Universal health care is now in sight

This article is authored by Varun Aggarwal, Vijay Chandru and Tarun Khanna.

The recently released report from the Lancet Commission calls for ‘a citizen-centred and technology driven system’ for Universal Health Care (UHC) in India. Lack of UHC is a worrying problem for a country of 1.4 billion people from various socio-economic groups, large diversity in health care access and under-capacity in health-care infrastructure.

Health care

Yet, we contend that UHC is now in sight for India. We want to highlight three reasons for this. First, digital solutions at scale are now feasible in India and assistive AI technology is fast-maturing. Second, India has been building significant prowess in research in drugs, vaccines, diagnostics, medical devices together with an industrial base in large-scale manufacturing. Third, we are learning how to build so-called non-profit unicorns, those that have population-scale impact. Their complementary capabilities fill in gaps in the emerging envisioned UHC ecosystem that commercial startups governed by the price mechanism cannot address.

Getting these three superpowers to work in an integrated fashion can usher in UHC.

Digital solutions at scale: India has been hugely successful in getting digital access to the last mile. In parallel, the AI stack has had a recent leapfrogging of building capabilities to automate a significant proportion of routine diagnosis and prescription work of a primary practitioner. These two can be joined now.

Consider examples of how technology can support the full cycle of effective healthcare. In the covid era, India showed how it could use multiple data sources to predict the pandemic spread. This strength should now be brought to predicting different epidemics from past trends, recent and real-time data. We envision a living, continually improving digital infrastructure, anchored by a central agency collecting data, building prediction models and providing data feeds to trigger decentralised response. Elements of this are already falling into place. For example, the National One Health Mission under India’s Office of the Principal Scientific Advisor is coordinating some surveillance, state governments have several of their own surveillance programs, and research organisations such as the Tata Institute for Genetics and Society are all involved. Somehow, we have to ensure that the coordinating entity is a world-class autonomous institution, with strong ties to academia.

Turn to primary health care. Today’s AI can easily triage diseases quite effectively, relaying a minority of complex cases to experts. A chatbot can collect symptoms and prescribe tests. The US state of Utah is piloting a system to legally allow AI to handle prescription renewals for chronic diseases; this can significantly address the knotty problem of patient non-compliance to adhere to prescribed medication AI co-pilots can assist medical practitioners through suggested treatment protocols, enhancing effectiveness, reducing error rates and creating monitoring trails. Preliminary efforts for these have already begun. Just as the government has induced the creation of a dense network of primary schools across the length and breadth of India, imagine a dense network of testing labs, located as per India-specific data sets that optimise access with efficient utilisation.

Data and technology thus will not only significantly reduce marginal costs of care, but improve effectiveness and monitoring.

Science and technology: Covaxin was an example of Indian science making India one of the few countries inventing a vaccine. Abhay and Rani Bang’s seminal work on reducing infant mortality rates became one of the Lancet’s most influential papers over the journal’s nearly two century history. Devi Shetty’s mass heart surgery initiative, and Arvind’s low-cost cataract surgery both show a mix of applied sciences and smart processes. IISc houses novel scientific projects under the auspices of the Genome India Project and the Healthy Aging effort.

India now needs to take in mission mode creating solutions for the full cycle of UHC: creating low cost/remote diagnostics, better engineered equipment for use in hospitals (eg a fully indigenously made MRI machine) and new drugs and vaccines The newly formed Anusandhan National Research Foundation must partner with the health ministry to launch a UHC focused mission to build science, and translational capabilities for various aspects of the diagnosing, treating and monitoring patients.

At the same time, India has significant pockets of industrial strength. India produces 60% of the world’s vaccines and 20% of its generics. However, revenues from new drug discovery account for a trifling 3% of pharma industry revenues of $55 billion. Both Israel and China have taken steps to encourage novel drug discovery; Indian academia, industry and the regulator can work together to accelerate this.

Non-profit unicorns: Advances in science and mass digital technology are necessary but not sufficient conditions for UHC. As one of the expert commentators of the Lancet report notes, we also need the right incentives for healthcare practitioners to leverage these capabilities. This will require extensive piloting and experimentation in the months ahead possibly resulting in judicious policy recommendations.

Some of these issues can be addressed by commercial ventures, incumbent enterprises or startups. But not all needs can easily be addressed through the price mechanism. Non-profits are particularly important in bridging trust deficits in engaging local communities, and in nudging forward behavioural changes towards preventive care and wellness. Neither emergent trust, not situations where benefits manifest over longer time periods, are particularly easy to measure or contract upon, bedeviling the possibilities for commercial ventures. The Jan Samvaads organised by Population Foundation of India – highlighted by the Lancet report – provide an excellent example.

Additionally, non-profit unicorns can create a so-called soft infrastructure atop which commercial ventures might well thrive. If the Jan Samvaads induce trust over time, it might predispose citizens to engage with a broader swathe of health care entrepreneurs of all stripes. This is not dissimilar from the non-profit iSPIRT helping foster UPI, which in turn is complementary to the efforts of so many entrepreneurs. There is a UHI analog to UPI that we must consider.

We need to leverage the triple helix of scalable digital pathways, great science, and emergent national-level community organisations, to bring us ever-closer to UHC.

This article is authored by Varun Aggarwal, serial entrepreneur, co-founder of Change Engine and FAST-India, Vijay Chandru, co-founder of Strand Life Sciences and professor at IISc and Tarun Khanna, co-chair, Lancet Commission and professor at Harvard.