By Dr Shanker Adawal
The COVID-19 pandemic has exposed the deep vulnerabilities and
inherent gaps of India’s healthcare system. The outbreak of COVID-19 posed both
a challenge and opportunity for India’s healthcare startups. Despite several inherent challenges,
startups promptly engaged themselves and developed solutions for COVID-19
applications in the areas of prevention, detection, disruption management, and
operational efficiency and have provided innovations in medical goods and
services. The involvement of startups has helped the government to reach every
household during the pandemic.
By mid-March, it became apparent the pandemic has come to stay for a while and
thus, efforts were made to streamline the healthcare facilities in the areas
such as diagnostic kits, respiratory aids, ventilators, PPE, and other critical
capabilities as traditionally India was import-dependent of these vital
components.
The startup ecosystem rose to the occasion and produced high-quality products,
at scale and significantly lower prices than comparable products from around
the world. Except the testing kits (we had a shortage till June) and of course,
the COVID vaccine, we never felt any short-fall, even till date.
A variety of solutions were provided by startups in areas like rapid
diagnostics and screening, ventilator
and respiratory aids, preventing the spread of the virus by need innovation,
cold-storage to maintain sample integrity while transporting to COVID-testing
facilities and therapeutic candidate development and screening. The startups
also remained active in telemedicine,
online pharmacy, artificial intelligence / data analytics, transportation,
home healthcare and well-being segment.
Overall, the healthtech startups in India raised a total of $504 million
between 2014-2018.
As of 2018, there are a total of 4,892 startups in the Indian health-tech space
and the number has further gone up during the COVID-19 pandemic. Many startups
have also shifted from other sub-sectors to health-care. Not only that the
government has taken several initiatives to facilitate more number of
start-ups. To list a few, NITI Aayog recently set up a committee to boost the
government’s partnership with private companies to produce health equipment and
personal protection equipment (PPE). In April 2020, it announced eight startups
are working on innovative healthcare solutions to help the government deal with
the situation better.
Secondly, the government’s Centre for Augmenting WAR along with COVID-19 Health
Crisis (CAWACH), a unit of Department of Science & Technology has
shortlisted 54 startups developing solutions to tackle the pandemic. CAWACH
aims to quickly scale up responses to detect, test, treat and reduce Covid-19
transmission in India. The department filtered out 54 startups for developing
indigenous, low-cost and effective solutions to contain COVID-19. Other
government departments and bodies such as SIDBI have launched schemes to
promote startups.
Multiple activities are being done for startups at different levels in the
government system, but as observed, there was an absence of synergy. Now, the
Indian healthcare startups have matured and ready to serve the country, they
look to the government to formulate a national policy where adequate provisions
may be made for their participation.
As a startup progresses from inception to commercialisation to scale, one of
the most pertinent factors that shapes its operations and strategies is
adherence to governmental regulations. Here in India, health laws and policies
are localized-the startups move around the local municipal offices to state
health departments for months together to obtain licence, permissions and
obtain laboratory / clinical trials.
Non-availability of uniform regulatory and validation standards, leads to a
huge variation in validation requirements at States and hospitals. As a result,
hospitals often rely on foreign regulatory certifications such as FDA and CE,
especially for riskier devices and instruments.
Due to absence of a standard national policy, the startups often face
procurement challenges in both public and private procurement. The startups
also face operational liquidity crunch as they spend long periods of time in
the early development of their product. The process of testing the idea and
working prototype, receiving certifications, performing clinical and commercial
validations, and raising funds, in an unstructured environment makes the
gestational period unusually long thereby limiting the operational liquidity of
the start-up. There is a lack of incentives and adequate frameworks to grade
and adopt innovations.
Indian startups are more vulnerable than older incumbents to the shock brought
by the pandemic. They tend to engage in high-risk activities compared with
other small and medium-sized firms (SMEs), face constraints in accessing
traditional funding, and have a formative relationship at best with suppliers
and customers. In many countries, adequate measures were taken targeting
startups’ financial fragilities. These include measures such as loan
guarantees, direct lending, grants or subsidies. France has set up a €4 billion
fund to support startup liquidity, while Germany announced a startup aid
programme, expanding and facilitating venture capital financing. In the case of
India, although initiatives were taken, they have not been shaped properly to
meet the challenges on ground.
The statistics indicate, till date, there is only one government bed for every
1,844 patients and one doctor for every 11,082 patients (lower than WHO
standards) and the country is ranked 145 among 195 countries on the healthcare
index. In order to provide affordable health care facilities to the 137 crore
population, the government is to formulate a robust national health policy and
focus on expanding hospital and human resources, healthcare startups can be
effective to improve efficiencies, provide affordable services and bridge gaps.
The engagement of the startups in the healthcare ecosystem will put the health
system in a more robust position to help absorb the impact and save lives more
efficiently in the event of another pandemic.
Providing easy and affordable healthcare for India’s ever-growing population is
a challenge. Therefore, while formulating strategies, health rights of the
people must be kept at the centre and affordability, accessibility and
availability should be made the main mantra. The government may consider
integrating few of its flagship programmes with health-care startups. The
country has learned enough in the last six months and thus, it is critical that
the right to health be supported and the health-care start-ups may be made as
the key drivers to achieve affordable health-care for all. Mainstreaming of the
healthcare startups in the Indian health system is certain to accelerate health
system efficiency and bridge the gaps.
The COVID-19 pandemic has provided us an opportunity to improve our healthcare
system. The need of the hour is to formulate a robust national health policy
and promote the concept “One Nation One Policy for the Startups”.
(The Author is officiating as President, Manavadhikar Samajik Manch, a New
Delhi-based organisation which works in the areas of promotion and protection
of human rights)