R&D for Affordable Healthcare in India
In July 2010, a £45 million jointly funded partnership between the Wellcome Trust and the Department of Biotechnology, Government of India, was announced to support research and development projects that would provide innovative healthcare products at affordable costs. The aim is to bring together researchers from both the public and private sectors, largely working in India, to develop new medical devices, diagnostics, medicines, vaccines etc. that will reach the greatest numbers of beneficiaries, without compromising on quality.
During a successful pilot of the concept by the Wellcome Trust, a number of projects have been funded. These projects cover a wide range of applications including new treatments for tuberculosis, cardiovascular disease and a stem-cell-based therapy to restore sight in damaged corneas.
FRHS, Columbia University and WHO have been awarded translational funding to develop and create an “mHealth Package” to facilitate and support various aspects of rural health workers’ work and enabling a flow of communication between community members, health workers and health facilities.
India's rural, economically poor populations depend on health care provided by outreach and facility-based workers. But the current health management information system (HMIS) under the National rural Health Mission (NRHM) is failing to optimise these workers' performance: significant weaknesses in the predominantly paper-based HMIS are resulting in inefficiencies, inaccuracies, data under-utilisation and, crucially, missed opportunities for worker support, motivation and improvement, resulting in poor health outcomes. Mobile technologies offer the promise of enormous advances in such environments, with the potential to empower health workers through instantaneous communication and feedback, delivery of up-to-date educational content, alerts and reminders, remote support from experts and performance monitoring.
This project, to be piloted in Karnataka state, under the supervision of Dr Nirmala Murthy, will develop an "mHealth Package" - a strategic mix of mobile technology applications and support materials - to support NRHM reproductive, maternal and child health (RMCH) services. The technology will emphasise ease of use by low-literacy individuals, will be provided free of charge, and is envisaged for massive scale-up following rigorous pilot testing, impact assessment and revision. The resultant intervention will empower rural health workers and their clients along the continuum of RMCH care, integrating and streamlining data with existing HMIS standards for enhanced provider performance and population health outcomes.
The Indian Institute of Technology (IIT) Delhi has developed the 'Smart Cane', a navigation and mobility aid for visually challenged people. The Smart Cane is an innovative device that can be mounted on a traditional white cane to enhance its functionality, resulting in improved mobility and safety, while reducing dependence on sighted assistance.
White canes are currently the most commonly used visual mobility aid; however, a white cane can only detect certain types of obstacles within a limited range and cannot detect obstacles that are above the knee (e.g. a steel bar on the road) or protruding (e.g. a tree branch or an open window).
The Smart Cane device uses ultrasonic sensors to detect obstacles up to 3m away, and the range of the detected obstacles is conveyed using vibratory signals with different vibration characteristics. It is designed as a user-detachable unit and is powered by rechargeable Li-ion battery. The design emphasis has been on making an affordable device, and it is currently expected to cost less than Rs 2000 (£30) to the end user.
This project targets the design of a manufacturable device, optimising it based on user feedback from field trials and making it ready for regulatory approvals and certification. It has been proposed that extensive user trials should be carried out at multiple locations in the next 18 months. The project is being jointly undertaken by IIT Delhi with an industrial partner, Phoenix Medical Systems (P) Ltd, Chennai. The third partner in the project is Saksham Trust, New Delhi, who have domain expertise and links to the network of organisations working for the visually impaired.
Professor Bhargava and his colleagues at the All India Institute of Medical Sciences (AIIMS), New Delhi, have developed a preliminary prototype of a novel chest compression device that uses compression and decompression cycles uniquely.
Sudden cardiac arrest (SCA) is the abrupt cessation of heart pump function. This causes an inadequate blood supply to the vital organs of the body. If corrective measures are not taken immediately, this condition rapidly progresses to death. Manual compression of the centre of the chest (sternum) during cardiopulmonary resuscitation (CPR) is the 'gold standard' for managing such patients.
Improving cerebral and coronary perfusion still remains a challenge during CPR. Professor Bhargava and his colleagues at the All India Institute of Medical Sciences (AIIMS), New Delhi, have developed a preliminary prototype of a novel chest compression device that uses compression and decompression cycles uniquely. The [Affordable Healthcare] funding will be used in two phases. In phase-I, the concept will be refined and a prototype will be developed. In phase-II, feasibility studies and validation will be performed in animal models.
The researchers describe their work.
The LV Prasad Eye Institute in Hyderabad, in partnership with Sheffield University, has been awarded funding to develop and use new biocompatible materials for a stem-cell-based therapy to restore sight in eyes where the cornea has been damaged by chemical injury or burns.
This advanced tertiary eye care centre in Hyderabad offers high-quality, comprehensive eye care on an equitable basis, to millions across the state of Andhra Pradesh, through its pyramidal network that involves 17 secondary eye care centres in towns and 65 primary care centres in large villages, in remote rural areas. The centre at Hyderabad has so far provided limbal stem-cell-based therapy to over 700 patients.
Cadila Pharmaceuticals Ltd are investigating the concept of a combination pill for the control of cardiovascular disease in the primary prevention setting, through a Phase III clinical trial.
The pill (Polycap) will comprise a mixture of three blood pressure reducing agents - a diuretic (hydrochlorothiazide), an ACE inhibitor (ramipril) a beta blocker (Atenolol), and a cholesterol lowering statin (simvastatin). All of the agents were chosen based on the evidence of their reducing cardiovascular disease risk and their generic drug status.
Cadila’s pioneering work in this area has been to develop stable pharmaceutical compositions in a Polycap formulation. They will work with a group of experienced clinical collaborators including Salim Yusuf, Professor of Medicine at McMaster University, to undertake a study with 5000 subjects (without a history of previous heart attack or stroke) over five years. The proposed placebo-controlled study will recruit individuals (men over 55 and women over 60) with a INTERHEART risk score (obtained through a questionnaire based on family history and lifestyle factors) greater than a threshold value with a estimated yearly primary event rate of 0.75 to 1 per cent. The primary outcome will be a composite of CV death, non-fatal MI and non-fatal stroke.
AstraZeneca and AstraZeneca India have been awarded translational funding to identify lead compounds of novel structural classes capable of inhibiting NAD metabolism, as candidate drugs for the treatment of Mycobacterium tuberculosis.
Curative tuberculosis therapy requires killing a 'difficult-to-treat' residual population of non-replicating organisms. Significant evidence now suggests that NAD metabolism is an essential factor in the survival of non-replicating M. tuberculosis bacilli and thus provides a rare opportunity to drive a discovery program directly addressing sterilising capability. The programme aims to inhibit NAD(P)(H)-utilising enzymes, including those involved in the biosynthesis of NAD, by competing with the NAD binding domain, using NAD mimetic libraries.
The programme of work is based on a NAD mimetic pilot study that identified a number of lead-like scaffolds with promising activity and selectivity. Building from the molecular starting point library used in the pilot study, a second generation library will be created and tested in a screening cascade which blends the strengths of target-based optimisation with the power of whole cell screens. The design of the primary library involves pharmacophore and substructure overlap together with the mapping of key interactions between NAD and the cognate binding site, based on known co-crystallisation studies. The screening cascade is designed to build on the strengths of (a) target-based approaches (early structural knowledge facilitates compound optimization) and (b) whole cell screening (early proof of whole cell activity ensures drug-like behaviour in all early series). The key challenge in targeting the ubiquitous NAD molecule is to introduce specificity. The literature precedence and AstraZeneca’s initial work suggest that this is achievable.
