By Sharmila Das
Professor Sarang Deo, Deputy Dean of Faculty & Research and Executive Director at the Max Institute of Healthcare Management (MIHM), ISB, believes currently there is a big gap in identifying and formulating a digital health vision at the state level and underlines the need of drawing up a blueprint of digital health priorities based on the health priorities in each state. In a freewheeling discussion with Financial Express, he shares insights on a wide range of topics, including public health, digital health, healthcare accessibility and affordability, and the growing role of AI in the sector. Here are excerpts from the candid and thought-provoking conversation.
Why is the Indian healthcare sector confronting a doctor–data scientist gap?
India’s traditional higher educational system creates a huge distance between people who pursue medicine and those who pursue engineering or math. This implies that one side really does not know anything about the other. Moreover, medical colleges and engineering colleges are not even part of the same university. As a result, there is no interaction between the two sides. This problem persists going forward as most good doctors either practice independently or are part of private hospital chains (with some exceptions who join top educational institutions such as AIIMS or PGI). These are not the places that are attractive to the brightest engineering minds.
What are Indian hospitals and healthcare organisations doing to overcome this challenge?
Some forward-looking organisations are attempting to build internal capacity by hiring and creating engineering/data science teams. Others have created incubators and accelerators to provide preferential access to selected startups and perhaps get preferential treatment in return if the startup succeeds in creating a solution that is relevant to their business. In some cases, the hospitals have entered into partnerships with other educational institutions that have strengths in data science/analytics. But the number of such progressive organisations is very small and the investments made by these organisations is also limited. So, there is a lot of room for growth in this space.
When we speak about healthcare in India, the issues of accessibility and affordability remain constant. What are the government and private healthcare institutes doing on this front?
It is true that the issues of affordability and accessibility remain but those gaps are reducing in some domains and resurfacing in others. For instance, vaccination rates among children have increased consistently over time but anemia rates among pregnant women and women of childbearing age have remained stagnant. There is a growing incidence of non-communicable diseases (e.g., diabetes, hypertension) and their complications (e.g., chronic kidney disease, cardiovascular diseases) and the public health system is not transforming quickly enough to address those challenges.
The investments made in health and wellness centres, for instance, are welcome and needed, but it is not yet clear if those investments are bearing fruit either in terms of reducing the incidence of such conditions or better management. Patient behaviour, which is a large part of managing such conditions, remains unaddressed at a public health level. Private institutions are mostly focused on treating hospitalizations, which does not help society in the long run as the key to success is managing chronic diseases and preventing or reducing hospitalizations. The challenge is difficult to achieve unless there is a fundamental change in the financing of healthcare.
How do you feel Digital Health has been making progress in India?
Digital health is still in its infancy. There are a lot of solutions emerging from the startup ecosystem, but they are not gaining scale due to poor adoption. This is partly because user challenges are not being accounted for while developing the solutions. Also, under the current financing regime, private players do not see any benefit from adopting most of these solutions. On the public health front, a massive drive is underway to digitalize the workflows of frontline health workers like ASHAs (full form) and ANMs (full form), but that journey is in different stages in different states. However, the biggest gap is in identifying and formulating a digital health vision at the state level and drawing up a blueprint of digital health priorities based on the health priorities in each state.
How are institutes, including the Max Institute of Healthcare Management, helping in educating and preparing clinicians?
At ISB Max Institute of Healthcare Management, we are working with some private hospitals to build capacity among clinicians. The aim is not to convert them into data scientists but for them to design important and relevant problem (statements?) on which data science teams can work. We are also working with some of the state governments to help build a landscape of digital health needs and priorities. We are in the process of developing customised modules for state and district health officials on how to use data to drive decisions.
What does AI adoption in healthcare look like in India? Throw light on some of the challenges in this area.
Some of this has been answered in Q4. The main challenges are:
1. There is very little collaboration and communication between clinicians and data scientists. As a result, the most important and relevant questions / areas are not picked up for technology development.
2. The solutions developed do not often directly address the challenges faced by all stakeholders and often increase their challenges, which limits the adoption of the tools.
3. There is a lot of fragmentation in the health system which also limits the adoption of technology that requires big investments and a long planning horizon to make them successful.
4. There is a significant focus on short-term profitability given the way healthcare is financed (out-of-pocket expenditure) and the source of investments (private equity).