Capacity Building in Digital Health

Just by choice, very small fraction would probably take it by choice. Still people want to do jobs in manufacturing or R &D in the pharma companies. So that’s a big factor which we have to solve, which ultimately falls into the remunerations which people get, the future potential of your profession and all that. The community pharmacy in reality has not picked up in this country because of the social structure which we have. Otherwise, the capacity building for anything to do with healthcare, these pharmacists, community pharmacists have to play a very strong role. If you see doctors, nurses, other health technicians, you will find them concerned. They are concentrated in hospitals. But in the society, if you see the spread, the most…

basically the the biggest possibility is for any profession in health care it is for pharmacists through the whole retail chain distribution supply chain management and they are the people who can actually contribute up to the last mile of the value chain so this this needs a strong change management the the change is happening but i think it would take some more time because it’s a professional and mindset change and thinking change for pharmacists

thank you so much i think very important point that it’s more about mindset change than just technology uh dr sarvajit kaur we are very fortunate to have you with us as the secretary of the indian nursing council you represent 2 .2 million nurses and more probably if we account for every registration is three so which is like 10 percent of the world’s nurses how are nurses coping up with the changes in technology with regards to health care and what are you doing at inc

Thank you, Dr. Gupta, for this question and for this opportunity to be here in this esteemed panel. So to answer your question from the regulatory point of view, we have tried to integrate the AI and the digital health into the basic nursing curriculum. We had a change of the BSc nursing curriculum in 2021, and we have started by putting the emphasis on building competencies through the digital health and AI. So five simulation labs have now become mandatory. We have given lab equipments, the list of mannequins, VR, etc., that can be used to build up competencies, because we are also seeing that the clinical facilities that are out there for the nursing students to build up those competencies is becoming limited.

We are having almost 2 .5 lakh nursing students getting passed out. for GNM and BSc, like both getting registered as registered nurses, registered midwife. So we have started from scratch, if I can say so. We have started with computer education. We have given guidelines like for every five students, there should be one computer. We have given computer labs right out there. And we have also worked towards faculty preparedness. So there is, you know, complete adoption, like, you know, the panelists brought out. This has to be a change of mindset. So even if you have these expensive equipments out there, how do you use them and not just keep them in the cupboards, you know, safe as an inventory articles?

So we have started with two national reference simulation centers, one in Gurgaon and the other one just recently opened last two months back in the south, Bhagalkot. And we started with. Faculty preparedness. For the Gurgaon NRSC, we have trained around 2000 faculty on how to use these simulators for each and every nursing student. So what as a regulatory body we are looking is for each and every nursing student to embrace the digital technology as she is working to be a nurse to build up her competencies. And even for in -service, we are linking it up. As you’re aware, with a lot of push from your side, we’ve had this professional digital nursing course of six months, which a lot of takers are there in nursing who are wanting to do this.

But I think we need much more courses like that. We are linking it to C &E hours. We have also brought out our online registration system for the nurses, which again, we are trying to link it with all these. Kinds of opportunities for them. So more nurses benefit out of it. and in the abroad if you see we are having you know these chief technical nurses also now what you know trying to resolve issues like staffing, prevention falls, policies to improve nursing so I think we here also in India need to do a lot in terms of policies to empower every A &M who is working in the rural or every community health officer who’s working in the Arogya Mandir’s or every nurse who is wanting to do better for her patients in the super specialized hospitals there’s a lot more to be done.

Thank you.

Thank you so much it’s very exciting to see how you have moved to bring digital courses to nurses and the offtake for that and I also keep hearing very positive feedback on this opportunity for nurses. Thank you so much. Now I move to Dr. Suresh Yadav who I’ve known as someone who not just ideas the future but creates the future so working with the President of India whether he went to World Bank whether he’s in Commonwealth even in Commonwealth years back you put the agenda of AI as a high priority. What is your work and role today at Commonwealth’s vision for the 56 member nations and more so for the small island states?

Thank you. Thank you, Professor Gupta, and thank you for your leadership in this very important stage. He has been working in this Digital Health, Digital Health Parliament and global leadership when the world was not thinking. So it’s a great, great contribution by you to the system because digital has taken a frenzy only during the COVID and the post -COVID. Before that, it was just like a digital e -government systems around the world. Now, before I say anything, I’ll be very general in comment on the global level and then touching a little bit on the ground level. What did cost the global ecosystem? Anish described when there was a financial crisis. What global south at that point of time called a crisis triggered by the global north.

