Social Success note for Integrated Resistance Insights System (IRIS)

Social success note is used for incentives and nudge community level health providers to standardize, share anonymized data on resistance patterns seamlessly with the block-chain based secure and transparent Integrated Resistance Insights System (IRIS). The data analytics will be shared with providers, pharmaceutical companies and government agencies for appropriate action. 

Manjunath Shankar, is a Senior Public Health Specialist (Health Economist/Infectious Disease modeller), with 20+ years of experience in designing strong public health interventions He is director at Samridh Impact Solution

India faces a critical threat from antibiotic resistance, fuelled by a fragmented healthcare system and widespread misuse of antibiotics. About  66% of the care is provided by private sector which has perverse market incentives for indiscriminate  antibiotic use (over 70% of antibiotics are dispensed without a prescription), not share data with surveillance system (a public good) or take remedial measures. This is fuelled by both lax regulatory enforcement and market forces at play such as prisoner’s dilemma. This has led to India being global epicentre of antibiotic resistance, with 60% of neonatal sepsis and 80% of common bacterial infections resistant . 

The current AMR surveillance system is driven by public sector with participation from tertiary government hospitals and medical colleges with almost non-existent private sector participation. Even established corporate private sector hospitals do not share data since they are worried about losing market share due to adverse negative publicity let community hospitals. This blind spot impedes comprehensive understanding of resistance patterns for effective action. 

We address this through the blended finance instrument of social success note to incentivize community hospitals to standardize and share data with an IT platform for effective public health action. 

IRIS focuses on private hospitals and nursing homes in Tier 2 and Tier 3 cities. These facilities, estimated at nearly 55,000 across India, form the bulk of the private sector (60%). They lack efficient technological solutions and data management systems, hindering their contribution to disease surveillance. Private hospitals and nursing homes operate in a highly competitive environment, The market provides perverse incentives to distrust one another (Prisoner's Dilemma )and adopt actions (overprescribing of antibiotics, not share data) which are detrimental to social common good.  In addition there are other technological barriers which makes data sharing cumbersome for hospitals. As such they require financial incentives (the itch for profitability) to dislodge them from the inertia of the current market equilibrium. If they receive actionable insights in addition to financial return, will convert them fully in the long run. By providing secure and user-friendly data management systems, fostering collaboration and data sharing addressing concerns about data privacy and security, ensuring transparency and control through the use of blockchain technology, IRIS will build trust among stakeholders and competitors to take collective action.  

Surveillance is a public good. Our solution directly provides the public good by increasing participation of private sector in a decentralized surveillance system that integrates with existing public surveillance systems.  

Our blockchain-based platform facilitates the secure and transparent collection and analysis of antibiotic resistance and use data at community level. This data empowers public health officials and healthcare providers with crucial insights to: 

• Track the emergence of AMR strains: Early detection of resistance patterns enables quicker public health responses, potentially preventing outbreaks. 
• Monitor trends in antibiotic use: Identify potential over-prescription or misuse, allowing for targeted interventions to promote responsible antibiotic stewardship. 
• Inform broader public health initiatives: Data-driven insights can guide the development and implementation of national and global strategies to combat AMR. 

By improving access to accurate data and insights, our platform fosters responsible antibiotic use and ultimately contributes to a healthier global population. This public good is freely accessible and benefits everyone by mitigating the threat of AMR and preserving the effectiveness of life-saving antibiotics. 

Our solution targets healthcare providers and public health officials at community level , where limited resources and data access often hinder efforts to combat AMR. The platform's impact unfolds through a series of steps: 

Improved Data Collection: Secure data integration from hospitals enables comprehensive analysis of antibiotic prescribing patterns. 

Actionable Insights: By identifying potential over-prescription or misuse, the platform empowers healthcare providers to adopt responsible antibiotic stewardship practices. 

Early Detection of AMR: Tracking data on antibiotic resistance patterns allows public health officials to detect emerging threats and implement targeted interventions, potentially preventing outbreaks and safeguarding vulnerable populations. 

This approach is supported by research demonstrating the effectiveness of data-driven interventions in promoting responsible antibiotic use and managing AMR (Source: The role of electronic health record and “add-on” clinical decision support systems to enhance antimicrobial stewardship programs; Kuper et al., 2019. Infection Control & Hospital Epidemiology, Cambridge University Press, Volume 40, Issue 5: 501 – 511 (https://www-cambridge-org.ezproxyberklee.flo.org/core...). By equipping LMIC healthcare systems with actionable data and insights, our solution directly empowers them to improve antibiotic use and ultimately protect the health of their communities, particularly those most vulnerable to AMR's consequences. 

Our scaling strategy has a three-year horizon, leveraging initial success for broader impact. 

Year 1: Focus on establishing a robust platform in three states (Gujarat, Karnataka and Rajasthan). Gather user feedback and refine the platform based on real-world data and user needs. Collaborate with local and international stakeholders to ensure cultural sensitivity and ethical data governance. 

Year 2-3: Once the social success model and IT platform is proven ina partciluar context (for eg AMR patterns), the performance will be linked to other data sets like AMU or to other contexts like antibiotic use in animals or pharmacy stores .With the proven model, we will scale thematically  expanding partnerships with healthcare and non healthcare entities to achive greater network effect.  

