The COVID19 crisis has been raging for six months now, and the conversations around managing its spread have been rapidly evolving. While norms like social distancing and mask-wearing are very new, the focus on developing technology solutions for low-resource settings has resurfaced. Frugal innovation is not new, but finds itself ubiquitous in the global COVID19 healthcare strategy. This is especially a critical topic in developing and under-developed nations. The infection rate in India is climbing steadily while the disease is slowly spreading in African nations, most of which have less than favourable healthcare infrastructure to manage a pandemic. 

What is Healthcare Solutions in Low Resource Settings? 

Low resource settings are areas where access to medication, medical devices and in recent times, internet connectivity are limited. In countries like India, access to healthcare remains highly polarised even today. The rapid advancements made in technology are however proving to be an able carrier of last mile healthcare delivery, to rural areas of the country where more than three-fourths of the country resides. Today, as the nation battles its worst health crisis in a century, the call for better healthcare to every part of the country has grown louder. Recently, during a webinar on technology solutions for COVID19, renowned cardiac surgeon Dr. Devi Shetty from Bangalore laid emphasis on the need for frugal innovation to save the country from the disease. There are countless examples of low-cost innovation done to date - one of the earliest versions of the ECG and C-PAP machine are among the earliest and are hailed by medical practitioners for their durability, portability and endurance to thrive even in harsh conditions with little access to maintenance. With the proliferation of the Internet, even to India's most far flung areas, there is a huge potential for healthcare solutions to reach these areas. In the past decade, major leaps have been taken in healthcare solutions using technologies like AI and IoT in treating a range of illnesses and conditions like diabetes, cardiac disease, maternal and neonatal health and more. 

How Can AI Help? 

Over the years, Artificial Intelligence has proven to be that crucial bridge to healthcare delivery. It has shown results in diagnostic imaging, remote consultation, maternal health monitoring, assessing vital parameters and more. For instance, in the case of diagnostic imaging - India has a very low number of radiologists. For a population of 1.4 billion, we only have 10,000 practising radiologists. However, companies are working on a host of solutions that makes it easier to send images to radiologists no matter the location and ensure prompt diagnosis. AI is helping take this a step further by helping with simple image recognition, applying deep learning to multiple images and hastening the process of diagnosis for the specialists. Similar strides are being made to diagnose life-threatening diseases like TB, cancer and assist with improving outcomes during birth as well. High income nations are already applying AI across diverse healthcare fields. One study has found that the use of AI could save healthcare costs of upto $150 billion in the USA by 2026. In low-income nations, there is abundance of data across geographies, making a strong case for AI to improve health outcomes. 

The ongoing COVID19 crisis has created a windfall for telemedicine. Companies in India like mFine, Remedo, Practo are reporting a surge in their telemedicine offerings. AI is cementing this high-growth potential by offering doctors to develop personalised care models based on individual patient data, enabling chatbot and video deployment to address patient queries remotely in addition to maintaining meticulous patient records. 

Building for Bharat - What Startups Say 

Several healthcare startups in India have been working on developing solutions for low resource settings using tech built on AI. These enterprising and socially-tuned enterpreneurs are excited by the potential of working on tailored healthcare solutions for rural areas, but are also acutely aware of the challenges they have to face. India is a land of vast geographies, weather conditions and genetic patterns. This throws unique challenges in diagnosis and treatment protocols. In addition, procuring data from far-flung places is a Herculean task since maintenance of health records remains rather rudimentary. While residents in urban areas are well versed with EMRs and PHRs, these concepts are not robustly implemented across the country. Entrepreneur Senthilkumar Murugesan understands this all too well. Hailing from Madurai, the founder of JioVio Healthcare witnessed firsthand the lack of adequate medical care facilities and follow up care for pregnant women near his hometown of Madurai, Tamilnadu when his sister was expecting a baby. This led him to develop portable health kits called SaveMom that are designed to continuously monitor the health of pregnant women in a non-intrusive manner. Senthilkumar is an avid product builder, but believes tech expertise alone is not the answer to building devices for low-resource settings. "If you're trying to build a product for a low-resource setting, it requires a thorough understanding of the cultural and social milieu as well as the immediate need of that particular area. Most technology solutions today, however robust and state of the art, don't succeed in these areas because the user doesn't understand how the product can help him. It is critical for a product engineer to sit with public healthcare officials to understand the target group and build a product accordingly. While this can be accomplished, one area that remains tricky to getting adequate data to train AI and apply ML principles to. Healthcare data in rural areas are either not maintained adequately or are manipulated, leading to the AI being skewed." While he was developing the SaveMom kit, Senthilkumar and his team collected data from the target groups over a year before they started a prototype. 

