Sangita Reddy: Future Ready

The Joint Managing Director of Apollo Hospitals Enterprise Limited talks to Healthcare Executive about the role of women in healthcare, the evolution of the Indian healthcare sector and her vision for the decade.

Sangita Reddy of Apollo Hospitals needs no introduction. One of the smartest women in the Indian healthcare industry, her contribution to the industry is second to none.

But India is a challenging place to run any business, under any circumstance. People, processes, finances, government bureaucracy, infrastructure, and sometimes even the weather are all factors. And Reddy loves challenges.

"Entrepreneurship is about not following precedents and transcending boundaries," says Reddy. She points out that patient-centricity has been at the core of Apollo's focus. "Each of the service models is built around the needs of the patient and their family. So, Apollo is present at every critical touchpoint of the healthcare ecosystem, be it through Alexa for appointments or Homecare post-discharge, and even up in the Himalayas through its Telehealth service," she says.

She also points out that currently, India is reeling under a pandemic situation with the growing prevalence of non-communicable diseases(NCDs). "Apollo has taken the battle against illness beyond the physical realm of its hospitals and is working to empower Indians with knowledge about preventive and proactive healthcare, the key to averting avoidable mortalities especially those due to NCDs. Recently, Apollo was honoured with a commemorative stamp for having performed over 20 million preventive health checks," she elaborates.

Woman Power

Representation of women in leadership and other decision making roles is a crucial pointer of development of any sector. Has the role of women in Indian healthcare changed in the last decade? "For decades, healthcare has been one of the best industries for women in several dimensions. The inherent ability of women to nurture gives them an added advantage as empathy is the cornerstone of the care continuum in healthcare," she says.

Reddy continues: "Traditionally, it was assumed that women in healthcare were about nurses and a few doctors. However, now, women are present across board in healthcare, and at Apollo, we have women leaders helming our hospitals, finance, research, quality and many such functions. At Apollo, an individual's capability and performance is the only barometer for evaluation, and we also greatly value the merits of diversity."

Key Measures required to unlock the Growth Potential

For Reddy, healthcare can be an engine for job creation which can address the growing challenge of unemployment in the country. She, therefore, brackets, the critical steps required for growth of the sector into tho three.

"India is a young nation. So a concerted effort in skill building for healthcare would help India address the paucity of resources in the sector, help Indians serve patients around an ageing world and unlock the potential of the industry," explains Reddy.

She also adds that efforts to grow the medical tourism opportunity could be an excellent Forex generator for India. "Healthcare is over trillion-dollar industry globally, and medical tourism is over 400 bn. India has demonstrated that clinical outcomes are equal to the best centres in the world; costs are less than 10% of the international price and is offered with great compassion and care. More significant efforts could make India the preferred healthcare destination of the world; it will help India earn a substantial amount of foreign exchange, and also provide employment to millions of young Indians."

Reddy reasons that the third aspect of unlocking the potential is incentivising manufacturing of medical devices and equipment in India. "This aspect is in line with the government's vision of 'Make in India' and would also work to make costs lower and thereby affordable to millions. However, at present, India imports nearly 80% of all medical devices and domestic manufacturing was impacted as post-GST, the imports became cheaper by 11%. It is estimated that the medical devices industry in India has the potential to grow at 28% p.a. to reach $ 50 bn by 2025," she adds.

Ready for Challenges

Reddy also agrees that it is a matter of pride that India took firm steps to combat the growing prevalence of non-communicable diseases. "Over five years ago, in 2015, in line with WHO's Global action plan for the prevention and control of NCDs 2013-2020, India was the first country to develop specific national targets and indicators aimed at reducing the number of global premature deaths from NCDs by 25% by 2025," she says.

She adds that in 2017, the Union Government launched the National Multisectoral Action Plan for prevention and control of NCDs. "Developed by the Ministry of Health and Family Welfare, the Action Plan states that the aim should be prevention and improved management of NCDs, with screening, early diagnosis, and sustained management of those with or at high risk for significant NCDs. The plan advocates active engagement of different stakeholders – Union and state governments, private sector, civil society, academia and others."

What does she think of Ayushman Bharat scheme? "Ayushman Bharat was a decisive step that India had taken towards UHC in 2018. Not only was it the world's most massive government-funded health insurance scheme covering over ten crores families, almost 500 million financially challenged Indians, but it also addressed the principal cause of indebtedness in the country. Also, under its aegis, over 1,50,000 PHCs will be transformed into H&W centres, a decision that will make primary healthcare much stronger across India and also promote a culture of wellness," she explains.

Digital Innovation

She is also sharply focused on digital solutions for the healthcare sector.