I mean, naming that particular country. So there, and he described how beautifully President Obama. steered the United States out of that very complicated and complex situation. Now, if you look at the shortages of the healthcare professionals to the global economy, what it costs, shortage is one part, it’s number. Maybe somewhere 100 ,000 people short, somewhere more number. What are the global implications? So the economic cost of these shortages of the healthcare workers, which is around, in all the categories, around 10 to 12 million, almost costs 15 % of the global GDP. And you can imagine that 15 % of the global GDP of $120 trillion economy. So it’s a huge, huge cost, just because we don’t have people. It has a multiplier effect, and it’s leading to the cascading effect on the various other segments of the society.

The other thing which is happening is that the healthcare workers are not getting paid. the global temperature rise, if you look at the climate and health, there is a latest Lancet report which brings very beautifully how the climate is driving health and leading to a different kind of a challenging situation. But also on this other side, I wanted to say that how health system is also contributing to the climate because one of the largest emitter on the planet. Now, given this situation, we know that so much is the shortages of the healthcare professionals and the nurses shortage is so much that Anisha will know better than I know that the US has a special visa for the nurses.

You may have a computer science degree but may not get a visa. But if you have a nurse experience certificate, you get a visa. So that is the level of the challenges which the world is facing. Now, we know that this is a challenge. What do we do? How do we do? How do we move forward? The other… Before I go to that, the other challenge is the aging population. If you look at Japan, if you look at the Nordic countries, the aging population number is rising. There are not many people to take care of that. Even if I have to get a health care worker in my village in eastern Uttar Pradesh, it’s so difficult.

Even if you want to pay the money, there are no people to serve you. So what do you do? One is, of course, the obvious solution that you train more number of people because there are a lot of people who are looking for the job. It’s not that people are not there. So how do you ramp up that capacity? I know in India, for creating a nursing school, you need to have hospitals, hospitals, and there are so many challenges in spite of setting up a lot of hospitals in the country. So one low -hanging fruit is the digital solutions. And on the top of that digital solution now is AI solution. Can I make one doctor serve 10 people?

Can I make one health care worker serve more than 5 times, 10 times more using the technologies management of the… system using the healthy ERP like multinational enterprises? are doing. The whole system is fragmented in the healthcare system. It should be in that ecosystem. The one good thing about the U .S. is that the doctor, the pharmacy, everybody is connected. So that at least fragmentation is not there in the U .S. system, but that fragmentation still exists in the U .K. system. But in India, that silo is very much there. So even if using this health ERP on the lines of corporate ERP, we are able to fix it, I think that will be a transformative approach of creating a very ecosystem approach where the health workers, the doctors, the nurses, those who want to volunteer and contribute, they will be all connected.

So that is one quick fix solution I see. The other I see that in the global market, and this was my pet project that particularly came out from the post -COVID that there are doctors who want to do more, but they have challenges. So how do you connect? a global or doctors without borders how can an Indian doctors so a patient in Kenya rather than Kenyan or Tinjanian patient traveling to India or if they have to travel they should travel only small portion rather than a big big time of two months three months so these technologies offers you that you can have your scans remotely you can upload send to doctor have all the diagnostic except the procedure which you are required to be there so it’s it’s not only a country health ecosystem but also a global health ecosystem which can which can be made available using the technologies and and then and I see that using that approach any best hospital or doctor the United States can be accessible to a patient in India or vice versa because a lot of Indian wants to consult a doctor in India my wife was in the US for 10 years is still believe in the Indian doctor and wants to have a medicine from India and this one so So 2 million, 20 million persons of Indian origin around the world.

So India can connect 1 .5 billion people within the country and 20 million people who still believe that I should have the Indian medicine, I should have the Indian doctors. So this is a huge, huge opportunity for India to take the leadership because you have the manpower, you have a lot of young people who enter the job market looking for the job, and you have the digital technology power. The only question is to putting these two together and make the nursing institutes, the hospital administration, the startups be all the part of the thriving ecosystem. I think if we can do it, we will have, we will really rather recreating or reimagining a healthcare system not only for India but for the entire world.

