Take the Bull by the Horns
I am a mechanical engineer who worked for 15 years at the Defence Research & Development Laboratory (DRDL) in Hyderabad. There, I developed the Trishul and Akash missile airframes and Titanium Airbottles. In 1992, Dr APJ Abdul Kalam, then Chief of the Defence Research & Development Organization (DRDO), decided to develop civilian spinoffs of defence technology. I came out of the mainstream to interact with doctors and learn from them to indigenously develop medical materials and devices as affordable import substitutes.
The success of developing a unique variety of 316L stainless steel led to the development of an indigenous coronary stent that became famous as the Kalam-Raju Stent. Cardiologist Dr B. Soma Raju, who guided this effort, invited me to leave the confines of defence research and development. We created the Cardiac Research and Education (CARE) Foundation, a biomedical research platform recognised by the Department of Scientific and Industrial Research (DSIR), Government of India.
The importance of indigenous development cannot be overstated. Innovation—a new method, idea, or product—is at the root of creation. Innovation involves creative brilliance and a particular type of people who think differently from the typical and conditioned ways of life. Using the vast infrastructure of defence R&D for civilian spinoffs was a historical innovation. We were driven to address the cost prohibitiveness, and our little initiative prepared the ground for many multinationals to open their factories in India.
By the turn of the new millennium, I found myself stranded, working with doctors and with little government support forthcoming. The advent of broadband connectivity saved the day for me, and we remained relevant by developing teleradiology, which became the basis of the Pan-Africa e-Network launched by the Government of India to connect African hospitals and universities with their Indian counterparts. The concept of delivering medical images directly from where they are generated to expert radiologists at their locations addressed the issue of a shortage of radiologists in the country. For a while, radiology became the most sought-after medical speciality, but as imaging machines became intelligent, the role of radiologists was reduced to verification.
Then came the era of generative AI, and machines started learning from radiologists’ work. Major equipment manufacturers integrated machine learning features into their machines, enabling imaging machines like CT and MRI to instantly identify patients’ apparent health issues. Today, machines can deliver highly accurate results, not only in imaging but also in laboratory tests. Blood is still needed, but in minimal quality—a drop rather than a vial—and soon, even that may be replaced by non-invasive methods.
Saying that COVID-19 was a watershed moment in modern times may sound like a cliché, but the fact remains that it has changed the way the world works. The way in which primary healthcare was abandoned during that period and private hospitals made money, is an embarrassing testimony to the fact that healthcare has become a commercial business. The medical profession has almost destroyed itself, being controlled by big money; most hospitals function with profit-making policies and how things will change is unclear.
So, the focus shifts back to innovation; its purpose is now redefined as delivery rather than mere availability. How do we take intelligent machines to needy people? They cannot access expensive hospitals because of a lack of money, nor are they always welcomed, as their presence is often viewed as spoiling these hospitals’ clean, polished ambiences that outshine even five-star hotels. This situation is untenable and, unless corrected, will lead to another healthcare crisis sooner rather than later.
Over a decade ago, I met Dr Bharat Veeramachaneni, an Internal Medicine specialist. The grandson of legendary leader Smt. N.P. Jhanshi Lakshmi (1941–2011), Dr Bharat is conscious of his responsibility towards primary healthcare. We create unsolvable issues for ourselves if we neglect to serve the poor and fail to address their issues. Once a pathogen develops anywhere, it becomes impossible to stop it. Today, the biggest problem is the need for more doctors in primary healthcare settings. Before the NEET system, state governments used to deploy doctors to work in such settings before granting them a PG seat, but now, no one goes there. What is the remedy?
I shared the famous story of Belling the Cat with Dr Bharat. In it, a group of mice agrees to attach a bell to a cat’s neck to warn them of its approach in the future, but they need help finding a volunteer to do the job. Technology, funds, and people are available; political will needs to be improved. I asked Dr Bharat if he would bell the cat. He surprised me by saying, “The time to bell the cat has long since elapsed. Our inability to mount a combined and concentrated effort, which included the screening and triage of patients at the primary healthcare level, adversely impacted and overwhelmed our secondary and tertiary healthcare response to the COVID pandemic, causing morbidity and mortality on an unprecedented scale. It is time to deal decisively with a difficult or dangerous situation or live burdened with chronic diseases.”