Another major challenge startups encounter onground is the quality of Internet connectivity. This concern was echoed by Suthirth Vaidya, CEO of Predible Health, which is developing AI-based solutions for radiology. Since COVID19, Vaidya has witnessed a significant increase in telehealth consultations on their platform, especially from rural areas. While Predible Health has done largescale deployments with Tata Memorial Center, Mahajan Imaging & Max Healthcare, there is sustained interest in deploying in rural areas of India where the environment and settings are very different. Vaidya says, "The conversation is no longer about AI alone. When it comes to deployment in low resource settings, it requires a collaborative ecosystem from end to end to make the endeavour successful. For instance, spotty or poor Internet connectivity is a major challenge for startups like us as we cannot upload images of X-Rays on our cloud and share with a specialist. In such a situation, a technical specialist has to be present to troubleshoot, and getting this kind of help in rural areas is a huge challenge."

Agile Startups Find Solutions 

Entrepreneurs are tough people and don't get deterred by any challenge. It's notable that founders like Senthlkumar and Vaidya have developed fixes for these challenges too. Senthilkumar says, "My team and I have worked extensively on ground and across many districts in Tamilnadu to understand the challenges commonly encountered. This also involved multiple product iterations and refinement. Our marquee product is the SaveMom bracelet or wearable, which has multiple elements such as an IoT sensor, voice interface and application-centric optimisation. This device works even if Internet connectivity drops due to powercuts or low bandwidth - a common occurence in rural areas. Once the Internet connectivity picks up, the device backs up all the data on our cloud and we have a continuous flow of patient information on our database." Predible Health too has come up with a similar fix - Vaidya says his team built a small form factor box or a mini server for their product. If the product is in a low-resource setting with limited Internet, the server utilises the Internet only for device updates. 

Another example of a successful deployment in a low resource setting is by Yostra Labs, a Bangalore based healthcare startup that specialises in diabetes screening and treatment. The company deployed its proprietary Point of Care device Neuro Touch at an NCD clinic in Ernakulam General Hospital last November. Cofounder Vinayak Nandalike said that the device, which is very successful in its urban pockets, was deployed keeping in mind possible constraints of the hospital. A three-member team of medical staff led by a doctor were trained to use the device on patients. In addition, an on-ground support team in Kochi was on stand-by to troubleshoot. 

A Heightened Interest In Tech For Low Resource Settings 

The buzz around building low resource products in healthcare was present even before COVID19 but understandably, the need for the same has gone up in the past six months. Danish pharma major Novo Nordisk is on a mission to beat diabetes in vulnerable countries. For World Sickle Cell Day, Hemex Health launched the Gazelle Diagnostic Platform - designed for low resource settings - is integrating miniaturised technologies with AI to revolutionise Sickle Cell Disease screening and diagnosis. The company said its also working on similar solutions for malaria testing and other diseases. TEAMFund closes a $30million impact fund focused on medtech companies to improve patient access in low-resource settings. And the Bill & Melinda Gates Foundation, Wellcome and Mastercard announced an initiative focused on combating COVID19, with the combined goal of enabling product development and access to quality healthcare for those in low-resource areas. 

Developing technology solutions for low resource settings is probably one of the most noble endeavours in healthcare, and could also prove profitable as more VCs, medtech companies and medical professionals come together to help those really in need. As Dr. Aravind Kasaragod of Cloudnine Group of Hospitals said a healthcare crisis like COVID19 is a perfect opportunity to Carpe Diem. Question is, will we?