However, one of the key challenges to innovators is sustainability as the start up sector in general has a high failure rate of 90 per cent, which means that one out of 10 will fail.
Though, in the case of medical technology start ups, it’s a mix of good and bad news. The bad news is that medtech has more entry barriers. Most innovations in this space need in depth technical/medical knowledge, and considerable money and infrastructure to take it even to a prototype stage. So, medtech start ups took time to make their mark but now, almost every start up seems to be targetted at a gap in the healthcare delivery ecosystem. The good news is that the failure rate is lower, possibly because the ones who do venture into this space, have done their groundwork more thoroughly.
But all the fire in the belly of healthcare entrepreneurs and all the high tech innovation will not be able to change attitudes of healthcare practitioners. For example, three years after the Government of India declared TB a notifiable disease, TB case notification rates remain low among private healthcare practitioners.
A research article published in April this year in PLOS One, sums up the dilemma aptly: “They Know, They Agree, but They Don’t Do” – The Paradox of TB Case Notification by Private Practitioners in Alappuzha District, Kerala.” Only three TB cases were notified by private practitioners in this district in 2013, even though the public sector reported 2000 TB cases on an annual basis.
Even though the PLOS One study might not be considered statistically significant since it covered a relatively small number (169 private practitioners) and was confined to one district, the findings resonate with other data. In line with the PLOS One study, conducted between December 2013 to July 2014, it is worrying that of an estimated number of 2.1 million people developing TB each year, the Revised National Tuberculosis Control Program (RNTCP) reported notification of just 1.4 million TB patients in 2013. It means that a good one third, around 40 per cent, called ‘missing’ TB patients, are not within the ambit of the RNTCP and are thought to be managed by the private health sector. Thus, unless private practitioners also adopt national standards for TB care, we will be nowhere close to controlling, forget, eradicating TB from India.
It is important that these ‘missing’ TB patients are covered by the RNTCP so that they can access the recommended treatment regimens, without which they might end up worse off. But notification has not taken off for various reasons. As Bharathi Ghanashyam, Founder/ Editor of Journalists against TB points out, checks and balances are not in place and there is a fear among private practitioners of the ‘fence eating the crop’, i.e. of losing their patients to the public sector.
For notification to be successful and effective, it is vital for the authorities to put in place, systems that are accountable, simple, and can assure confidentiality as well as the confidence to private practitioners that they will not lose their patients to the public health system, summarises Ghanashyam.
But even with these obstacles, some projects have shown the way. Dr Oommen George, Project Leader, of USAID’s SHOPS -TB Prevention and Care Initiative suggests that an amended title reflects a solution: “They Know, They Agree, but They Will Do, if Meaningfully Supported by an Interface Agency”. The Strengthening Health Outcomes through the Private Sector (SHOPS) project he is referring to worked with RNTCP in Karnataka. Running from October 2013 to September 2014, the SHOPS project chose Karnataka because its annual TB total case notification rate of 98 per 100,000 people, is one of the lowest among the southern states of India. Dr George’s study report details how capacity building of private healthcare practitioners (HCP) was institutionalised through engagement of private medical colleges, and continuing medical education (CME) programmes, aimed at medical students, college faculty and private clinicians, were accredited by the Karnataka Medical Council.
The study results were encouraging, with the team managing to network nearly 1000 private providers, demonstrating means to increase TB detection under RNTCP, as well as identifying many of the ‘missing’ TB patients through private provider engagement. Importantly, these interventions halved delays in TB diagnosis and initiation of treatment. Thus, we will need a mix of high-tech start up innovation and high-touch intervention (like the SHOPS project) to make healthcare more affordable and accessible in India.
Viveka Roychowdhury
Editor