H.E. Klas Molin has been serving as the Ambassador of Sweden to India since 2017. Prior to this, he served as the Ambassador and Chief of Protocol at the Ministry for Foreign Affairs in Stockholm, Sweden.

He also held various positions at Ministry for Foreign Affairs in Stockholm. He earned his Masters of Arts in Law and Diplomacy from the Fletcher School of Law and Diplomacy (USA).

Q. What is the Swedish interest in India and your priority topics for the Indian health sector?

We have a very fruitful bilateral collaboration with India in the health sector, beginning with our development cooperation in areas such as mother- and child health, midwifery, and work against communicable diseases. Cooperation has now increased to mutually beneficial partnerships. For the past ten years, we have had a Memorandum of Understanding on Health between our countries and next year we are going to celebrate this with an India-Swedish Health Year.

Many collaborations of mutual interests are ongoing and being planned that focus in a wide range of areas like antimicrobial resistance, elderly care, pharmaceuticals, non-communicable diseases and digital innovations including artificial intelligence, where the emphasis will be on knowledge transfer, capacity building and skills training.

InnoBRIDGE Sweden 2019 : Report

Q. An MoU was signed during Prime Minister Modi’s visit to Sweden on 17th April 2018 at Stockholm on “India-Sweden Innovation Partnership for a Sustainable Future”. Can you share the progress with respect to healthcare?

We are in the process of putting out calls and setting up incubators which will encourage close collaboration between the innovators in Sweden and India. Solutions are only sustainable if both sides contribute and share a strong sense of ownership. Progress has already been made in laying the groundwork for such partnerships within the sectors of clean energy and smart cities, and we hope to launch initiatives targeted to healthcare during the coming year. The Embassy will be sure to keep you posted.

InnovatioCuris signed MoU with Swecare

Q. India and Sweden will complete 10 years of Partnership in Health Sector in 2019, any plans in store for 2019?

India and Sweden plan to commemorate the ten years completion of the MoU in 2019. We hope to enhance our collaborations in new areas with new stakeholders like the new AIIMS that have come up in some states. We also hope to have high-level visits from both sides to enhance policy dialogues and bilateral relations. Some of the collaborative partners are also developing new plans to strengthen their cooperation.

Q. What can Indian healthcare businesses gain from Swedish healthcare businesses?

Any suggestions on possible partnerships? It is not so much what the Indian healthcare system can gain, but rather, how can we join forces to overcome common challenges. Swedish businesses have been in India for many years. Within healthcare, we have AstraZeneca, who recently celebrated 40 years in India, and Getinge who has been investing in the Indian ecosystem for many years. Their focus, like many others, has been in building the capacity of their employees and the users of their products to increase efficiency. The businesses also bring with them lessons from Sweden so that we can help India leapfrog outdated technology. Sweden also ranks high in most innovation indexes – it can be argued that our relatively small size makes collaborations outside traditional silos necessary in order to succeed. Public actors, private companies, and institutions often work together in finding innovative solutions to serious healthcare challenges. We would like to work with India to build spaces for similar ecosystems across India.

Q. What are the common areas for healthcare research and ongoing partnerships for both sides to collaborate?

Under the MoU, there are extensive collaborations between public authorities and universities from both countries. For instance, the Swedish Public Health Agency, Medical Product Agency and Forte (the Swedish Research Council on Health, Working Life and Welfare) have an ongoing collaboration with their Indian counterparts. There are ongoing discussions on extending collaborations with new players like our National Board of Health and Welfare and E-Health Authority as well as between our medical universities such as Karolinska Institute, Uppsala University and the different AIIMS.

Through these collaborations, we hope to demonstrate best practices and technologies. We have research calls in different areas for example with EU in big data and artificial intelligence for monitoring health status and quality of life after cancer treatment, under JPIAMR call on diagnostics and surveillance 2019.

Innovation-the UNNATI way is an India-Sweden Innovators for strategic business development to address global challenges. It is an industry-supported initiative coordinated by Business Sweden in collaboration with AGNIi-Invest India and ATAL Innovation Mission, NITI Aayog.