And this 15 % GDP, this global temperature rise, the climate health nexus, which I can talk about, these still will be a great enablement for the entire world. And I think that the government, the government of India, I think that the government of India will be able to do this. And I think that the government of India will be able to do this. And I think that the government of India will be able to do this. And I think that the government of India will be able to do this. And I think that the government of India will be able to do this. And I think that the government of India will be able to do this.

And I think that the government of India will be able to do this. And I think that the government of India will be able to do this. And I think that the government of India will be able to do this. And I think that the government of India will be able to do this. And I think that the government of India will be able to do this. there will be universal health access cutting across the boundaries not that

within your boundaries but you can have access to rest of the words of the medicine of the supplies of the doctors of the procedures so I’ll stop here on this positive note and over to you thank you thank you so this is very interesting and you know I I always like optimism over technology even if you’re not optimism technology will move fast coming to use all you can’t you are an entrepreneur in technology while dr. Rajiv approved DTX you make DTX you have made amazing

AI driven technologies what’s your take on capacity building do we have enough capacity to have more entrepreneurs like you we will have ideators like you but not entrepreneurs because we don’t have executors how do you define this thank you Rajiv ji while of course I will be speaking on the on that part of technology as well how we can create entrepreneurs you But I think more to the point that my fellow panelists talked about, I think technology, when it comes to capacity building, technology companies have a significant role because they influence how the current workforce is practicing. And also they influence how the next generation of workforce will get trained. So that way we have a dual responsibility.

And in that sense, I think there’s a design principle that every technology company should keep in mind or any budding entrepreneur should keep in mind. And that is that the way they design their AI or tech solutions, it should be in a manner that is scalable, not in terms of volume, but scalable in terms of complexity. Because if you’re building something. And if you’re providing the healthcare industry with something, then you have to particularly in a. a country like India where you have a diverse spectrum of digital maturity across various institutes. Some hospitals might be digital native, some of them might be completely analog. So in that sense, you have to have a product that hand -holds the healthcare workers through the digital transformation journey.

So the product is able to scale in complexity as the institutes scale in readiness. That’s how we have been building products. As an example, our EISU solution, its functionality ranges from basic remote vital monitoring to more complex smart alerts and advanced clinical decision support systems based on the readiness of the clinicians. And that’s something that every institution needs. So I think that’s something that techpreneurs should keep in mind. impose AI or technology, rather the technology should adapt to the capacity, or rather it should be able to handhold the capacity and pull it up. One more point that I wanted to add was that just like technologists have been creating or co -creating the next generation of workforce when it comes to programmers and innovators, similarly I feel health tech companies have a responsibility in co -creating the next generation of healthcare workers.

So with the academies like Academy of Digital Health Sciences, I think technology companies or specifically health tech companies should come forward and co -design some hands -on courses as well, like the one ma ‘am mentioned, the professional nurses course. So that, we’re able to expose the students early on to

so i’ll have a few two questions to the you know experts before we move to audience questions uh this is to uh first dr sarrajit to you because you’re a regulator you made an important point that you want to change i mean you have already done that by incorporating digital health as a part of the education you know when i was writing the education policy my biggest worry was technology moves with the pace that you can’t change your curriculum every now and then because by the time you go to the academic council governing board new technology has come so you is there a way you’re looking at to make i think you talked about cme but is that the way we should look at looking at training all professions you know adding cmes rather than changing curriculum every now and then because that’s going to be really tough

um curriculum changes normally occurs say once in a decade and that also is a long process when we brought out the bsc nursing change we took almost three years to bring about a change with all the you know there’s a whole process to it including the public amends and bringing about changes so yes at that point of time whatever is the best for the nursing students we have tried to do that but at the same time we also need to understand that there is this like 40 uh lakhs like you know four million nurses already out there in the country in different states whose competencies also need to be built because they are the ones who are working be it in the rural or be it in the specialized hospitals and for this as a regulator we push upon having simulation centers that’s what we are saying one should be in every district so that you know there are some states who have already started taking this like you know we had Nira Maya in Uttar Pradesh and we had Union in Bihar where they are building up these competency centers integrating the digital technology with it certifying it so that and linking it to the CNE so the nurse carries it forward with her there are incentives there for the nurses to come up for these programs and to better integrate this into the health systems a lot needs to be done in this and as you’re also aware with the digital health academy we are now working towards having a one year or maybe a two -year program we are still working that out so when this also comes as a specialization more takers will be there I think it will again disseminate down it’s a mammoth task no doubt.

