India's healthcare sector is experiencing a remarkable transformation, driven by innovation and entrepreneurship. The nation has long grappled with healthcare challenges, including remote and underserved regions, as well as the high cost of medical care. However, innovators are using technology to address these issues. Telemedicine and remote diagnostic tools are now bringing healthcare to even the most distant areas. This underscores the potential of technology to solve real-world problems and offers a lesson for businesses: harnessing technology can bridge gaps and open new opportunities.

One remarkable aspect of healthcare innovation in India is the balance between affordability and accessibility. Innovators have shown that making healthcare accessible to all does not require compromising on cost. By integrating affordability into the product or service cost, they have expanded access through remote equipment diagnosis, telemedicine, digital solutions, and financial inclusion. The journey of Indian healthcare innovators, such as Wipro GE Healthcare, offers essential business lessons. They started by building credibility and trust, making their products acceptable. By focusing on creating a direct market and local manufacturing, they managed to lower costs and provide intensive training. This emphasizes the importance of creating a supportive ecosystem and offers a blueprint for businesses aiming for industry leadership.

India's healthcare innovations serves as an inspirational source of business lessons. These lessons highlight the potential of technology, the importance of affordability, the significance of patient-centered approaches, and the balance between accessibility and cost. As India strives to become a global hub for medical technology innovation, these lessons are not confined to the healthcare sector alone.

ET this month looks at 'Innovations in Indian Healthcare: Inspirational Business Lessons'.

In the Thinking Aloud section, Jay emphasizes the need for significant innovations in India's healthcare sector, particularly in areas like cheaper medicines, hospitals, insurance, and medical records, and highlights the potential for growth in the medical devices industry, as well as the role of AI in transforming healthcare. On the Podium, D A Prasanna highlights that technological advances have transformed the Indian healthcare sector with accurate diagnosis, remote access, and patient-centered solutions, while innovators need to focus on comprehensive benefits for success. This way India can become a global hub for MedTech innovation by balancing affordability and accessibility. In the We Recommend section, Ramona Parsani, Vice President - Alliances at Ignite Life Science Foundation, reviews D A Prasanna's book Innovate Locally to Win Globally which offers valuable insights and lessons on leadership, ethics, and industry development, particularly in the MedTech sector, and India's future prospects in this industry.

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A recent story in The Print caught my eye. It mentioned: 'For the first time in four-and-a-half decades, Gorakhpur has passed its peak season without any Japanese Encephalitis (JE) cases or deaths reported.' Even for Acute Encephalitis syndrome, from a high of 764 cases (with 111 deaths) in 2017, the number has come down to 88 (with zero deaths) this year. The story mentions that 'Year after year, between July and September, the tragedy would repeat itself at Uttar Pradesh's encephalitis epidemic epicentre - until now'. And, 'It has taken six years and a coordinated public health crackdown for Gorakhpur to pull back from the worst era of encephalitis deaths. And it all came down to demonstration of priority and political will - a combination of bringing together water sanitation, health departments, improving the primary and community health centres at the rural level, bringing in specialist doctors to the Gorakhpur hospital, creating a new 500-bed dedicated facility, and battling the virus and lack of hygiene at source - the turnaround is nothing short of a public health miracle in India, not unlike the polio eradication programme.'

Gorakhpur's annual heartbreak is just one instance of the horrendous, periodic medical tragedies that hit the headlines from different parts of India. Unfortunately, such awful news doesn't elicit any outrage any longer, as the urban elite that has been the beneficiary of modern medical amenities, has been numbed by the frequency of such disasters. Indeed, you need to combine various elements to deliver good public healthcare (as the news article mentions above) and the innumerable holes in the system has caused immense healthcare calamities in India in past years. While it is too early to say that those nightmare scenarios are over and done in the India headed for the much vaunted 'amrit kaal', it is no exaggeration to state that India deserves major innovations in its healthcare sector. On all fronts of the health-care ecosystem, innovation is essential: cheaper medicines, hospitals (more - and better - doctors and nurses, physical elements, process flows, etc.), insurance cover, medical records, etc.

The pandemic compelled emergency action and everyone rallied to the call of saving lives. India pulled out all stops and battled the virus marvellously by creating its own vaccine, ramping up production, marshalled distribution and delivery and created the CoWin app for digital record keeping, and took various other novel steps. At the height of the second wave of the pandemic, many firms (even small ones) stepped up and ramped up production of ventilators. Besides, the number of pathology labs that accelerated their work to provide rapid results to patients, was phenomenal. All this is proof that when pushed to the wall, Indians can innovate in the healthcare space as much as they have done in other sectors.

