Bottom of Pyramid (BoP) market in India mainly resides in rural areas.
This market has little access to healthcare. Healthcare services are
unavailable in many parts of rural India due to government’s constraints
in healthcare investment. Private sector healthcare investment even
with concessions for setting up small rural hospitals has not taken off
in a big way. Concessions for rural hospitals represent possibility for
large hospital chains to invest. However, the issue is mainly of
economic viability. Economic viability constraints for private sector
means limited healthcare access for rural poor.
A look at rural
healthcare consumers in BoP market shows that they cannot easily afford
transportation cost to nearest town and cost of specialty medicines.
Thus, we face a catch-22 situation as healthcare services do not reach
rural BoP markets and rural BoP consumers are unable to afford
healthcare services in the present form. This condition needs urgent
attention of both government and the private sector players in
healthcare.
Healthcare consists of preventive, diagnostic and
curative dimensions. Preventive healthcare usually takes the form of
education for the targeted audience. Diagnostic healthcare helps
diagnose health problems in many cases when clear symptoms do not
present themselves in ‘prospective patients’. Curative dimension of
healthcare deals with all efforts targeted at alleviating suffering from
an acute/chronic disease/condition afflicting humans. Each one of these
dimensions has their own advantages and disadvantages.
At
policy level, government would like to concentrate on all these three
dimensions. While preventive healthcare can be effective among rural BoP
consumers, it has had little practical impact. As is common to human
nature, ‘prospective’ patients tend to react only when they face a
trouble/symptom related to health. All governmental efforts at providing
preventive education/communication through celebrity endorsement using
popular mass media fall mostly on deaf ears. In addition, media dark
areas among rural pockets are unaware of these efforts. Thus, preventive
healthcare has not been effective.
Curative healthcare requires
infrastructure creation for in/outpatient treatment. In addition to
hospitals and clinics, it also requires trained staff to operate a
typical healthcare unit. Replicated on a mass scale, this effort
requires tremendous financial commitment of government at various
levels. Moreover, it needs to tackle doctors/other healthcare staff not
willing to work in rural areas. Several state/central governments have
tried using mandatory rural service but not with much success. Junior
doctors in rural areas also bemoan lack of enough patients to obtain
experience.
Urban areas with higher population density present a
vast array of patients/diseases to deal with in several medical
specialties. Without massive investment of governments for a long time,
curative healthcare has become the preserve of the private sector.
Private healthcare spending with reckless use of secondary/ tertiary
hospitals has become quite common. Absence of a basic/primary healthcare
infrastructure and diagnosis has vitiated the curative dimension of
healthcare.
Diagnostic healthcare can help prevent negative
impact on demographic dividend that we can reap through our human
resources in rural areas. In fact, diagnosis is the first step towards
treatment of a disease. Moreover, with outbreak of several diseases,
which do not produce unique symptoms, there is greater need for disease
detection/diagnosis. Medical technology developments have facilitated
greater diagnostic accuracy over time. Clinical examination and
diagnostic tests together help doctor in health problem diagnosis
precisely and get to treatment options faster. Thus, this dimension of
healthcare requires special attention.
Diagnostic healthcare
presently uses medical equipment that is mostly bulky, not easily
transportable, and usually not operational in non-hospital/inhospitable
conditions. Moreover, they require specialized technical knowledge and
are time-consuming especially considering time from obtaining diagnostic
inputs to final diagnosis. Doctor- focused, hospital-centric diagnosis
along with bulky medical equipment make healthcare inaccessible to rural
areas. Development of point-of-care diagnostic testing (POCT) devices
is a significant solution to this problem.
Point-of-care
diagnostic testing devices are devices that help administer diagnostic
tests near patient/at her bed. Common examples are blood glucose
measuring meters or pregnancy test kits. Such devices help patients to
self-monitor health condition using a simple, easily operable device.
Such devices that even functionally literate persons can operate can
bring a major difference to rural health care services access. A step
ahead is point of care devices in general, which not only help in
diagnosis but also in health monitoring and treatment
Designing
POCT devices is a focus area for many medical devices companies in USA
for an entirely different reason. USA faces an ageing population
compared to India. With increasing lifespan due to medical sciences
development, there is a greater need to serve older patients at home.
Healthcare services provision at an old patient’s bed was the trigger
for POCT devices development. Distributed diagnosis and home healthcare
are the new healthcare trends. These trends can also solve rural India’s
access constraints to diagnostic healthcare. However, several aspects
need consideration while developing POCT devices for rural BoP market.
Rural
areas hardly have access to quality power. POCT devices designed for
rural India’s needs require longer battery-powered option. Examples of
devices incorporating similar requirements are mobile phones that
require recharging only once a month and can be battery-powered. Device
operation needs to have simple steps. Para-medical staff that may be
semi-literate, should be able to operate the device easily.
Practical/simple display of vital parameters on screen is a key
requirement in addition to local languages capabilities. Mobile
telecommunication access is expanding rapidly in rural BoP markets.
Mobile use for data capture/transmission to a nearby specialty hospital
would facilitate tertiary treatment options. Device consistency and
reliability in differing temperature/ humidity conditions is vital given
diverse climatic conditions across the country.
POCT devices in a
highly populated country like ours will find use for
screening/detection of large patient numbers. This necessitates device’s
ability to cater to high usage volume/ frequency. With different users
and usage styles, devices also need to be rugged. After -sales service
has to be a major consideration in POCT device development for rural
Indian BoP market. Costly/sophisticated devices and use of experts for
maintenance/reuse will hamper POCT device penetration in rural areas.
Thus, new POCT device design and development becomes crucial.
POCT
devices development research requires close interdisciplinary
collaboration to be successful. Diagnostic device development inputs
would come from varied fields like biochemistry, biomechanics,
biomedical engineering, nanotechnology etc. On the other hand, marketing
inputs require understanding of markets and economics of production/
marketing incorporating business management thinking. Further, design
and specifically usability/human factors engineering play a key role.
User and environment/context of usage are significant in developing a
successful product. Medical device design and development requires
significant boost in India. Many in India perceive design unfortunately
only in relation to fashion. However, its role in healthcare access is
significant. Appropriate POCT device design along with supporting health
infrastructure can ring in major changes in Indian rural healthcare
scenario.
The author is Professor Marketing, T.A.Pai Management Institute,Manipal.