The George Institute for Global Health is improving the lives of millions of people worldwide through innovative health research. Established in Australia and affiliated with The University of Sydney, the Institute today also has offices in China, India and the United Kingdom. The latest edition of ‘Chat with BioVoice’ features Dr Vivekanand Jha, Executive Director, George Institute who emphasized on the need for a Health Policy Think Tank that drives the discussion.
Which focus areas remain at the top of its activities by George Institute of Global Health in Indian context?
Dr Jha: The institute remains committed to developing the definitive evidence using high quality research to find solutions to the major health care challenges that far the Indian population, in particular those at the bottom of the pyramid who are effectively excluded from the current healthcare system. In terms of systems research, our focus is to work on developing and testing innovative models of care that are affordable scalable, high quality, evidence and guideline based and acceptable to the community. Our aim is to do impactful research, develop a mechanism to convey the findings to all stakeholders – public, physician and nonphysician healthcare community, policymakers, opinion formers (press, multilateral organizations, professional societies etc) and support change in healthcare system from a reactive to a pro-active one. We hope that the models developed by the work done by the Institute in India will have lessons for the rest of the world – especially in the emerging markets.
What are the topmost healthcare challenges that India faces today and in the next decade?
Dr Jha: The challenges faced by the Indian healthcare system are particularly daunting. The system needs to consolidate the gains made in improving the area of reproductive and child health and infectious diseases, and at the same time deal with the onslaught of non-communicable diseases, which are going to get worse as the population gets older. Reducing deaths due to road accidents and suicides add to the challenges.
This needs to be achieved in the face of a deficient and dysfunctional healthcare delivery mechanism and low public sector healthcare spending. Reliance on the physician centric healthcare model imposes major limitations in democratization of healthcare. Not fully appreciated is the burden of disability imposed by mental diseases and musculoskeletal problems.
Move of 80% of health care delivery to private sector has shifted the focus to expensive curative services rather than health promotion and disease prevention. Inpatient is care is given priority over outpatient services. Inexplicably, health insurance is comfortable funding procedures rather than health prevention, leading to high claims ratio. Inconsistencies in application of programs between states is also not ideal. All of this is made worse by lack of robust data on disease burden, program implementation, and exclusion of experts from policymaking. A last point is the ceding of the policymaking space by the government to donor organizations, to the extent that the healthcare agenda is largely donor-driven.
“Healthcare related issue do not find resonance in public conversation and debate. A few important issues are to try and find evidence-based models of innovate health care delivery, generation of data around the healthcare burden in India, development of innovative financing models, insurance reforms to prioritize disease prevention and legislative solutions.”
Do you see more innovations in health technologies coming from India now? What more needs to be done to promote entrepreneurship in this space?
Dr Jha: There have been examples of innovation – both in terms of basic laboratory science based solutions and some in healthcare delivery space. Limiting myself to the latter – I would like to cite the example of the SMARThealth platform developed by the George Institute for Global Health India. This uses an information technology platforms to embed the latest guideline-based decision support that can provide user-appropriate output at all levels of health workers, provide motivation to patients, and serve as a reminder system. After a short training, village health-care workers identify patients at the risk of developing cardiovascular disease(s) and choose the optimal treatment using standardised, evidence-based approaches with the help of a simple decision-support algorithm. They refer high-risk patients to medical practitioners at the nearest primary health centre. A study showed that trained village workers outperformed unaided physicians in accurate identification of at-risk subjects and selection of treatment. The biggest drivers of transformative change in the delivery of health care are likely to be wireless technology, linkages to electronic health records, drug supply chain management systems, simple point-of-care diagnostic devices and cheap wearable sensors.
Social entrepreneurs, who recognise that financial success and humanitarian contribution are not mutually exclusive, can accelerate this transformation by supporting development of innovative, affordable care solutions. Success stories include Aravind Eye Hospital and Narayana Hrudayalaya, which rely heavily on paramedical personnel and standardisation of processes.
Has the health policy in India received the attention it deserves? What should be top priorities?
Dr Jha: Clearly not. Healthcare related issue do not find resonance in public conversation and debate. A few important issues are to try and find evidence-based models of innovate health care delivery, generation of data around the healthcare burden in India, development of innovative financing models, insurance reforms to prioritize disease prevention and legislative solutions. We need a Health Policy Think Tank that drives this discussion, and the George Institute is keen to set it up.
Where does India stand on IT based healthcare solutions such as mobile healthcare and telemedicines?
Dr Jha: The space of innovation has unfortunately been crowded by proliferation of untested and non-evidence based solutions. Just because they are promoted as technology-based, an aura of legitimacy is sought to be created. Many of them have folded since they do not take into account the need to make a system-wide change. Unfortunately this creates a toxic environment where all “m-health” solutions are looked at with suspicion. It is important to understand that any standalone solution is unlikely to work, unless embedded in a sustainable and affordable model of healthcare delivery. I would like to emphasize that just like any other medical intervention (drugs, devices etc), such solutions should first generate high quality evidence around safety, efficacy, scalability, acceptability and affordability in order to meet the standards for driving policy and practice change.
Dr Vivekanand Jha in the past has also served as Professor of Nephrology and Head, Department of Translational Regenerative Medicine and Officer-In-Charge, Medical Education and Research Cell at the Postgraduate Institute of Medical Education and Research in Chandigarh, India.