Sustained provision and minimal disruption of essential healthcare services across primary, secondary and tertiary care . 

Healthcare sector was at the frontline bearing the brunt of COVID19. The sector has been stressed to the very limit, owing to a multitude of factors. First, a large fraction of the sector’s delivery capacity has been deployed to fight the pandemic. Second, this battle is significantly affecting the capacity for healthcare delivery (through infection of clinical and non-clinical staff), thus prolonging the path to recovery. Third, despite these challenges, some capacity has to be reserved for essential healthcare services even in the midst of the pandemic. Fourth, inadequate capacity allocation to some seemingly inessential services (e.g., managing non-communicable diseases) may lead to increased burden on the health sector through more hospitalizations and deaths. Fifth, demand for inessential services (e.g. elective surgeries) may never be truly “lost”, and may actually become essential (e.g. emergencies) if postponed for a long period. 

Preliminary evidence from the National Health Mission shows a significant decline in services across the board ranging from maternal and child health services (institutional deliveries and vaccinations) and outpatient consultations (for non-communicable diseases) to inpatient treatment (for communicable diseases) and emergency hospitalisations. However, every crisis carries with it seeds of opportunity in it. The Ministry of Health and Family Welfare, in collaboration with the NITI Aayog and the Medical Council of India, issued long-awaited guidelines for telemedicine. This has not only paved the way for large-scale adoption of technology by existing players in the market but has also created an opportunity for numerous start-ups in the health-tech sector. 

Projects here aim to develop an in-depth understanding of ground realities for each of the above challenges and the role that emerging technologies can play along with existing best practices to overcome them.  

Projects under this topic are:

Project 1 : Business-model Innovation to Ensure Sustainability of Frugal (high volume, low-cost) Models of Healthcare Delivery in the Aftermath of COVID-19  

Faculty: D.V.R. Seshadri, Sarang Deo 

Project Brief: Several single specialty healthcare organizations (e.g., Aravind Eye Care Systems, L. V. Prasad Eye Institute, Tata Memorial Center) seek to provide equitable access to high quality healthcare services to all patients irrespective of their ability to pay. These models often employ differential pricing and quality of service (i.e. more affluent patients pay market prices and receive high quality service whereas low-income patients pay subsidized prices and receive basic service quality) to improve access while achieving financial sustainability. A key driver of their success is their capability to develop standardized workflows that can service high patient volume thereby delivering on low costs (e.g., bulk procurement, vertical integration, low overheads) and high clinical quality (e.g., learning by doing, adoption of standardized protocols). 

COVID-19 poses significant challenges to the financial sustainability of these organizations. First, health facilities in these organizations are associated with significant physical crowding. Thus, they will pose significant risk of infection to patients as they resume their operations. Second, a large fraction of their patients travels over long distances to access care which would be difficult due to travel restrictions, lack of transport options and associated increase in expenditure during periods of economic hardship. As a result, it is imperative for these organizations to innovate their marketing and service processes to ensure their financial sustainability while continuing to serve their mission of expanding healthcare access to low-income communities. 

This project will involve developing a deep understanding of the current operating models and their associated risks. This will be followed by documenting the organizations’ short-term response to COVID and associated challenges, wherever possible, validated with operational data collected from the partner organizations. A report with critical analysis of various business model innovation strategies under evaluation or adoption by healthcare delivery organizations.

Project 2 : Assessing the Readiness of India’s Vaccine Manufacturers and Health System to Rapidly Produce and Distribute Anti-COVID Vaccines at Scale 

Faculty: Sarang Deo 

Project Brief: A vaccine against COVID-19 may well be the most awaited and most sought-after biopharmaceutical product in the world in recent times. It is estimated that more than 100 independent efforts are currently underway to develop a vaccine, 30 of which involve Indian entities, either independently or as part of global teams. This is not entirely surprising, given that Indian companies are among the largest global manufacturers of vaccines. Serum Institute of India, which supplies 20 vaccines to 165 countries, has partnered with Oxford University and plans to unleash its excess capacity of 400 to 500 million doses. Bharat Biotech has partnered with FluGen and University of Wisconsin and claims to have capacity for 300 million doses.