Q. You have signed for skilling nurses on infection control, wound care and diagnostics with Govt of Maharashtra in 2016. What is your experience of the last two years?

I believe the overall experience has been good. Business Sweden will, however, be able to provide more information on this as they have been coordinating this activity.

Q. Anti-Microbial Resistance is an important issue right now. How do you propose the Swedish Govt. support in this area?

The Swedish Public Health Agency and the Indian National Centre for Disease Control have an ongoing collaboration with a focus on antimicrobial resistance. Additionally, the Indian Ministry of Health has proposed that Sweden collaborate closely with a new-AIIMS and its associated Health and Wellness Centres. AIIMS-Jodhpur has been suggested to us and we are currently considering the scope of such collaboration.

Q. Artificial Intelligence seems to be a focus area for Sweden in the Health Sector?

Do you see any collaboration in this field with Indian providers? This is a hot topic all over the world right now. I know India is well ahead in AI technology while Sweden has more long-term experience in extracting relevant information from vast amounts of data. Our patient registries have enabled us to have one of the highest cancer survival rates in the world and that is only one example. I believe we will see some collaborations in the coming year, especially as you are arranging a delegation to Sweden addressing this exact topic in May next year. I will follow this progress closely.

Q. What is your message for InnoHEALTH Magazine readers? How can we, as a platform, support India-Swedish collaboration?

I congratulate InnovatioCuris for collaborating with Swecare Foundation and Swedish Medtech in facilitating innovative and promising solutions for India. Sweden has a long tradition of developing innovations in healthcare. We also have a well-functioning public sector, together with extensive health data registries, biobanks and digital connectivity infrastructure, that provides great opportunities to develop innovative, demand-driven, competitive solutions for healthcare. Exciting opportunities abound in an environment dedicated to medical innovation, drug discovery and pharmaceutical commercialization. Sweden and India have lots to share and learn from each other!

Exclusive interview of Union Health and Family Welfare Minister Jagat Prakash Nadda

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Prathistha Jain is Director, VibaZone Private Limited (India). She is an aspiring Entrepreneur having been involved with start-ups and her passion is in Entrepreneurial Development and Innovation. She is also an image consultant and a regular co-speaker at Entrepreneurship conferences.

Healthcare innovation should be sustainability beyond anything else. Sustainability can be weak or strong. It is weak only when technology is the focus. There will come a time when the technology would be outgrown, thus, it is important that a strong sustainability model should be the focus as it would consider multiple parameters to ensure sustainability. Healthcare innovation should focus on frugal innovation and recombinant innovation.

What is healthcare innovation first?

Healthcare innovation should focus on innovative information technologies, devices, workflow processes, care models or business models. Many companies focus on devices as the returns on these are more tangible. However, it is equally important to focus on the other areas mentioned too.

Technology for Healthcare vs. Healthcare Technology

It is important to understand the difference between the two. Technology for healthcare would be things like mobile phones which can be used for better health and interventions that reduce malnutrition, improve sanitation, and increase safety on roads. Healthcare technology would be specifically designed to prevent, diagnose, or treat an illness, from the highly specific focused on a disease to the more widely applicable monitoring devices.

Why is innovation in healthcare so critical and yet hard?

Innovation is critical because of the need, potential and impact of affordable healthcare technologies on a society like India. Given India’s low healthcare spending, is it possible to use technology efficiently and effectively to tackle India’s healthcare challenges? Besides the core technology aspects, we need to examine the nature and pathways of healthcare R&D and innovations in India, proposed evidence-based policy measures to overcome the bottlenecks and barriers, and to enable positive and healthy growth of the med-tech industry, eventually leading to strengthening the public health care system and the public health conditions of the country.

In the 12th 5-year plan for India the following was cited in the chapter on health. “Health should be viewed as not merely the absence of disease but as a state of complete physical, mental and social well-being. The determinants of good health are : access to various types of health services and an individual’s lifestyle choices, personal, family and social relationships. The focus is on the strategy to deliver preventive, curative and public health services. Other sectors that impact good health, such as clean drinking water and sanitation are dealt under other headers. These are essentials in health care hence the chapter should cover and handle these areas carefully.” Innovation should also focus on basic needs like clean water and hygiene besides affordable healthcare technology, along with advanced communications as these will be able to reduce disease burden and improve healthcare.