The productivity of a nation directly depends on the health of the country. With the existing secondary and tertiary healthcare infrastructure, which has neither the required manpower nor the physical reach, it is impossible to cater to the healthcare needs of 1.42 billion Indians. This challenge is compounded by the financial burden of accessing secondary and tertiary care centres for health issues that can often be managed at the primary healthcare level at a fraction of the cost. The responsibility for healthcare delivery cannot rest solely with corporate hospitals and private health insurers, who would manage it for their profits, which is a no-brainer.
There is an urgent need to develop a robust primary healthcare infrastructure: a formidable force of specialists fully vested with knowledge, power, and authority tasked with protecting our nation’s health. Further strengthening our primary healthcare with government policies and new-age tools such as AI would help improve surveillance, delivery and service efficiency and provide an opportunity to educate people on maintaining good health and preventing diseases. AI can bridge the six cardinal information gaps in receiving treatment in the hospital – first contact, longitudinality, comprehensiveness, coordination, person or family-centeredness, and community orientation.
Yes, the time to bell the cat has long since elapsed. The bull is running amok in the shop of fragile glassware, and the only way to prevent further damage and destruction is to take the bull by the horns, wrest control of our great nation’s health from the clutches of private and for-profit players and place it firmly back in the hands of capable, empowered primary healthcare providers. The question is not who will allow it but who will stop it. Life is all about taking the right actions at the right time.
MORE FROM THE BLOG
Will 2025 be ‘Year One’ of the New World?
Certain words and phrases gain prominence at different times, and this is becoming a fashion in the Internet media world. “Deep State is currently circulating about the mysterious powers that run the world…
Knowledge comes from Within
David Deutsch (b. 1953), a British physicist at the University of Oxford, is among the world’s foremost philosopher-scientists alive. He has worked on fundamental issues in physics, particularly quantum computing, quantum information and constructor theory. I learned about him through his books…
Mythology: Imagination or Coded Secrets?
Myths often reflect the creativity and storytelling traditions of cultures. They can be seen as symbolic narratives that explain natural phenomena, human behaviour and societal values. These stories often incorporate fantastical elements and characters…
The architecture of IoT in health care delivery consists of 3 essential layers: (1) the perception layer, (2) the network layer, and (3) the application layer. The perception layer needs to be standardised, and much work is required to make a seamless system.
Some of the most promising medical applications that IoT provides are through artificial intelligence (AI). AI can read available EMR data, including medical history, physical, laboratory, imaging, and medications, and contextualise these data to generate treatment/diagnosis decisions and possibilities.
IoT-based health care and deep machine learning can assist health professionals in seeing the unseeable and providing new and enhanced diagnostic capabilities. However, the first step would be to have a million people served at the primary care level.
Very nice article Sir. While technology advancements have been substantial over the last decade, the adoption of technology in healthcare delivery has not been as fast as in the banking and entertainment industry. One of the major challenges that healthcare in India faces is the lack of quality services that are available at primary healthcare centers. The advent of IoT devices can sure help in empowering services that are offered at PHCs.
Integrating IoT and Artificial Intelligence (AI) technologies into primary healthcare centers (PHCs) in India can revolutionize healthcare delivery, especially in rural and underserved areas. IoT devices enable remote patient monitoring, real-time diagnostics, efficient medicine supply chains, and emergency alerts, ensuring timely and effective care. AI complements these efforts by providing advanced tools for disease prediction, risk assessment, decision support, and telemedicine consultations, while also analyzing public health data to guide policy and resource allocation. These technologies improve accessibility, affordability, and scalability, promoting early detection and prevention of diseases like diabetes, hypertension, and cardiovascular issues.
By addressing critical gaps in healthcare delivery, IoT and AI can enhance patient outcomes, reduce healthcare costs, and empower public health strategies, creating a transformative impact on India’s healthcare landscape. The most important thing needed today is the will to implement these technologies and ensure availability of quality healthservices at the PHCs.
