5 ways collaborative action can transform primary care

The urgent need to strengthen our public health systems against existing and emerging infectious diseases became evident with spread of COVID-19.

Ready and emerging innovations which focus on prevention, screening, early diagnosis, effective treatments and robust surveillance can help minimize the burden of infectious diseases. However, these continue to face challenges in widescale adoption. Enabling this in public and private healthcare requires collaboration among stakeholders to establish effective pathways to scale-up.

A multi-disease approach enables a scalable and effective model to address a wide range of current and emerging infectious diseases. The disease landscape is evolving, with new communicable diseases emerging at population scale, and an increase in co-morbidities. Thus, taking a patient-centric view which screens for multiple diseases at the same time is more effective, especially in primary care.

This helps make the most out of existing primary care infrastructure. A single disease approach results in trade-offs during emergencies, which offsets years of progress in control. For instance, there was a 78% decrease in number of patients detected with TB and 69% reduction in standard immunization care in India in during lockdown in 2020 vs. 2019.

A stronger primary healthcare system also helps reduce the burden on the tertiary healthcare facilities. The lack of effective tools and systems for disease prevention and screening also results in higher incidence and preventable hospitalizations.

In moving to a multi-disease approach, it is important to develop capabilities among front-line workers to ensure effective implementation of solutions, as workers are currently mapped to specific diseases and programmes. They need to be upskilled to use a wider range of technologies, to develop an understanding of how to engage with patients using technology enabled products and services.

We need to envision health systems as a hub and spoke model where the district/state headquarters are developed as hubs and last mile solutions are deployed through front-line workers at spoke locations. For instance, 5C Networks partnered with GE to analyse data in small towns by aggregating at a central level, eliminating the need to hire radiologists across towns.

Ensuring a combination of top-down and bottom-up approaches will help ensure a focus on strengthening primary care facilities to become the single touch point along with enabling systems such as financing, payment, public and private partnerships and regulation.

Although technology holds promise, there is a strong need to be value centric while evaluating new and existing innovations

There are specific areas where technology can play a significant role in Infectious diseases. New screening tools can simplify complicated screening tests and reduce response time. Surveillance using multivariate analysis can be used to mitigate an outbreak or detect a new disease. AI technology has the potential to ensure connectivity across states and centres to share data and provide alerts on diseases. Point of care devices or solutions that can be self-administered by end-users can help ease the regularity of treatment.

Technology can also strengthen front-line workers’ ability to engage patients effectively and ensure stronger adherence to treatment. It can be leveraged to gather data at source, analyze and understand the pattern of diseases, their origination and spread. This is especially important at the foundational level of health rather than at the foundational level of disease.

A value centric approach towards these innovations will ensure scalability and wider adoption. Applying design thinking at the outset will ensure these are relevant for rural and urban areas.

Markets and mainstream investors look for three key outcomes to enable mainstream adoption: successful clinical validation and unit economics that enable scale and understanding of the end user. A lack of access to essential resources, investments for demand creation, expertise, and networks impede enterprises in achieving these outcomes.

Government is working towards mitigating these challenges by providing grants and developing platforms for easy access to regulatory institutions. Strategic philanthropy and civil society have established networks to drive quality implementation at scale. Private markets bring in a focus on unit economics and scale. Hence, it is critical for all stakeholders to work together to create pathways to scale.

This can happen through a two-step process: clinical validation ensures innovations meet the clinical and regulatory frameworks; community validation involves working with stakeholders to validate the solutions at a meaningful scale. This enables solutions to demonstrate last mile readiness and unit economics at scale. The creation of data overcomes a key challenge faced by the entire ecosystem.

A critical success factor for the success of innovation capital is to ensure that the onus to achieve outcomes is on entrepreneurs.Complementing innovative finance instruments with active engagement, with government authorities and private markets is essential to ensure long-term adoption.

Communicable diseases are a global challenge, and it is important to enable relevant innovations, from around the world for the greater good. Innovations looking to scale globally need support in access to global networks, funding for scale, support in adhering to the global regulatory ecosystem and enablement at the last mile. Global partnerships can help transfer best practices in a contextual manner across countries.

COVID-19 has helped to identify gaps and challenges in public health infrastructure. It has also highlighted opportunities to improve solutions.

A multi-disease approach, especially in primary care, can provide an opportunity to strengthen the existing healthcare infrastructure to improve patient outcomes. Enabling solutions from lab to field requires focusing on the systemic barriers and building pathways for these innovations to scale-up. The challenge of infectious diseases is a global one and requires collective action to address the issues.