With a single screen in your hands, you could — in the span of a few minutes and a few taps — track your sugar level, check your urine for markers, keep a cardio-health journal, search for cancer clinical trials, check in with your therapist, do a basic diagnosis of your pain, and book a doctor’s appointment. The boom of smart technology in the past decade is reflected very well in the healthcare industry.
The catch, of course, is the comfortable assumption that everybody owns a high-end smartphone with good Internet connectivity. Furthermore, does everyone have access to healthcare professionals? According to the National Health Profile released last year, one allopathic doctor in India attends to 11,000 people. And that’s the average; the situation worsens in states such as Bihar and Uttar Pradesh.
Every person, no matter what their financial status, has the right to benefit from health services. With this as the motto, the World Health Organization decided on universal health coverage as their theme for World Health Day this year — ‘health for all’.
Even as the rhetoric on Ayushman Bharat rises and quality, affordable healthcare plummets, Indian technology startups have been silently working towards making healthcare less expensive, and reachable to everyone. Here’s how.
Bringing doctors to villages
Since 2016, the rural districts of Haryana have been dotted by brick-and-mortar kiosks. Frequented by villagers in need of primary healthcare, these centres were set up by Ajoy Khandheria, and his Gurugram-based company, Gramin Healthcare. “We wanted to institutionalise healthcare in areas where there is no accessibility, to bring down costs of travel,” says Sonia Vohra, operations head at Gramin Healthcare.
Inside the primary healthcare centres are nurses; doctors are available on screen remotely, performing diagnoses with the help of telemedicine. Each patient is given a health card, and their medical history is digitised. In the three years of their operations, they have expanded to over 120 centres, in Haryana, Rajasthan, Uttar Pradesh, West Bengal, Bihar and Madhya Pradesh.
The company, that is working with the Ayushman Bharat scheme to offer tertiary services, now also has three poly-clinics, which “will employ three to four specialised doctors,” says Sonia.
“One individual can’t create the difference that is required in rural India, hence our model allows communities and corporates to come together and make the difference at the last-mile level.”
Companies such as Forus Health have focussed on creating medical equipment that makes remote diagnosis easier.
Diagnosis on the cloud
Started in 2010, its first product was 3Nethra Classic, a device that does retinal imaging, with the aim of catching conditions that could cause blindness. “We create cheap, portable products, that can be installed in remote locations. The images are sent to ophthalmologists in cities, who then recommend the next course of action,” says K Chandrasekhar, founder of Forus Health.
In strengthening the roots of his company, Chandrasekhar has personally held screening camps in Tier-4 and 5 cities, from Nandurbar and Sindhudurg in Maharashtra, to villages around Puri in Odisha, and Pavagada, Tumkur in Karnataka, besides camps 14,000 feet above sea level in Leh.
“My first camp was in Madurai, where we met one person who found out that he had diabetes only after the screening. That’s the thing, in India 80% of blindness is preventable; patients only get their eyes checked in the later stages,” he says.
The main difficulty in getting equipment to remote places, according to Chandrasekhar, is the poor condition of the roads. “Optical equipment is very sensitive, so the challenge was to make it rugged enough to travel in autos, cars and buses,” he says.
With a global presence now — 3Nethra is also available in Nigeria, Kenya, and the Amazon basin — it is headed to scaling up its operations by collaborating with Microsoft. “We partnered with Microsoft that created an artificial intelligence engine to grade the retinal images as normal and abnormal, before they go to a doctor. That makes the diagnosis much faster and more efficient,” he says.
AI steps in
But what if you could eliminate the need for a doctor completely for a primary diagnosis? Let’s look at another start-up ChironX, also working in the retinal imaging space.
Started in 2017 by Sombodhi Ghosh, Mausumi Acharyya and Rito Maitra, ChironX has developed a method of analysing fundus images (the image of the back of the retina) using artificial intelligence. The software will then tell you if your fundus image steers away from the normal, indicating whether you have any cardiovascular conditions, hypertension or diabetes.
“You only have so many retinal specialists to analyse images. And those ophthalmologists are on a rotational basis at different hospitals,” says Rito. Instead, the startup uses machine learning to feed millions of images into the computer, until it can identify a normal, ideal image from a dysfunctional one. Collecting that data wasn’t easy, he says, because India doesn’t have a very strong electronic record system. “The AI can get you a diagnosis within a minute,” he claims. For this, the startup has teamed up with hospitals such as Dr Shroff's Charity Eye Hospital in New Delhi, and with ones in rural areas of Haryana. It has also done camps in rural Karnataka and suburbs of Kolkata. Adds Rito, “We are now working with the Maharashtra Government to employ our AI in Nandurbar and Wardha.”