Thank you for thought provoking write up. Two points that are standing out
1. The productivity of a nation directly depends on the health of the country
2. AI can bridge the six cardinal information gaps in receiving treatment in the hospital – first contact, longitudinality, comprehensiveness, coordination, person or family-centeredness, and community orientation.
AI can ohelp with identification of issues such as weak infrastructure , lack of quality manpower so we know where to focus.
I agree with Dr. Chinnababu that decision-making, referrals, risk stratification, and triage remain the most defining factors. No technology can handle it at this point. but it can idetify quality issues which then can be bridged.
Excellent articulation Arun ji
Process automation is currently more developed in tertiary and, to an extent, secondary care but not primary care. Based on the transferable learning from secondary care and the priorities identified through engagement with primary care, the opportunities identified for automation within primary are Reduced administrative burden, Improved efficiency, Improved staff experience, Improved patient experience, Improved process assurance, Improved Long Term Condition Management; and Improved data and information capture/quality.
However, clinical decision-making, referrals, risk stratification, and triage remain the most defining factors. No technology can handle it at this point. Generative AI is promising, but we will only talk if a million patients are managed and their data is integrated. The chasm between primary and higher levels of medicines will only increase rather than bridge. And it will prepare the ground for another pandemic to arrive, God forbid.
IoT introduces a new generation of healthcare technologies to address the significant gaps in the medical services field. I have been working on an electronic medical tablet for intensive care specialists. This simple and rugged device relieves the burden on healthcare professionals, enabling remote tracking of core vital signs and sending notifications to physicians if the patient requires a check-up. We also integrated a voice control feature, following accessibility standards to make the device user-friendly.
The next logical step is to take IoT to primary health care. The challenge is the diversity of devices, each with its own communication protocols and data formats, often leads to compatibility issues, which can hamper the interaction between devices belonging to different manufacturers or systems. This fragmentation can often lead to what is referred to as data silos, whereby certain health information may not be well shared with healthcare practitioners. I foresee a standard PHS system in place by 2025 end.
प्राथमिक स्वास्थ्य देखभाल स्वास्थ्य और कल्याण के लिए समाज का एक दृष्टिकोण है जो व्यक्तियों, परिवारों और समुदायों की आवश्यकताओं और प्राथमिकताओं पर केंद्रित है। यह न केवल विशिष्ट बीमारियों के लिए बल्कि जीवन भर स्वास्थ्य आवश्यकताओं के लिए संपूर्ण व्यक्ति की देखभाल प्रदान करता है। प्राथमिक स्वास्थ्य देखभाल सुनिश्चित करती है लोगों के रोजमर्रा के वातावरण के – गांव, बस्ती. मोहल्ले में, जितना संभव हो सके रोग उपचार की देखभाल मुफ्त मिले।
सार्वभौमिक स्वास्थ्य कवरेज में गरीबी, भूख, शिक्षा, लैंगिक समानता, स्वच्छ जल और स्वच्छता, कार्य और आर्थिक विकास, असमानता को कम करना और जलवायु कार्रवाई शामिल हैं। सभी उम्र के लोगों के लिए स्वास्थ्य और कल्याण प्राप्त करने के लिए प्राथमिक स्वास्थ्य देखभाल की केंद्रीय भूमिका को पहचाना सामाजिक जिम्मेवारी है।भारत में इतने सारे करोड़पति और अरबपति होने के बावजूद, यदि किसी गरीब नागरिक को प्राथमिक स्वास्थ्य सेवा नहीं मिल पा रही है, तो यह उनकी संपत्ति के लिए शर्म की बात है।
Fabulous eye opener!! To improve the quality of healthcare for the poor, there must be increased transparency in healthcare spending and services. This involves reducing corruption in the distribution of resources, ensuring that the benefits of schemes like Ayushman Bharat reach those who need them most. The path to improving healthcare in India lies in expanding access to affordable, quality healthcare, increasing health literacy, and implementing effective healthcare policies. With a focus on building infrastructure, enhancing social safety nets, and reducing costs, India’s healthcare system can be more inclusive and equitable, ensuring that the needs of its most vulnerable populations are met.