The healthcare system suffers from the following weaknesses:

1. Availability of health care services from the public and private sectors taken together are both qualitatively and quantitatively inadequate. We are short of medical personnel and hence we should focus on increasing the number of people by bringing in methodologies which require minimal training to up-skill an individual to use medical equipments and carry out processes.

2. The quality of healthcare services varies considerably in both the public and private sector depending on various factors. As we do not have proper regulation, it is difficult to measure the standard of care and effectiveness of healthcare delivery.

3. Affordability of health care is a serious problem for a vast majority of the population, especially in tertiary care. As many cannot afford the services and most families end up selling their assets to treat the family members, in some cases, treating the bread winners themselves. Also, drugs for chronic conditions are expensive and require regular monitoring and management.

4. Physical Reach / Accessibility of a healthcare facility which is having an outpatient department (OPD) for common ailments, and an inpatient department (IPD) for hospitalization.

The problems outlined above are likely to worsen in future with increasing disease burden and limited health systems capacity. Over the next several years, the cost of health care would go up unless proper regulations and new models are created in India to provide health care.

The Indian medical devices industry is a very small part of the total manufacturing industry, accounting for only 0.2 percent of all certified facilities. Following points are worth noting in this context.

1. Indian Government’s National health policy aims to increase and upgrade healthcare facilities.

2. The government acknowledges the need for foreign/ private involvement in medical technology.

3. The duties on medical equipment have been reduced over a period.

4. Most critical medical devices do not require import duties.

5. Make in India Policy to boost this sector.

Need for Indigenous Technology is well felt in the sector due to following factors.

• Huge growing market supplies predominantly by imports
• High healthcare delivery costs
• Growth of indigenous technology essential for strengthening the Indian industry
• Public supported R&D is hugely required
• Development of materials and devices is a major challenge.

Other Challenges

It is worth noting that currently there is no act for Biotechnology Regulatory and the one which was drafted has lapsed in the parliament that covered primarily biotechnology and not medical technology. A specific medical device bill (currently it is covered under Drugs and Cosmetics Act) and Indian’s own certification (like FDA in US, CE in Europe) is important; passing a bill in this area will make a huge difference to the market needs.

Infrastructure gaps remain substantial and are exacerbated by under utilisation of existing resources. Healthcare infrastructure is poor, compared to urban areas. Underutilization of infrastructure further compounds the problem of meagre infrastructure.

Current World Bank data shows India spends only 4.7 % of its GDP on healthcare. This has only grown 0.7 % in over 20 years. We have 0.7: 1000 ratio for physicians, 1.7:1000 ratio for nurses and midwives and 0.7:1000 ratio for hospital beds.

Leading economics spend up to 10 % of the GDP on healthcare and have two or three times as many medical personals and beds.

The healthcare sector is currently multi-layered and complex, which makes it difficult to unlock its true potential and provide quality services.

It extends to information gathering, interactions across roles, and the potential for control over wider ranges.

How can co-working spaces, incubators and accelerators in India help innovation?

Given the severe challenges of cost, availability of health care personal and weak delivery system – the rise of co-working spaces, incubators and accelerators in India can play a role in helping innovative projects to bring medical care to the masses at a reasonable cost. These innovations will also create business and impact the employment generated by these start-ups. Unlike e-commerce and aggregated models based start-ups, healthcare start-ups require specialized skill sets, larger funding and entail longer gestation period.

All three can play a different role, let us look at each of their roles.

Co-working space

Co-working spaces have easy access in most cities and are affordable so start-ups which are technology light like application, business models and systems can surface in these places. Most of these places have a reasonable amount of networking events with minimal support and can help start-ups get going.

Incubators

These are generally publicly funded and housed in colleges and research centers. Here technology development can happen as these facilities have some equipment and that can be used by start-ups to build their products. The start-ups would get expert advice and assistance from faculty and staff.