The government's Make in India push and the Production Linked Incentive (PLI) scheme is the perfect platform for some Indian hardware solutions. Multinational firms have seen the potential of Indian markets, and firms like GE Healthcare has taken its creations global after generating them here, part of their 'reverse innovation' success story. GE has seen opportunities and last year announced the world's first 5G Innovation Lab in Bangalore, and also recently made another declaration of their intent to ramp up production to balance the China factor.

The list of major medical devices firms in India is still dominated by multinational companies. Invest India (a government body that promotes global investment into India) estimates that there are over 750 home-grown manufacturers in the medical devices field. Start-ups too are projected to be over 250 attempting to address the plethora of ailments and challenges that plague India's healthcare sector – which to an entrepreneur spells opportunities. However, here lies the paradox: given Invest India's forecast that the market for medical devices can grow by four times by 2030, to $50 billion (and with immense potential for export), it begs the question why there is no Indian firm that has been ambitious enough to do a Poonawalla (become a global giant, as Serum has done in vaccine manufacturing). A few innovative manufacturing unicorns in this space are also welcome. With overall improvements in national infrastructure (hard & soft: airports, roads, digitalization, etc.), there is bound to be an increase in the arena of medical tourism too.

The other major excitement that awaits us is the role of Artificial Intelligence as it is expected to change the medical landscape from diagnosis to treatment, and more. The medical fraternity is debating its new role in this brave new world where patients will no longer accept the doctor's answers blandly, but there are more surprises waiting to be unveiled. As the anticipation grows there is anxiety on moral grounds too as AI regulators sharpen their knives figuring out how to tame the genie that has begun to emerge out of the bottle. Watch this space, is all that we can say at the moment.

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ET:  What role do you believe technological advancements have played in transforming the Indian healthcare landscape?

DP:  Accurate diagnosis at affordable cost has been possible due to technological innovation. Accessibility in remote areas became feasible due to remote equipment diagnosis. In later years, the internet, smartphones, IoT enabled equipment have all helped improving accessibility.

ET:  What are some key challenges that innovators face when trying to introduce new healthcare technologies or services in the Indian market?

DP:  There is a misconception with innovators that if you bring cost of a diagnosis/procedure down, the solution will be embraced. Breaking new solution into healthcare system involves examining – does the patient benefit? Do doctor/caregiver benefit? How does it affect the hospital or clinic? How does the payor get affected? If any of these four are sceptical or have serious objection, the new solution flounders.

ET:  Patient-centric care and patient engagement is a growing focus. How can innovative healthcare businesses ensure that their solutions truly address patient needs?

DP:  Physicians and surgeons are more and more relying on tests, technology to be more accurate and reduce errors. In many societies, it has come at the expense of physician not looking into the patient's eye or less and less of nurse's healing touch to the patient! Half the battle is won if there is trust between the patient and care giver. Looking into the eye, engaging in a dialog to get symptoms, healing touch in nursing care, combined with accurate diagnosis, goes a long way in patient recovery and satisfaction.

ET:  How do you foresee the affordability and accessibility of innovative healthcare solutions being balanced in a country as diverse as India?

DP:  Affordability and accessibility are not at the expense of each other. Affordability of a procedure of a diagnosis can be built into the cost of product, medicines and consumable. Accessibility often has more complexity. Physical access of product/service to patient in a remote area requires service reach through remote equipment diagnosis. Clinical access requires doctor/medical personnel made available by care giver through telemedicine or connected care. For patients to be able to use it, he needs digital access of a smartphone and Ayushman Bharat (ABHA) card. For accessibility to be a reality, patient has to have financial access through Ayushman Bharat or other insurance schemes. Indian health infrastructure which was accessible to middle class, has undergone a huge transformation where all sections of society have access.

ET:  As a pioneer in the medical technology space from your days in Wipro GE Healthcare, please share some of the milestones in your journey to establish the firm as a leader in the industry.

DP:  First we had to create credibility and trust that Wipro GE has capability and capacity to install and maintain high tech scanners like CT and MR. Next we had to learn how to win customers ethically. When we found B2B share growth will take a long time, we focused on creating a B2C market - making aspiring Radiologists, Pathologists, Pharmacists, businessman - successful medical entrepreneurs in diagnostic center service. Through local manufacture lowered product cost, with NBFC got fiancé, offered intensive training...every hurdle we crossed holding customer hands. When Indian solutions found applicability in other countries, learnt to export. We started product development to suit Indian requirement. We started solving global challenges for GE in the diagnostic world. The journey took 7 years to become India number one with the mantra 'nothing is impossible'. And a decade to make India a MedTech global hub believing 'Innovate Locally to Win Globally.'

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When I picked up the book and went through the first few pages, I thought to myself, with the review at the back of mind, this is a book that will appeal to ONLY those who had stepped out of colleges and who had started their careers in the late 80s and early 90s. How can the larger audience find this book interesting? Life then was a far cry from now.

