Yojna public insurance scheme; thus streamlining the access and delivery of care for citizens depending on public health infrastructure.

The learnings from tele-ICU deployment indicate that regular ICU beds can also be converted into Smart ICUs i.e. empowered with a digital monitor for remote care. A smart ICU solution is a versatile system that can be seamlessly implemented in any hospital, offering a range of benefits. One of its key advantages is the ability to configure hardware, independent of manufacturer specifications.

This means that even low-resourced hospitals can integrate the Smart ICU solution with their existing equipment, regardless of the brand or model. Such hardware agnosticism ensures compatibility and flexibility and enables healthcare providers to optimize their ICU operations without the need for extensive equipment replacements. By leveraging this technology, hospitals can enhance patient care, streamline workflows, and harness the power of intelligent data analytics to improve overall efficiency within their intensive care units.

During our analysis, we conducted a comprehensive comparison of the development cost for the Smart ICU solution from various commercial sources. Remarkably, we discovered that the OHCN model offers a significantly more competitive option. Not only does it provide an affordable solution for hospitals, but it also addresses the education aspect by incorporating an industry-ready curriculum for training senior engineering students.

This dual advantage ensures that hospitals can adopt the Smart ICU technology without straining their budgets, while simultaneously contributing to the education sector by equipping future tech talent who are familiar with health-tech, ABDM etc. with the necessary skills and knowledge to excel in the field.

By merging cost-effectiveness with educational impact, the Smart ICU solution becomes a compelling choice for continuing our support to the Open Health Care Network and we can’t wait to be a part of their journey ahead, as it unfolds its numerous possibilities.

India continues to be the tuberculosis capital of the world, accounting for every 1 in 4 TB cases worldwide. Although we have made great strides in identifying and treating TB patients with innovative policies and aggressive testing, we still miss millions of TB patients who are not caught by the public healthcare radar. Because while active case finding (ACF) is an established measure for the systematic screening of TB in high-risk populations, there has been a lack of affordable, rapid response and sensitive screening tools that can help find undiagnosed active TB cases.

Addressing this need, ACT For Health and India Health Fund (IHF) are co-funding the development of Swaasa® – a mobile app by Salcit Technologies that records cough sounds from suspected TB patients using a phone’s microphone and analyzes them to decode unique cough signatures to detect the possible presence of pulmonary tuberculosis using a proprietary AI algorithm and give a report in just a few minutes.

Salcit’s non-invasive innovation can run on any smartphone, requires no additional equipment/consumables and offers the key advantage of being used by patients themselves in the confines of their households, without the risk of infection spread or the need of trained staff. It can also be easily used by frontline health workers in low-resource and remote settings and thus, promises to be easily scalable to enable early detection of the disease.

The co-funded grant will aid Salcit Technologies in the technical validation of the Swaasa®’s AI algorithm – the six-month long project will include the collection of cough sounds from about 5700 subjects (TB and Non-TB), the technical validation of the platform across 6 public health centers and the enhancement of the platform to reach an accuracy of 90% for detecting the likely presence of TB.

We believe that our support will help Swaasa® emerge as a gold standard TB screening tool that could supplement and strengthen existing Active Case Finding (ACF) in low resource settings and herald a new era of cutting edge technology being deployed for tackling the public health problems at scale to create a playbook for AI based mobile health solutions!

During the onslaught of COVID, India’s healthcare infrastructure faced several challenges as we struggled with a shortage of beds and oxygen during the two waves of the pandemic. While the crisis has slowly receded, it has left an indelible impact by disrupting primary healthcare delivery in India in the following ways:

Restricted access to healthcare facilities: During the lockdown, healthcare facilities were either closed, converted to COVID hospitals/containment zones or were operated with reduced staff. Patients were thus unable to get timely treatment and medicines.

Transportation challenges: Patients faced challenges in travelling to healthcare facilities due to unavailability of adequate transportation.

Diversion of healthcare workers: ASHA workers were diverted towards COVID-19 screening through door-to-door visits. This adversely impacted their other primary healthcare responsibilities.