However, translating vaccine production into vaccinations is not trivial. Despite several missions and campaigns India’s childhood vaccination coverage remains low, especially in states such as UP and Bihar, where 40-50% of the children are estimated to not have received all recommended vaccines.2 In fact, adult vaccination, unlike more developed countries, is almost non-existent with penetration being less than 1-2% even in higher income segments.3 In 2015, several doses of flu vaccine against H1N1 were left unused due to a plethora of factors including reluctance of doctors and lack of awareness.4 On the one hand, the economics of vaccine supply chains, which will drive the uptake in the private sector, is not well understood. Further, vaccination programs in the public sector are primarily designed for childhood vaccines.

This project involves critical analysis of current barriers for rapid and large-scale uptake of COVID vaccines in the public as well as private sector. These may range from economic incentives for various players to logistics and supply chain barriers in the last mile delivery to increasing awareness and demand generation. 

Project 3 : Designing a Centralized Platform to Optimize the Blood Supply Chains in Metro Cities

Faculty: Sarang Deo 

Project Brief: Unlike developed countries, blood supply chains in India are unorganized, fragmented and lack coordination. Patients and their caregivers bear the responsibility of either arranging a donor with matching blood group or replace the blood procured from blood banks with voluntary donations of any blood group. Blood banks rely on these voluntary donations or organize blood donation drives, both of which impose significant uncertainty on the supply. Furthermore, there are no centralized platforms, where blood banks can exchange information on the available inventory of various types of blood and its components. As a result of the structural constraints highlighted above, blood supply chains in Indian cities are characterized by significant mismatch between supply and demand. In 2017, the clinical demand for whole blood and blood components in India was about 14.6 million units but the actual collection of blood was only 11.1 million units. However, at the same time, it is estimated that 2.8 million units of blood were discarded by blood banks across India in the last five years. The inefficiency is further exacerbated due to COVID-19 pandemic, owing to which donations across the country have reduced by 75%, thereby making it even more important to match demand and supply efficiently.

The project will focus on conducting secondary research on existing centralized systems in other countries and their relevance in the Indian context with focus on: (i) governance and financing structures, (ii) operating model and performance metrics, (iii) use of IT to match supply and demand. The team will also conduct situational analysis of blood banks in India through analysis of secondary data on key challenges facing them with regards to inventory and demand management and conduct advanced analytics on inventory and demand data collected from a few large blood banks in Hyderabad to quantify the challenges identified through the situational analysis.

Project 4 : An Examination of Technology Absorption Capability in Indian Hospitals 

Faculty: Vijaya Sunder M 

Project Brief: The rise of digital technologies has presented a contemporary landscape of business transformation in the healthcare sector. The pace of technology absorption is likely to increase in hospitals. Technology absorption refers to the acquisition, development, assimilation, and utilization of technological knowledge in response to environmental dynamism. For realizing strategic benefits (top-line and bottom-line impact), hospitals should develop technology absorption as a dynamic capability, and not merely as an effort to manage day-to-day activities. 

The large hospitals in top-tier cities that often provide multi-specialty healthcare services and located in multiple regions have the upper hand towards the development of technology absorption capability. However, other smaller players that lack relevant resources to develop such a capability are worthy of attention. Consequently, in the scope of in small and medium-sized hospitals in India, this project aims to: 

• Examine the state of sensing (internal opportunities and available technologies) capability 
• Examine how the sensed opportunities are seized (assessment and investment decisions) 
• Examine how the transformation is brought in by exploiting the digital technologies and leading associated change management 

This project involves data collection and subsequent analysis towards presenting the current state of technology absorption capability in small and medium-sized hospitals in India, towards addressing the above aim. The success of the project will be based on objectively measuring the above three stages of technology absorption, as a detailed report that should assist further research in this area.  

Project 5 : Designing an Empathetic Digital System to Report Violence Against Women

Faculty: Saumya Sindhwani 

Project Brief: Media coverage and academic reports paint an alarming picture of a substantial increase in reports of gender-based violence during the covid-19 outbreak, with physical distancing measures acting to exacerbate existing barriers for victims to access resources. India’s National Commission for Women (NCW) reported that there was a >90% increase in cases in the first three weeks after lockdown while NGOs operating helplines to counsel victims of violence reported a drop in calls which they attributed to the forced proximity with their abusers.

The idea behind this project is to a) diagnose existing channels and systems for reporting gender-based violence and b) suggest changes to address concerns or propose a new digital channel to enable reporting. The team will reach out to experienced practitioners and victims and users of helplines to identify pain points and gaps in support while identifying factors which maximize access, comfort, security, and delivery of the best care to the victims of gender-based violence.