But how wrong I was, so very wrong. For one who began her working life at this time, it was going down memory lane with the actors in the book, and be warned, there are many of them. Prasanna calls them 'Cast of Characters'. But as I progressed with my reading, the larger and more important takeaways leapt out of the pages.

For those, not wanting to read further, let me say it upfront here. This is a book worth reading! One might find the detailing tedious – but dear reader, do go beyond. Today we talk about 'Make in India', being self-sufficient, especially when countries around the world seem to be circling the wagons, and we talk about fixing and solutioning for India. Challenges today in industry may seem different, but a closer read, and you will find you have been given the playbook to think big and better still - the building blocks to translating those thoughts into action and to achieving lasting results. This book is a primer for the newer players in industry, especially if you are building for the long term. Let the reader be warned that I have found it hard to delineate Prasanna the man from the MedTech industry. But not for one minute am I taking away from the many that built what we have today. That said...In 'Innovate Locally to Win Globally', D A Prasanna through his narrator, Arun Tiwari, details a remarkable journey of building the MedTech industry during one of the most challenging times of the Indian economy. With great contextual setting, aided by the handy reference the 'MedTech Sector timeline' at the start of the book, the book starts off with how the Western companies knew that to capitalize on their investment in technology development, they had to globalize through setting up distributors in overseas markets. When GE decided to come into India, they were very clear that they would only partner with someone without questionable practices.

Alongside, IBM had just been given the boot from India. Azim Premji and Ashok Narasimhan, a Tata Administrative Services (TAS) officer shared the vision of Premji's, that of filling this gap, hired Prasanna who was also from TAS at that time, to transform Wipro. From here the narration takes on the feeling of a juggernaut, moving through the minefield of setting up the MedTech industry, making the impossible - possible, encountering difficulties, the never-say-die attitude, the learnings, the growth and above all the strong values and work ethics that built this industry. Here I make special mention of strong values and ethics because it stands out in the many anecdotes, that make for insightful reading and is what an entire workforce imbibed, who then took it to the many other companies they worked for or started. In the 'Cast of Characters' you will find many names who are respected leaders today who have gone on, to build their own successful companies, founded on these ethics. It is no surprise then that many of these are well-known philanthropists today.

Each chapter has been aptly named that helps your focus on the learning that you get out of it. Long before 'design thinking' became a buzzword, Prasanna's every leadership lesson to his team was solve for the customer, put the customer at the centre. Ask the right questions, to get the right solutions.

At the heart of it, this book is about leadership and how Prasanna the leader navigates and innovates his way in the MedTech industry. The number of books written on leadership are plenty and you would ask yourself why you would need to read yet another on leadership. This is a book that details leadership with a difference, that's why. Here's how.

At every opportunity, Prasanna has been humble and learnt from the very best of his many interactions with his counterparts from around the world. When working with the Japanese he comes across the Daruma ceremony. It is undertaken when taking up a project. This starts with a red doll being brought from the temple. When the project starts, one eye of the doll is painted black, showing that the project has been 'opened'. On completion of the project, the second eye is 'opened' by painting it black and the doll is taken back to the temple and burnt along with prayers. The Japanese believe that through the duration of the project they are being watched by the divine and consider the completion of the task divine grace and not an egotistical achievement.

I make mention of this especially, because in the book one can see this non-egotistical achievement of building the MedTech industry through the way Prasanna has conducted himself, managed his employees, built the ecosystem of suppliers, vendors, support services, partners, etc. He knows and acknowledges that he has not been able to achieve this without them and acknowledges their part and gives them their rightful due.

As testimony to this he has devoted an entire chapter to the women that stood with him and built this industry. The author's recognition of the contribution of women is not only heart warming but also an essential lesson in inclusive leadership. And by featuring a photograph, the children of one of the employees, R Basil, who changed schools up to 9 times, he has been generous in acknowledging the contribution of the spouses and the families of those who helped build this industry.

In one of the last chapters, 'Technology Won' we learn how the entire MedTech industry, being built locally, to competitive international standards, over the previous three decades, was able to produce low-cost solutions, ventilators, and vital equipment, that saved so many lives during COVID. Had it not been for the rigorous building blocks set in place early on, we would never have been able supply and install 100,000 ICU ventilators when the need arose, over a period of a few weeks.

He closes with his thoughts on how India can achieve the goal of $50 billion by 2030 in MedTech, with the target of $100 billion also not out of reach. And since we already know that Prasanna believes that nothing is impossible, this is a chapter worth reading for those present in this ecosystem

Before I close, I must say, I am very glad that Prasanna listened to his wife Rajani, who urged him to find a narrator. She had felt the book would be unreadable to those who did not have the context. Arun Tiwari has done a magnificent job putting down the thoughts of Prasanna. There are some areas I would have liked him to have been less detailed. But when you know that you are being freely handed lessons to building something great, you can be forgiving.

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