Reduction in home visits by ASHAs: Many ASHAs did not have adequate PPE (Personal Protective Equipment) including masks, gloves and sanitizers. Due to this, they were unable to perform their regular home visits.

Loss of family income: A large number of families were affected by loss of income. This impacted their access to proper nutrition, medicines and clinical treatment.

High-risk stratification for patients with comorbidities: Patients with existing chronic conditions were more vulnerable to COVID and thus, classified as a high-risk category. They faced severe challenges in accessing healthcare facilities and getting medicines regularly.

Sunderbans is a geographically vulnerable place as it experiences natural calamities on a regular basis and this vulnerability of the delta often affects people’s access to healthcare services. As per the International Research Journal of Social Sciences in 2014, not a single block has been found where less than 30,000 people are served by one PHC.

COVID has further exacerbated the situation by impacting the livelihoods of the 5 million people in Sunderbans, making healthcare even more inaccessible than it already was.

To combat this gap in healthcare delivery, solutions such as iKure are meeting primary healthcare and prevention needs through a unique combination of health outreach initiative, skills development and technology intervention.

iKure’s health management services span preventive, promotive and curative aspects of healthcare and focuses on addressing primary healthcare needs across rural, semi-urban as well as urban areas. Leveraging the power of ICT, they have developed a medical collaboration platform called Wireless Health Incident Monitoring System – WHIMs – which is an aided telemedicine platform used by doctors & iKure’s community health workers to screen and monitor patients at their doorstep.

The platform allows patients to:

1. Connect with doctors instantly
2. Manage patients health profiles
3. Make patient diagnosis
4. Provide access to treatment plans and prescriptions

ACT For Health is supporting iKure in strengthening primary care delivery in Satjelia and Kumirmari islands of Sunderbans by setting up clinics to offer face to face and teleconsultation services, pathology, ophthalmology, physiotherapy, dermatology, sale of medicine, health screening camps and other such services.

Through this project we aim to cater to 1 lakh people across these islands by leveraging technology to train community health workers and deploy primary care protocols on ground.

According to a survey, 70-80% of clinical decisions require lab reports and on an average, two tests are prescribed per patient. However, the entire process is still dependent on the access to pathology labs and trained pathologists. In their absence, health professionals often resort to empirical decision making or ‘gut feelings’ for treatment, leading to massive misuse of antibiotic prescriptions.

Although point of care devices (POC) continue to foray into underserved locations, they’re limited by recurring cost and minimal options. Microscopy continues to be a crucial component for pathology labs to inspect body fluids in order to detect infections and identify cellular abnormalities. However, primary and secondary care in the country faces an acute shortage of manpower and trained pathologists; with only 1 pathologist serving approx. 65K people in the country. This shortage has led to the proliferation of many unlicensed labs and personal operations in the market. On the other hand, pathology labs are majorly concentrated in urban areas and far from reach of the rural population. It is therefore important to address these massive gaps in the healthcare delivery system.

We’re observing a paradigm shift in pathology with the growing acceptance of digital microscopes over optical ones – given the ability to instantly store and share images from a remote primary healthcare set-up with a pathologist sitting in an urban setting. It is also easier to train the lab technicians in digital microscopes and the solution reduces the time taken for diagnosis by enabling better clarity of the images.

Cilika, a digital microscopy solution developed by MedPrime Technologies, aims to facilitate telepathology in low resource settings where both infrastructure and human resources are limited. For example, patients in Melghat in the Amravati district of Maharashtra have to travel about 100 km to get tests done. Additional costs incurred due to travel and wage loss often discourage them from availing diagnostic conditions, thereby often exacerbating their medical conditions due to lack of timely treatment. Cilika will allow pathologists to remotely analyse the test reports for patients living in Melghat without the hassle of transporting or storing the sample slides which will turn out to be quite cost-effective in the long term.

ACT For Health will support MedPrime in generating evidence for tele-pathology use cases by deploying Cilika devices in various CHC’s, rural hospitals, NGOs across India with the aim of decentralising such healthcare services.

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!