Perspective

Donors to the fore

Philanthropic organisations can play a critical and catalysing role in fostering healthcare innovations that are targeted at those most in need

In the past year patients, doctors and healthcare workers in more than 90 community health centres, district and rural hospitals in 17 states across India have experienced how artificial intelligence (AI) can be a force for good in medical care. High patient loads, limited staff and the shortage of radiologists meant that patients either had to endure long waiting periods to be screened for tuberculosis (TB) with a chest X-ray — the most effective way of catching the disease — or rely on inaccurate manual risk assessments.

The use of AI-enabled software to read and interpret chest X-rays has changed this. X-rays at these 90 facilities are now being read within seconds and patients at risk of TB identified within two minutes, without the need for a radiologist. As a result, X-ray machines are better utilised, the limited pool of radiologists is able to focus on high-risk cases, and patients can get confirmatory tests inside a day and start treatment earlier, helping improve recovery rates and reduce mortality from a curable disease. The health system is, as a consequence, beginning to see better resource efficiency resulting from the lower cost of screening and the reduced requirement for confirmatory tests.

Madhav Joshi

Madhav Joshi is the chief executive officer of India Health Fund, a Tata Trusts initiative

This is the story of a tool developed by Qure.ai, an innovator supported by the India Health Fund, a Tata Trusts initiative. We are beginning to see several such transformative developments taking shape. The biggest beneficiaries of these developments are patients in underserved areas and those from vulnerable sections of the population, people who don’t have the resources or access to well-equipped but expensive medical care facilities.

The ability to bank on the transformative power of science and technology developed in labs and research centres that are far removed from patients who can benefit the most is where philanthropy and collaborations play a catalytic role, especially in countries such as India.

New trouble in town

India is in a unique situation, with a rising incidence of non-communicable diseases, while the burden of communicable diseases, neonatal and maternal health issues remain high. With the poor disproportionately affected by this dual burden, primary care has a significant role to play in enabling early disease detection, initiation of treatment, monitoring and follow-ups closer to where patients live.

A researcher with Qure.ai, an innovator supported by the India Health Fund, a Tata Trusts initiative

With constraints in infrastructure, resources and manpower likely to remain, science and technology can help meet some of the challenges in improving access to, and affordability of, healthcare to all. However, while there is clear potential, there are several hurdles to developing and validating these science-driven solutions in clinical and community settings, and in demonstrating their ability to make an impact on a large scale.

First, there is often a lack of clarity in defining the problem that needs to be solved. Scientists and technology developers work best when there is precise direction on what is required and, equally, what is not required. Public health policy is often aimed at achieving the widest possible impact, with a resultant loss of specific focus. This leads to problem statements that are either too broad or incorporate too many factors for scientific developments to address effectively.

Closing the chasm in problem definition is critical to identifying solutions that have the potential to leverage science and technology to secure impact at scale. This is an area which neither providers of public health nor research organisations are able or resourced to undertake efficiently. Philanthropic organisations are, in the circumstances, well positioned to play this role, given their understanding of the issues, access to networks and funds, and ability to remain objective.

The second problem lies in identifying high-potential innovations that can address public health challenges. Developers of solutions often don’t have the reach required to present their solutions, resulting in funders and healthcare providers being unaware of new developments and the benefits of funding and implementing these.

Here again, philanthropic organisations have the networks, convening ability and neutrality required to bring public and private stakeholders, funders and the research community together to identify best-fit solutions that go beyond the tried and tested.

Philanthropic entities overseas have played this role with considerable success, resulting in measurable impact on global health outcomes. Philanthropic organisations in our country can play a more catalytic role to enable greater innovation from India, for India and other developing countries.

The third, and potentially the biggest problem, is funding. Early-stage scientific research receives public funding and is often enabled by cross-border collaboration among researchers. The application of this research for product development and for clinical and community validation is where funding usually dries up. The longer lead times and higher risk associated with translational work deters the private health sector from financing innovation development. Angel and venture funding for early-stage innovation in public health is non-existent, and public funding is fragmented and inadequate.

With money from corporate social responsibility coffers usually going to short-term projects with clear outcomes and very specific requirements, transformative healthcare innovation for the underprivileged doesn’t get developed due to lack of resources.

Philanthropic funding as patient capital — the kind that de-risks innovation development and facilitates collaborative approaches to fund development, validation and scaling up of innovation — can be catalytic in both role and impact.

Partnerships between philanthropic organisations, public and private sectors and the government, centred around enabling the development and scale-up of innovation for public health, can help aggregate funding while going beyond resource mobilisation to build collaborative approaches that make a meaningful difference to underserved and underprivileged patients and communities.

With the current focus on strengthening access to primary care and delivering universal healthcare, there is an opportunity to go beyond using dated tools and technologies by enabling science to make a positive impact on the health, and lives, of those who need it the most.