Dr. Rajiv I wanted to ask you on that point only that you have drug inspectors across the country who were in the conventional you know world what are you doing for them to understand and of course for pharmacists too I want your point.

So, yeah, so before moving to that, I just had one comment on this one, the curriculum change, right? So this actually point comes again and again in pharma education also. And colleges and teachers say that we are not allowed to change. It is governed by PCI. But always I say one point. See, PCI or anybody which actually sets the courses, they give you the minimum which should happen. They don’t say that don’t go beyond this. So you have all open at the top. Whatever you want to do, you keep this minimum. Plus you go on adding if you want to. So if pharma is not having a course on innovation or management or any modern technology.

Computer programming, PCI doesn’t say that you can’t do it. PCI says that you keep pharma papers over and above this. If I want to keep innovation paper, I’m free to do that.

Rajiv, I’m sure this message will go viral, but the problem is how many people read it in that manner. You know, when we started courses, we put a line. The contents of this course will change based on the developments in the field. And we had really tough time telling that it can be in the prospectus. I said, we have to do that. The field is changing. And that brings me to Anish, because always the problem comes, what do you do to governments? You know, when you’re talking of technology, we can have regulators change it. We can have, you know, councils change it. But how do politicians get changed? Do we have a crash course for them?

Well, so here is the, there’s a, that’s a spicy question, but let me, let me, let me handle it. Well, this is in the U .S. It was funny when you saw the senators asking Mark Zuckerberg questions that were not very smart. So there was obviously a push to get education about what the technology means. But let me, let me shift that question in a different way. A lot of this assumes that the job to be done is the same. but you’ve introduced new tools so that you train people on how to do the same job but with the new tools. The politician or the policymaker is often focused on the outcome or the objective, the problem to be solved.

And it may be that we spent 10 years doing it this way, we’ve funded it, organized it, and you should be educated on how technology will influence it. But at some point, there’ll be a flip. Hey, I’ve got an entirely new way of solving that outcome. And why don’t we reorganize this whole thing that takes advantage of new capacity that wasn’t possible but for the technology? Earlier in this conference, we heard from Sunil Wadwani from the Wadwani Foundation. He talked about tuberculosis deaths, half a million deaths. And he said a portion of those deaths come from individuals. Who obviously get later, you know, they’ve been detected later. And then others, they dropped off their medications too early.

So you’ve got these sort of error rates on both sides. And so you have a nurse or someone in the community, asha workers, someone helping, engaging. And so you could think about politicians saying, okay, do I have to fund a new program to do this technology? Or it turns out they’ve come up with an entirely new AI -based detection system, and they found 25 % more tuberculosis cases, not because they’ve educated, but they’ve introduced a whole new concept that you can change the diagnosis model through voice. You cough into a phone and it tells you, I’m paraphrasing what I heard earlier today. So this is the moment where the more we have flexibility in the political dilemma, dialogue, and some say this is zero -based budgeting that’s changed the way we fund our government.

There are lots of policy debates. but if you start with the principle that there’s a problem to be solved, we have too many people dying from tuberculosis too early. Now, let me say, look, we’ve got programming and funding and staff and people that do things to do this, but now a new technology shows up that allows me to think of this in an entirely new way and only possible to implement the strategies that come from this because it exists. That is a whole level of training that’s not training, oh, here’s how the buttons work. That is connecting the dots on what the capacity is to fundamentally reimagine the way to go about this. And so not to go back to capacity building, but I have coined this term innovation pipeline management in government.

DARPA, very famously, it’s our research arm in the U .S. government, sets ambitious but achievable targets and then lets professors, entrepreneurs, innovators sort of come up with ideas. And so you want to have… You want to have a stage gate to test ideas. You want to test more ideas. Then some of them graduate to the next stage and then you want to sort of validate those successes. And then you want policymakers to scale the ideas that work. and so I think your question was meant to it was sort of funny, the politicians need to be trained but there’s also some seriousness which is it can also be the vehicle by which we fundamentally re -imagine the way to go about it and then that brings a whole new cycle.