Great warning to the nation through this blog to course correct now or repent later. While this reflects the state in most of the metro and 2nd tier cities, with our recent experience of staying in Goa, glad to say that smaller towns and talukas here still have reasonably strong primary healthcare system functioning. The concepts of family doctor and small single room clinics are still around. And truly they are the saviours running the show and scaling through tough times at least for not critical illnesses. Hope this system can be strengthened all across including major cities, while corporate hospitals lead the research and serve the ones who can afford them.
As Dr Mpoki rightly pointed out in his comment, the promise of primary healthcare still needs to be fulfilled in much of the world.
In 1978, the WHO Alma Ata agreement between 134 countries acknowledged ‘health as a foremost human right’ and identified primary healthcare as pivotal to delivering health to all by 2000. It was envisaged as ‘the first level of contact of individuals, the family and community with the national health system bringing health care as close as possible to where people live and work, and constituting the first element of a continuing health care process’.
Why the leading health problems in the community remain unserved through promotive, preventive, curative and rehabilitative care is a baffling question. I share your optimism about AI and non-invasive diagnostic methods in community clinics. I must add that ley young local people are trained in this work. I don’t expect much from the doctors and nurses in this area, as they are overburdened.
Thank you sir for highlighting the pressing need for robust PHC system in India. The COVID-19 pandemic laid the cracks in our healthcare infrastructure, where secondary and tertiary care facilities were overwhelmed due to the absence of strong primary care system. It is crucial to redirect focus toward the delivery of affordable, accessible care, powered by innovations like AI, which can bridge the gaps in early detection, triage and treatment. Relying solely on high-cost corporate hospitals is unsustainable and impractical for a country as vast and diverse as India.
With the right government policies in place and collective effort to prioritize primary care, we can prevent another healthcare crisis, empowering doctors and healthcare providers to serve where they are most needed.
It was indeed an eye-opening article, sir. With so much advancement in science and technology, most people in our country still grapple with the backbreaking cost of medical and healthcare provisions. While people from far and wide come to our country to get treated, our people sadly feel the heat of such gigantic medical bills.
It’s every citizen’s primary right to get the best medical care without being haunted by the cost of their treatment, which also affects each member of the family. You are correct that the time has come to take the bull by the horns. Let’s hope steps will soon be taken to provide quality medical to each one. As every life matters
The interconnectedness of a food secure, healthy population that is able to contribute to the growth and sustenance of a people is quite obvious yet we have treated healthcare as though it is a privilege rather than a lifeline, at least in my geography. I find myself often asking if my prescription is as a result of what is needed or because the health chain has to sustain itself by raking profits, through prescribing procedures and medications that are counterproductive and irrelevant. No wonder those who cannot afford it are left to the mercies of spiritual comfort. Its a high time………
Dear Prof
Thank you for the excellent piece on AI and healthcare.
In Rwanda, some young professionals are making innovations that could impact primary healthcare delivery. However, they need partnerships and growth for them to scale up and reach their dreams. This is their website: https://keezatech.rw/
African countries need partnerships to grow their homegrown innovative solutions. Any help offered to this startup would be appreciated.
Your excellent blog this month falls on the first day of the 109th. Radiological Society of North America (RSNA) annual conference & exhibition in Chicago where I’m attending and brings fond memories of how we met some 17 years ago while you were at the CARE Foundation, helping bring medical imaging technologies to India. Indeed, AI will help save many lives as well as extend lives of people across the globe. I’m confident the young generation of India will take the bull by the horns and contribute greatly to that end.
Arunji, Very nicely explained about inaction in the area of improving secondary health care system and who will save it from private and profit oriented entities. Yes its not about who will bell the cat now, its about who will prevent this from happening and make quality health care accessible to everyone.
Thank you so much for this insightful reflection Prof Tiwari, when diseases are picked early in the community, they get managed effectively with the assurance of healing, this saves families and community from catastrophic expenditures while nursing relations back to health. While the article’s context is the Sub Continent, the application is global as are the principles employed.