The DocSuit Debrief

Potential for Public Health Innovation

Valued at approximately 30 billion USD, the healthcare innovation industry in India is projected to continue expanding at a rapid pace. The rising consumerization of health has promoted dramatic growth in entrepreneurial ventures along four vectors: pharma, medtech, biotech, and healthtech. Innovations like rapid point-of-care diagnostics, standardized health information systems, and integration of AI into health technologies herald a new era with incredible developments poised to change the face of healthcare.

In stark contrast, India stands 66th out of 189 countries when it comes to per capita out-of-pocket (OOP) expenditure. Thus, a large proportion of the Indian population continues to pay for healthcare services out of their own pockets, with catastrophic spending on healthcare being a major cause for poverty. The COVID-19 pandemic highlighted the worsened socioeconomic inequities and disparities in healthcare access and delivery, with the worst-affected groups being from the lower-income strata and vulnerable communities. 

Rapidly expanding economies of developing nations like India continue to battle this extreme disparity of health, education, and income among citizen groups. As one of the few countries in the world where private healthcare companies enjoy immense power and presence in the health industry, solutions to problems in equitable health access and delivery are possible only through partnerships between the public and private sectors. The healthcare system can be fortified by focusing on crafting unique solutions tailored to the local context and using public-private collaborations to facilitate the scaling of these innovations for greater outreach.

An elegant and practical solution to the problem of addressing these health inequities by engaging the 4 Ps (private players, public sector, people, partnerships) is materialized in the concept of Living Labs. A micro environment for research and innovation focused on addressing end-user needs, a Living Lab provides a space for multiple stakeholders engaged in a problem, including the citizens, to work together with state actors and private players to develop solutions in a real-time environment. These innovations are then implemented and tested in the same environment to check their efficacy in solving those problems.

This is especially exciting because it flips the narrative of health inequity. Instead of passively advocating for change and better policies, disadvantaged groups are empowered by being proactively engaged in the process of solving the problems plaguing their own communities. 

There are 5 key elements in a Living Lab: 

1. User engagement: The end-point users at whom the innovation is targeted are the most important actors involved in the process of co-creation at living labs.


2. Multiple Stakeholder involvement: The Quadruple Helix (public sector, private sector, academia, and society) is typically engaged in health and social innovation.


3. Multiple Methodologies: There are no fixed methods to the process of co-creation, with a flexible approach centered on user needs being adopted.


4. Real-life environment: The implementation of research findings takes place in real-time spaces with direct community engagement.


5. Co-creation: Open innovation spaces will be created to foster the growth of new ideas by engaging multiple stakeholders in effective collaborations.

While the concept of user-engaged open innovation spaces has been around since the 1970s, the last decade has seen much greater attention being focused on “democratising” the process of innovation through co-creation. With a rising focus on sustainability and circular economies in the UNSDG 2030 Agenda, Living Labs have been used to build more resilient communities, especially to develop sustainable cities and healthier rural ecosystems. A Smart City Initiative in Goa has established India’s first Urban living lab (ULL) built on partnerships between actors like Royal Danish Embassy (New Delhi), Ministry of Housing and Urban Affairs (Government of India), TERI( The Energy and Resources Institute), Oxford Policy Management Ltd. (OPML) and Tandem Research. The goal is to work towards helping cities address sustainability and liveability by integrating global and local solutions.

In the context of healthcare, work done by PATH goes on to demonstrate how living labs can successfully be used in the public health diaspora to address problems of healthcare delivery. 

In a low-resource setting like Kenya, a living lab was established to ensure access to affordable and reliable products, tools, and information for good blood glucose control for people living with diabetes (PLWD). During consultations with the community, some key challenges were identified. PLWD had limited knowledge about diabetes management or self-care. Over 70 percent of the PLWD did not own monitoring equipment. There was frequent reuse of needles/syringes due to cost or unreliable availability, and a number of visits needed to be made to multiple facilities to get all supplies due to stockouts. All these factors were taken into account to develop a solution: Diabetes CarePak: a “human-centered co-packaging” solution that increases access to the combination of medication and associated supplies needed for safe administration of insulin and self-care to improve quality of life and health outcomes.

Similarly, living labs have been used by PATH, to advance lifesaving interventions for postpartum hemorrhage in Kenya, design vaccine preparedness and distribution plans in Zambia and address COVID 19 hesitancy, among other projects.

Closer home, a living lab was established as a collaboration between the Department of Informatics, the University of Oslo (UiO) and the Post Graduate Institute Medical and Education Research, Chandigarh, India (PGIMER). With a cross disciplinary team leading the project: “Design of Patient Centric Systems for Primary Health Care in Resource Constrained Settings”, a digital health system was developed that acted as a repository of important health information. From patient demographics and lab results to specific health program data, this health system developed through feedback and user inputs from patients and medical staff proved highly efficacious in a primary health set up and was scaled to other locations in Punjab and Himachal Pradesh.

All this being said, a few concerns surrounding the wide scale implementation of living labs in public health have been raised by researchers. Strong leadership and management at the helm is required to keep the projects progressing, because the involvement of many stakeholders can potentially lead to delays in decision making. Strong commitment is required from all stakeholders, especially the end-point users. Instead of engaging them with financial compensation, it is advised to involve them through voluntary recruitment cycles to ensure quality of representative pool. An open culture of interaction, engagement and innovation needs to be vigorously nurtured to facilitate productive dialogue among the relevant stakeholders. 

The apprehensions surrounding this innovation methodology are far outweighed by the potential benefits because employing this strategy has been proven to improve cohesion among state actors, private players and the regional communities. As the users are involved in the co-creation of solutions, there is less mistrust and hostility from communities in adopting the innovations. Moreover, the implementation outcomes,which are the ultimate litmus test to assess the success of living labs, have been overall positive, showcasing their success in improving healthcare outcomes. 

Even as LMICs continue an uphill battle against socioeconomic inequalities in health, innovation through community engagement stands as a solution with the potential to revolutionise healthcare access and delivery services. And by embracing the tenet at the core of PATH’s ethos: Health Equity through Innovation and Partnerships- we stand to gain ground in the journey towards health for all.