Leveraging Technology Innovations to Improve Primary Healthcare Access

A people-centered and accessible primary healthcare system is the foundation on which our ambitious Universal Health Coverage targets rest. Primary health care (PHC) includes?the most basic package of essential health services and products?that are needed to prevent disease, promote health, and manage illness—covering about 80 percent of a person’s health needs over their lifetimes. Yet, it remains out of reach for most of the world’s population.

We need to increase investments in primary healthcare – on infrastructure, human resources and systems for last mile delivery of quality health services including screening; essential drugs; and diagnostics.?We also need to invest in digital technology, which has the potential to greatly improve primary healthcare by increasing access, improving communication, and enhancing the quality of care.

Role of digital technology in primary health care

Digital innovations are reshaping the way primary healthcare is accessed and delivered, overcoming some of the traditional challenges. Some of these ways are:

• Connected diagnostics: Connected diagnostics include electronic health record systems, laboratory surveillance networks, handheld diagnostic devices with internet connectivity, mobile-based health applications, which can be integrated with the broader health care ecosystem in order to improve the accuracy, efficiency, and accessibility of medical diagnostic technologies and data. They can engage and empower patients as active participants in their own care, and streamline and healthcare workers’ efforts.
• Teleconsultation: Digital technology can enable healthcare providers to conduct remote consultations with patients through video conferencing or telemedicine platforms. This can be particularly useful for patients who live in remote areas or have mobility issues, as it can save time and travel costs. This was evident during the Covid-19, where telemedicine initiatives ensured service delivery in remote areas.
• Patient monitoring: Digital technology can enable healthcare providers to remotely monitor patients' health status through wearable devices or other remote monitoring tools. This can help detect health problems early and intervene before they become serious.
• Health education: Digital technology can be used to provide patients with access to health education resources, such as videos, podcasts, and online courses. This can help patients better understand their health conditions and how to manage them. For example, Kilkari, one of the largest mobile health programmes in the world to strengthen families’ reproductive, maternal, neonatal and child health behaviours impacted nearly 14,000 lives, and contributed to higher reported use of modern, reversible contraceptive methods by women in India - particularly among poorer families.
• Appointment scheduling and reminders: Digital technology can be used to automate appointment scheduling and reminders, which can help reduce no-shows and improve patient compliance with treatment plans.

Accelerating innovations: PHC Tech Challenge

In late 2021, PATH and its partners launched the PHC Tech Challenge, a global search for innovators and entrepreneurs in the healthcare sector. The Challenge provides a platform for promising innovations in MedTech, digital health, and cold chain technology that can improve quality, access, and affordability of primary healthcare in India and in other low and middle-income countries. Our aim was to accelerate deployment of near-ready innovations by providing access to key stakeholders, expert advisory and assist in on-ground implementation.

The PHC Tech Challenge spotlighted innovations that could potentially transform how primary health care is delivered to the most vulnerable populations.

One of the winning innovations was AiSteth, a smart stethoscope to screen, detect, and predict cardiorespiratory disorders. The first point of contact for patients is a healthcare personnel at the primary healthcare centre who may not be adequately trained to evaluate heart or lung sounds. AiSteth provides access to digitally recorded heart/lung sounds with visualization, so that primary healthcare staff can do the initial evaluation and record, store, and share the digital files with specialists in hospitals for remote monitoring and/or second opinion.

In India and other LMICs, clinical breast examination (CBE) is the recommended breast cancer screening method in a primary healthcare facility, since mammography is not affordable. However, CBE only detects palpable lumps usually seen in later stages of cancer. Thermalytix, developed by Niramai is a portable, affordable, radiation-free test for detecting early-stage breast cancer in women of all age groups and is developed using novel artificial intelligence (AI) algorithms over thermal images. It detects small lesions even before symptoms appear, thus, prompting early treatment, lowering treatment costs, and improving health status post the treatment. Early detection reduces treatment costs, increases treatment efficacy, results in better quality of life post treatment and saves lives.

On the ground

Technological innovations can make remarkable strides in bridging gaps in diagnosis. COPD, for example, is the second leading cause of death and disability-adjusted life years (DALYs) in the country. As per the 2022 MoHFW annual report (2022), chronic respiratory diseases resulted in 10.9% of all deaths in India. Yet it remains underdiagnosed. Traditional spirometry services are available at private or government tertiary care facilities limiting access to diagnosis, which leads to patients going undiagnosed or getting diagnosed at a very late stage of illness.

In Maharashtra’s Satara district, PATH is supporting the deployment of Alveofit Spirometers at selected primary healthcare centers (PHCs) and district and rural hospitals. Alveofit Spirometers are point-of-care, handheld devices that make screening for lung function and disease prevalence easy and accessible at the grassroot level, through trained medical and paramedical staff. They are easy to use in low resource settings and screening moves patients up the ladder for further diagnosis and confirmation of respiratory conditions like Asthma, COPD, ILD, ALS, Fibrosis, etc. Till now, these spriometers have been deployed at 17 PHCs, one District Hospital, three Sub-District Hospitals, and 15 Rural Hospitals.

PATH is also supporting the deployment of Swaasa, a mobile based application for cough sound assessment, developed by Salcit Technologies, in public and private facilities in states of Haryana, Andhra Pradesh, Telangana, Karnataka, Tamil Nadu and Ballia, Uttar Pradesh. The pilot aims to look at the commercial use of Swaasa, its efficiency and effectiveness, and the willingness of clinicians and individuals to use the app.

In Arunachal Pradesh’s East Kameng District, PATH is supporting efforts to validate the efficiency of Redwing drones that can supply essential medicines, vaccines and diagnostics for remote locations.

Challenges and way forward

It is important to never lose sight of the ultimate goal of digital interventions: to make it easier for the end user to seek quality care. Without this guiding principle, they could exacerbate digital divides or become a barrier in care-seeking due to limited digital literacy and resources. According to the WHO, to integrate digital technologies in primary health care, countries must address its key components: building the physical infrastructure; deploying appropriate services and applications; developing a capable health workforce; ensuring a sound legal and regulatory environment; and improving governance, policy, standardization and interoperability.

Developing standards that enable interoperability and effective harmonization, such as the?Health Data Governance Principles is equally important. These could galvanize global collaboration and create an enabling environment to scale up healthcare innovations. Regulating the commercial digital health sector and addressing concerns of data ownership and ethical considerations is another critical piece of the puzzle.

Finally, putting people at the centre of digital innovations is critical – improving digital health literacy among the general population can educate and empower to practice self-care, take control of their health data and assess reliability of information. At the other end, it is equally important to invest in training the health workforce to use digital technologies, whether in the delivery of care or in planning and management.