"India has too few doctors, not enough hospital beds, and a low share of state spending on healthcare relative to GDP. Digital solutions can help alleviate the shortage of medical professionals by making doctors and nurses more productive. Telemedicine, for example, enables doctors to consult with patients over a digital voice or video link rather than in-person; this could allow them to see more patients overall and enable doctors in cities to serve patients in rural areas. Apollo Telehealth has helped over 20 million patients across diverse geographies and achieved noteworthy successes."

In the domain of prevention, cardiovascular diseases are the most significant cause of mortality in India, with nearly 25 per cent of mortalities – amongst the age group of 25 to 69 years. In 2018, Apollo Hospitals and Microsoft India partnered and launched the first-ever AI-powered Cardio Vascular Disease (CVD) Risk Score API, explicitly designed to predict the risk of CVD in the Indian population. Fuelled by ML, the API will keep getting better in determining a more accurate CVD risk score for the Indian population taking into consideration risk factors, thereby, saving precious lives.

Likewise, as the adoption of AI by people has fuelled the shift towards voice applications, IoT devices have given voice assistants greater utility in a connected user's life. So, with Alexa skill, Apollo Hospitals introduced power voice-assisted hospital search and appointment booking, making it ultra-convenient for present-day users.

Reddy elaborates that till as early as a decade back, Artificial Intelligence and Robotics were considered technologies whose active usage was still far away in a distant future. "However, thanks to new machine learning methods, AI and Robotics have evolved faster than most people would have imagined. Robot-assisted surgery allows doctors the use of a robotic surgical system that comes with a camera and mechanical arms. With robotic assistance, doctors can perform complex procedures with greater precision and control. In the field of minimally invasive surgery, robotic assistance gives a higher degree of control to surgeons as they can digitally plan the procedure and have a high-definition magnified view of the surgical area. The benefits include lesser blood loss, faster recovery, lower chances of infection, and, consequently, better surgical outcomes," she adds.

The future: Unlocking the potential of Indian healthcare

“I view healthcare as a service and not as an industry which regards returns of investment in monetary terms”. Dr. Reddy proposes a strong commitment to the protection, promotion and restoration of health at population and individual levels. “We must aim to reduce gaps in health equity in our geographically, culturally and socio-economically diverse population and emulate the commitment to health equity reflected by Scandinavian countries, UK, Canada, Japan, Thailand, South Korea and Cuba.”

He envisions appropriate AI application in population-based and personalized health interventions; molecular biology-guided diagnostics and therapies, greater deployment of technology-enabled non-physician healthcare providers and greater levels of home-care and self-care in the future.

“Areas needing empowerment are continuity of care for chronic conditions, reducing physician-dependency through nurse-practitioners and physician-assistants, patient-centric healthcare with patient and family-led decision-making, strengthening regulations to ensure clean water, sanitation, unadulterated and healthy food. Public policy and public financing are critical catalysts that can strongly mobilize healthcare. A responsive public sector, a responsible private sector and a resourceful voluntary sector can together do wonders to uplift our health system.”

What will Apollo focus in this decade?

Sangita Reddy is mindful of the fact that to create an equitable world; Apollo must look beyond the narrow confines of the medical world to understand what it takes to create a healthy population. "It includes five key areas - (a) Access to Healthcare, (b) Food and Nutrition, (c) Water and Sanitation infrastructure development, (d) Education, employment and skills development and (e) Physical activity. The understanding led to the Apollo Total Health model, which covers the Thavanampalle Mandal with a population of 60000 in 195 villages across 32 Grampanchayts. Total health connotes total well-being of an individual inclusive of physical, mental, social, ecological and spiritual health and more importantly, it transcends the barriers and caters to the health care requirements and aspirations of the community through their journey from womb to tomb. It is a replicable rural model, and portions of it or the whole model can be replicated in other parts of India and the world.SDG 3 is our singular goal as we realise that healthy citizens are the bedrock of a healthy economy," she elaborates.

For Reddy, preventive strategies matter the most. "There are new vaccines today, there is a change in disease epidemiology, and yet most adults are nonchalant about vaccination. Unfortunately, the number of adults who die from VPDs (vaccine-preventable diseases) each year is 350-fold higher than the number of children who die from such conditions. We must bear in mind that health enhancement is dependent on preventive strategies such as vaccination," she says.

She also reasons that healthy living must be inculcated early on as part of the school curriculum. "Therefore, Apollo SHINE works with academic institutions across India. The teams screen students and faculty and also provide engaging health bulletins that work to help them well-being a priority. To summarise, we at Apollo are going to focus on new technologies, science, holistic preventive care and connected health systems," she concludes.