India’s healthcare and laboratory leaders agree that meeting these demands will require better distribution of healthcare services. From expertise to infrastructure, 75% of healthcare assets are accessible by only 27% of the population [1]. Access is particularly limited outside the country’s major cities. 

“The next wave of growth has to come from tier-II, tier-III towns, [and] not enough people are concentrating there,” said Mr Sanjeev Vashishta, MD and CEO of PathKind Diagnostics, in a panel presentation at the 2018 LEADx Diagnostics Leadership Summit in Mumbai, India. To help change this situation, his company is building a hub-and-spoke network of laboratories and collection centres to expand their services.

Adopting a three-tier model, PathKind Diagnostics is setting up regional reference labs that are connected to network laboratories in metros and smaller rapid response labs in tier-II cities. These will be complemented by multiple collection centres, whose samples will be sent along the chain for processing.

A far-reaching network can also be built by franchising and partnering with smaller local laboratories. Either way, to realise the full value of this investment, laboratories need to integrate infrastructure with new technologies that can overcome the ‘last mile’ hurdle and bring the laboratory into people’s homes and communities.

Point-of-care testing’s potential to expand access

With less disposable income, many people living in rural areas delay obtaining vital healthcare until it may be too late. Figures suggest that only 10% of people in India have ever had their blood taken for diagnostic testing. Being able to offer tests and results directly in the community reduces the opportunity cost of diagnostic testing when loss of a day’s income simply cannot be afforded.

Point-of-care testing (POCT) is one solution to the last mile-hurdle. Its potential for rapid diagnosis of infectious diseases like malaria, dengue and HIV is widely acknowledged, even if challenges remain for its implementation in low-resource settings. And with skyrocketing incidence of non-communicable diseases like diabetes in India and other countries around the world, it could also prove useful in the diagnosis and ongoing monitoring of chronic conditions. 

“I have an experience in an earlier hospital where as part of our CSR [corporate social responsibility] programme we had adopted 200 villagers in the nearby area, and we could establish [POCT] for as little as about a dollar a month,” said Mr Dilip Jose, now Managing Director and CEO at Manipal Hospitals. “Diabetes could be controlled… by monitoring at their homes and using generics.”

While a dollar per month may not be a large investment, scaling this up to cover whole communities or regions would increase the cost significantly.

“We have been clamouring about POCT for years,” noted Mr Varshita. “At one level, you want the test to be accurate. Sensitivity and specificity has to be high. [But] POCT eludes this. [And] for the areas where you want screening to be done, it is still expensive.”

While POCT may not be a panacea that will deliver accurate and affordable care to all, it does help healthcare providers to reach out to patients in more remote areas, close the care loop, and avoid unnecessary loss to follow up.

Coupled with mobile platforms that track POCT results, laboratories and healthcare providers can offer further value by effectively extending services even those patients who live far away from any care providers. With mobile phone penetration projected to rise rapidly in the coming years , laboratories can complement physical infrastructure with virtual networks through which to provide innovative services and create low-cost digital solutions.

“I do think the mobile is going to be the hub for diagnostic services in India and that’s where the patient will be the centre and the epicentre of care,” said Dr Ajay Gupta, MD and Group CEO of the Indo UK Institute of Health believes laboratory medicine will evolved.

[1] Patil, A., 2002. Current health scenario in rural India. The Australia Journal of Rural Health. 10(2), pp.129-135.

This article is based on a panel discussion “Are we ready to drive the next wave of healthcare growth?” at LEADx Diagnostics Leadership Summit in Mumbai, India.