So that’s the positive side of

Thank you Anish so much and now let’s get to the public questions so any audience questions yeah, you first

Hi Anish, thank you for your inputs as someone who has been as an entrepreneur, also coming from a Catholic background, researching brain and AI and has spent a lot of time in the US, last four years in US and India. Be specific to the question because we have less time here. Context to what you were saying, the need for the digital portions. So if somebody has come up with a solution for mental health, for the professionals themselves, like the nurses and the doctors what would be a good platform because right now it’s like you educate them for the need of it and then the skills and the outcome get measured. what will be a better way to scale this because the need is there we see it we work with kids also doing that and we see the same need for professionals as well right and it’s contextualized to the Indian context as well what will be the good platform to sort of take this to scale when such needs exist with all professions as well I do have a separate question on the pricing with India so as two ventures that I’ve been part of that have scaled pretty well in the US one of them has become 100 million revenue the other has taken public route in the US but they failed miserably on the pricing here so spending two years up front here we couldn’t get the same product to work at the pricing here so what are your suggestions for how to make pricing work for India when you have the intent to solve for India as well so those are my two questions

because if you go back and look to GDHS session on pricing of digital health you will get a detailed answer from those who build it globally so that will help you solve that problem and the other one does someone want to take an answer it

answering your question from the regulatory point so uh we have for the nurses we have linked 150 cne hours and we have linked it to the renewal of their registration every five years so now nurses have to mandatorily do these courses then only their license will get renewed so there’s a lot of need to have these kinds of courses there are some platforms where these courses are put free of cost inc being one of them this i got this swam so i’m sure there are a lot of opportunities uh for you to you know take up anything that works for the nurses the technical experts have to you know take a look at it to see if it’s okay and then we can take it

right now it’s developed by doctors for doctors but it can certainly be i’d love to take inputs from you where to take it forward thank you

after this dr freddy yeah

thank you very much uh uh my very simple question is that i am born before technology and suddenly bombarded with the last four five years you and the times are like this the fate is this that i’m from best colleges being a faculty and now join era medical colleges need faculty medicine and suddenly this institution is in a hole into ai now people like me who worked with mci and the curriculum has already been changed but believed me that nothing has changed because i actually had a audition also my question is that how are you emphasizing in future there are people who are supposed to implement ai people who are supposed to train these people in gen z now who themselves have no between so there’s a dilemma between them do you have any solution for that so that at least people who have been trained now are being trained by people who are inverted commas not trained that’s my worry

so i will ask around in one minute

sure yes so uh I think there are still people far and few in between who can be those ambassadors for change. It’s just a matter of giving them the tools, being able to, you know, get them on the platform of university or digital health sciences academy so that they’re able to train or build capacity at scale. That’s the only way. Otherwise, we don’t have enough people to do it one on one or, you know, in a physical capacity. We have to use virtual tools even for that. And at the same time, I think there shouldn’t be a bar at offer, you know, a certain experience or a number of years of teaching for these kind of courses.

So this has to be age agnostic, I feel.

Rajiv, 30 seconds for you and then we have to close.

No, we have to close because we are running out of time. We have to launch also one thing. So I think answer lies in the system itself. If I just give one example, remote surgeries. The doctors who were trained 30 years ago, they were not trained on remote surgeries. Today, they are doing remote surgeries. How did they shift? So, I mean, this is something. I don’t think that these trainings and capacity building should be restricted from within the profession. Whosoever is suitable for those trainings, they should be engaged. It’s a continuous process in regulatory system. Our inspectors and drug controllers, they actually are trained into the modern, in basically approving and reviewing these medical devices also.

It was not there when they were appointed. So everybody is getting upgradation and there are systems.

Yeah, and in our courses, we have seen 80%. 80 % of the people. are above 20 years, highest is 50 years after MBBS. So I think age is not a thing, it’s a mindset thing.

Rajin, I’d also like to add about the consortium of innovative healthcare universities.

We have to launch this and close this session. We have a very strict timing here. And I see that clock ticking up.

I understand.

So we’re launching the Global AI Academy, which you will see is about training people. You have platforms, it’s not about that. Together, yes. Here we go, something’s happening. There it is, a screen. Oh, that is coming. It’s coming and going. Yeah. So it’s never about the platform, it’s about the mindset. And start now if you have not. Thank you. Thank you very much. A big round of applause. Thank you. Thank you. Thank you. Thank you. Thank you. you Thank you.