Accelerators

Accelerators are usually managed by organizations which are looking for good technology to be applied to their existing products and customer line. They are crucial because they would give a start-up a channel for distribution and manufacturing as these companies would already have successfully entered markets earlier and would have a good market reach to support the new technology.

Opportunities in the Healthcare Innovation

The Indian healthcare sector is diversifying and opportunities are emerging in every segment, be it providers, payers or medical technology. New players are building their entry strategy and domestic players are exploring new care models to stay ahead.

Innovation and Entrepreneurship

Healthcare as a driver for Innovation and Entrepreneurship can create innovative products and generate manpower in the healthcare sector. With the advent of alternate and innovative healthcare models, such as wellness centres, diabetes clinic, day care centres, diagnostic chains, among others, the entrepreneurial spirit in the sector has heightened.

Medical Research & Technology

Medical technology is a broad field where innovation plays a crucial role in sustaining health. From “small” innovations like adhesive bandages and ankle braces, to larger, more complex technologies like MRI machines, artificial organs, and robotic prosthetic limbs, technology has undoubtedly made an incredible impact on medicine. Medical scientists and physicians are constantly conducting research and testing new procedures to help prevent, diagnose, and cure diseases as well as developing new drugs and medicines that can lessen symptoms or treat ailments.

Growing demand

Rising income levels, ageing population, growing health awareness and changing attitude towards preventive healthcare is expected to boost healthcare services demand in future. Growing elderly population, changing disease patterns, rise in medical tourism, better awareness of wellness, preventive care and diagnosis has led to an increase in demand for healthcare services.

Private and Public Partnership

Private providers have shown a keen interest in partnering with the government on various kinds of projects, including primary health centres, emergency and trauma units, radiology and dialysis centres in public hospitals, as well as health insurance schemes.

Policy Support

NITI Aayog has allocated USD 55 billion under the 12th Five-Year Plan to the Ministry of Health and Family Welfare, which is about three times the actual expenditure under the 11th Five-Year Plan The share of healthcare in total plan allocation is set to rise to 2.5 percent of GDP in the 12th Plan from 0.9 per cent in the 11th Plan. The 12th plan focuses on providing universal healthcare, strengthening healthcare infrastructure, promoting R&D and enacting strong regulations for the healthcare sector. Establishing a system of Universal Health Coverage (UHC) in the country that means each individual would have assured access to a defined essential range of medicines and treatment at an affordable price, which should be entirely free for a large percentage of the population.

Way forward

Healthcare innovation should be sustainability beyond anything else. Sustainability can be weak or strong. It is weak only when technology is the focus. There will come a time when the technology would be outgrown, thus, it is important that a strong sustainability model should be the focus as it would consider multiple parameters to ensure sustainability.

Healthcare innovation should focus on frugal innovation and recombinant innovation.

Frugal innovation

Frugal innovation is the process of reducing the complexity and cost of a product and its production. Designing products for such countries may also call for an increase in durability and when selling the products, reliance on unconventional distribution channels. When trying to sell to so-called “overlooked consumers”, firms hope volume will offset razor-thin profit margins. Globalization and rising incomes in developing countries may also drive frugal innovation. Such services and products need not be of inferior quality but must be provided cheaply. Some great Indian examples are the Jaipur foot, oral dehydration salt and many more.

Recombinant Innovation

Innovators rarely come up with new ideas; instead, they convert old ideas into new ones, adapting them from one context to another. Henry Ford adapted his automobile assembly-line technologies from meat packing plant assembly lines. The Reebok “pump” was an athletic-shoe air bladder borrowed from intravenous bag technology. Even abstruse and highly specialized technologies like polymerase chain reaction have their roots in the existing practices of other genres.

Conclusion

Healthcare innovation should be focused on future needs and not today’s needs. Market needs are changing at a rapid rate with India’s rapid growth and modernisation. Technology will keep changing hence it is not suitable to depend on it alone. The key to healthcare innovation is simplicity based on strong sustainability combining technology, accessibility, affordability, quality and availability.

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