Approximately 453 million Indian women are at risk of developing cervical cancer. Despite this, only 3.1 per cent of are screened. Oncologist Smita Joshi’s study found that 85 per cent of cervical cancer deaths in India occur where there is a lack of population-based cervical cancer screening programmes for women in the age group 30-50 years.
As screening programmes are not available in a large percentage of public health service centres in India, 75-80 per cent of cases are reported in the advanced stage, and approximately 67,477 women die each year from invasive cervical cancer. This is attributed not only to lack of awareness, but also geographical and economic inaccessibility to health services.
Through the World Bank Group Initiative TechEmerge, MobileODT based in Tel Aviv has worked with the International Finance Corporation to forge partnerships with leading healthcare providers, Apollo Hospitals and International Oncology to increase access to low-cost, portable and effective cervical cancer screening in India. In March 2017, Apollo Hospitals deployed the Enhanced Visual Assessment (EVA) System into their clinical workflow. They conducted a pilot study evaluating the benefits of integrating digital cervicography into the primary screening for cervical cancer alongside PAP smear, HPV testing, and/or naked eye visual inspection. This would help assess the EVA System’s ability to reduce loss to follow-up and to provide improved point of care diagnosis.
MobileODT’s EVA System has been built to be a crosscutting, horizontal development solution to impact the health system across its key components. Together, these components bring providers across all levels together and fill critical gaps that plague broken systems including quality, oversight, human resources, and data for decision making.
So, what are the challenges faced while testing and launching the innovation in the Indian market? “When we launched in India, the EVA System had already been deployed in more than 20 countries, and was FDA and CE cleared,” says Cathy Sebag, Global Partnerships Manager, MobileODT. “However, the Indian market is very unique: the workflow, patient population and skill level were different from other markets. We realised that the software needed to be customised and that we needed better real-time collaboration tools. In response, we developed a suite of new software upgrades ~ including the ability to initiate secure collaboration from the point of care, request remote consultation, and collect unique data points. Together, the system became more tele-health friendly to address the challenge we faced in India that providers really wanted to be connected in a single system, in real-time, and to leverage expertise of colleagues.”
The initial response has been very positive, according to Sebag. She adds “Providers at Apollo Hospitals and International Oncology have shared that the system has good clarity, it is easy to use, has a simple and short learning curve; results can be checked by an expert, and it is a strong tool that can be extended to peripheral centres with training where PAP smear collection and interpretation is not easily available. From a patient standpoint, the EVA System has led to increased awareness and a better understanding for the need for follow-up whether it be biopsy or treatment.” Interesting to note is the inspiration behind the innovation. Co-founders Ariel Beery and David Levitz decided that they were going to find ways to make sure the 5 billion people around the world who lack access to a physician would still be able to access quality healthcare. They realised they needed to build both affordable, high-quality devices that would enable any health provider, anywhere in the world, to conduct visual inspections at the level of an expert practitioner, since the shortage of general physicians, and especially specialists, was so severe.
Are further similar innovations in the pipeline? “Cervical cancer screening is just the beginning,” says Sebag. “We plan to expand to additional clinical applications with the same model ~ affordable medical devices at the same quality as the market standard, while also deploying powerful software to strengthen the entire health system and build capacity. Our next deployments will likely be for ear, nose, throat/oral cancer screening.”