Beyond Year 3: We will mobilize additional grant pool through using Corporate Social Responiablity funds of phramceutical comonaies and other health care supply companies (consumables , medical devices etc). The grant pool will help expand the incentives to more hospitals and sectors fostering a holistic "One Health" approach to addressing AMR across human, animal, and environmental interfaces. 

We will employ multi-faceted approach to measure our impact against established goals: 

1. Data Collection and Analysis: 

• Antibiotic Prescribing Patterns: Monitor changes in prescribing practices within the pilot community, tracking trends in antibiotic use and potential reductions in overuse or misuse. 

• AMR Detection Rates: Analyze data on identified AMR strains to assess the platform's effectiveness in early detection and potential impact on outbreak prevention. 

• User Feedback and Engagement: Conduct surveys and interviews with healthcare providers to evaluate platform usability, user satisfaction, and perceived impact on their antibiotic stewardship practices. 

2. Pilot Performance Metrics: 

• Target User Enrolment: We aim to enroll a specific percentage of healthcare providers in the pilot program to assess platform reach and user adoption. 

• Data Submission Rates: Track the frequency of data uploads by healthcare providers, indicating their engagement and contribution to the data pool. 

• Stakeholder Feedback: Evaluate qualitative feedback from public health officials on the platform's perceived effectiveness in informing decision-making and public health strategies. 

By monitoring these indicators during the pilot and scaling phases, we can continuously assess the platform's impact on antibiotic use, early detection of AMR & overall contribution to combating the threat of AMR.  

We anticipate encountering three key barriers in the next year and three years: 

1. Legal & Regulatory Barriers: 

• Data Sharing: Establishing agreements with hospitals to ensure secure and ethical data sharing will require navigating complex legal and regulatory frameworks surrounding patient privacy. 

2. Infrastructure & Technical Barriers: 

• Limited IT Infrastructure: Tier 2/3 hospitals in India might have limited IT infrastructure to seamlessly integrate with the platform, requiring tailored solutions and potential hardware upgrades. 

• Data Security & Interoperability: Ensuring robust data security and interoperability with existing hospital systems will require careful planning and technical expertise. 

Overcoming these barriers: 

• Collaboration: We will collaborate with legal experts and stakeholders to navigate data sharing regulations and develop ethical frameworks. 

• Technical Partnerships: We will seek partnerships with institutes like IITs to develop cost-effective solutions for integrating IRIS with existing hospital systems. 

• Capacity Building: We will provide training and technical support to healthcare professionals to address potential resistance towards new technology adoption. 

By leveraging our team's expertise, actively engaging stakeholders, and seeking strategic partnerships, we are confident in overcoming these barriers and ensuring the successful implementation of IRIS. 

We are driven by a compelling mission to curb the alarming rise of antibiotic resistance in India, a silent pandemic threatening millions. We see the Trinity Challenge as a critical catalyst in this fight, offering the support and resources needed to overcome significant barriers and transform IRIS into a game-changing solution. 

The reason why we have applied are listed below: 

Global Recognition: The Challenge's global platform provides an invaluable opportunity to showcase IRIS and gain recognition from stakeholders worldwide. This can attract crucial partnerships, funding, and expertise. 

Data Sharing Advocacy: The Challenge's emphasis on data-driven solutions aligns perfectly with our need to encourage data sharing from private healthcare sectors. The Challenge's advocacy efforts can pave the way for policy changes that incentivize and facilitate data collaboration. 

Financial and Technical Support: The Challenge's financial support would enable us to design and develop the solution and invest in strengthening IT infrastructure in tier 2/3 hospitals.  

The existing barriers are the fragmented Healthcare System, limited resources, and data privacy concerns. By participating in The Trinity Challenge, we believe IRIS has the potential to transcend its current limitations and become a nationally impactful solution, safeguarding public health from the growing threat of antibiotic resistance. 

Srestha-Gujarat: We serve as technical support unit for Srestha-G (world bank funded project) and the extended team can facilitate community outreach programs and raise awareness about responsible antibiotic use. 

C-CAMP: Through their India AMR Innovation Hub, the collaboration can bridge the gap between IRIS's data-driven approach and the implementation needs of private hospitals.  

IIT Delhi: Renowned for their data science and technology expertise, IIT Delhi can collaborate on developing advanced data analysis tools and leveraging artificial intelligence to strengthen IRIS's capabilities. 

ICMR: As India's apex body for biomedical research, ICMR holds crucial disease surveillance data and research infrastructure. Partnering with them would grant access to these vital resources and ensure alignment with national surveillance efforts. 

World Bank: The World Bank's experience in supporting healthcare development in LMICs makes them a potential partner for securing funding and technical assistance. This would enable wider implementation of IRIS and maximize its impact. 

These organizations, along with potential partners like the Caspian, Rockefeller, and Ford foundations, bring a diverse range of expertise, networks, and resources. By fostering a strong collaborative effort, we can create a comprehensive solution with the potential to significantly curb antibiotic misuse and combat the growing threat of resistance in India.