Suraksha (सुरक्षा) from Non Communicable Diseases for women

According to the study report “India: Health of the Nation's States”- The India State-Level Disease Burden Initiative in 2017 by Indian Council of Medical Research (ICMR), it is estimated that the proportion of deaths due to Non-Communicable Diseases (NCDs) in India have increased from 37.9% in 1990 to 61.8% in 2016. According to WHO report on south east asia, 62% of all deaths are due to NCDs accounting for 9 million persons. The four major NCDs for women are cardiovascular diseases (CVDs), cancers (oral, breast, lungs), chronic respiratory diseases (CRDs) and diabetes which share four behavioural risk factors –unhealthy diet, lack of physical activity, and use of tobacco. Malnutrition, anaemia and obesity in later years of life increase the risks of these NCDs amongst women.

There is evidence of significant and systematic differences in diagnostic assessments of NCDs between men and women. A study conducted in Denmark across 21 years showed that women were diagnosed later than men for more than 700 diseases. For cancer, it took women two and a half more years to be diagnosed, for diabetes, the delay was four and a half years. In India also few studies have documented delay on part of women in seeking early diagnosis and care for NCDs due to socio-economical factors such as social stigma, family pressure, family responsibilities, fear of losing ability to work in non-organised and organised sector and woman’s “inclination” to de-prioritise her health compared to that of her family members.  

Research has also captured the gender gap in Disability Adjusted Life Years (DALYs) between men and women due to NCDs. Especially in the resource constrained settings such as rural, remote and tribal communities the prevalence of multi-morbidity due to NCDs and the corresponding DALYs is higher among women compared to men. The reasons are many, and they encompass biological, sociocultural, and economic causes. Women are more likely to have lower incomes, be single parents, carry a “double day” (working full- or part-time and carrying out household duties for their family), and work in lower-status occupations. WHO and other global agencies are working towards providing a sustainable policy framework for accelerating the prevention and management of NCDs with sufficient focus on gender specific interventions.

The implementation roadmap for accelerating the prevention and control of noncommunicable diseases in South-East Asia 2022–2030 was endorsed at the Regional Committee (SEA/RC75/R2). On similar lines, Govt of India, Ministry of Health and Family welfare has prepared Operational Guidelines 2023-30 for management of NCDs.

However, the biggest hurdle in managing NCDs and reducing DALYs and premature mortality is early screening and diagnosis of these NCDs at community or primary care level. The problem in screening and diagnosis of these NCDs at community or primary health care level is 3 fold - 1. Unavailability of affordable, easy to use, locally relevant and reliable Point of Care Testing (POCT) technology 2. Unavailability of trained manpower to conduct POCT tests 3. Unavailability of physicians to interpret the test results and start on treatment.

Our solution, Briota Suraksha NCD kit for women is integrated with our AI first disease screening, diagnosis and management platform - Briota SAVE™ (Screening, diagnosis and management Assisted Virtually Early). Suraksha (सुरक्षा) in Hindi means "safety coverage".  Our solution provides a comprehensive "safety coverage - सुरक्षा" from 12 NCDs to women. 

Suraksha NCD kit for women includes point of care testing (POCT) devices for -

1. COPD, Asthma, Post TB Lung Disease, ILD, Lung Cancer: spirometer Briota SprioPRO®, impulse oscilometer Briota IoSPRO®

2. CVDs: 12 node ECG device Briota CardiacPRO® 

3. Breast cancer: Breast examination LED light device Briota BreastPRO®

4. Oral cancer: Oral health examination fluorescent blue light device Briota OralPRO®

5. Diabetes, Hypertension, Anaemia, Cervical cancer - market available solutions

Suraksha kit is integrated with our SAVE™ (Screening Assisted Virtually and Early) software platform. SAVE™ uses no contact AI and several proprietary machine learning models with local data for NCD risk stratification. We have easy to interpret and communicate health scores namely - Lung Health Score (LHS™), Heart Health Score (HHS™), Breast Health Score (BHS™) and Oral Health Score (OHS™). The NCD risk stratification enables community health workers and primary healthcare medical officer to decide on next line of tests for diagnosis confirmation, second opinions or treatment plans. Suraksha kit is designed for administration of tests by community health workers such as ASHA, ANMs and other primary health care staff who have minimal training or may not have NCD diagnosis specialised training or education. The solution takes care of empowering the community and primary care health worker learn and adopt to the gold standards of screening and diagnosing NCDs. Suraksha product is designed with several efficiency and ease of use criteria in mind.  Suraksha mobile app is available in multiple languages and is also used for C-BAC (community based assessment checklist) survey. Suraksha mobile app is used to enter biomarkers such as height, weight, random glucose, blood pressure, haemoglobin. Random glucose checking device, blood pressure meter and haemoglobin device are also provided in the Suraksha kit. Suraksha mobile app and Suraksha POCT device kit both are integrated with SAVE™ platform. SAVE™ platform has machine learning models (built using local community health data over several months of work done by Briota) to generate health scores such as - Lung Health Score, Heart Health Score, Breast Health Score, Oral Health Score. Based on the health scores - the woman patient can be administered one or more types of POCT tests available with Suraksha kit. Based on the outcome of the POCT test, a NCD risk stratification with next step is provided to the healthcare staff available. If the local healthcare staff needs any assistance in deciding next level of tests for the patient, diagnosis confirmation and treatment options - the same can be provided through remote verification and tele-consultation with experts in the SAVE™ platform. Suraksha NCD Kit Video Link: 

Suraksha Product Video

Suraksha NCD kit is specially designed for women in in Low Middle Income Countries (LMIC). It's a ONE WINDOW ONE TECHNICIAN solution for 12 NCDs - 1. Diabetes 2. Anaemia 3. Hypertension  4. Cardiovascular Diseases 5. COPD 6. Asthma 7. Post TB Lung Diseases 8. Lung Cancer 9. ILD 10. Oral Cancer 11. Breast Cancer  12. Cervical Cancer

Since it's a POCT backpack it can be used for home based screening and "on 2 wheeler" or in "mobile vans". 

Globally data shows, women spend 25% more time in “poor health”than men. According to University of Washington's Institute for Health Metrics and Evaluation, “Global Burden of Disease Study 2019” the women’s health gap equates to 75 million years of life lost due to poor health or early death per year, the equivalent of seven days per woman per year. For LMIC these numbers are be higher. 

In LMIC where healthcare resources are limited there is no concept of annual health checkup for women especially in rural, tribal and remote areas. There are health screening camps organised by social and political organisation but they mostly focus on only Diabetes and Blood pressure. Women who are working in organised sectors to some extent are provided with annual health screening by a medical officer. However many of the women in rural and tribal areas are working in the non organised sector.  These women are solely dependent on the primary care provided at Sub Center or Primary Health Care center which are typically operated by limited staff and has minimal facilities. Most certainly these facilities do not have provision for "difficult to conduct and diagnose" tests such as require for COPD, CVDs, breast cancer and lung cancer. Today if it's not a tertiary care, a woman will typically need to visit 5 to 10 times/5 to 10 different locations - over several days or months to get these 12 NCDs screened. This requires a significant out of pocket expense, loss of income, time and most certainly results in delays in diagnosis. Early screening and precise diagnosis for these 12 NCDs in women simply "falls through the several cracks" in the system. Several studies have shown that women in India are disproportionately affected with NCDs. Early screening and precise diagnosis will go long way in prevention, treatment, control of these 12 NCDs and will also help women to improve health related quality of life (HRQOL), improve earning capacity, reduce missed work/school days, reduce burden on secondary and tertiary care and in many cases will reduce premature deaths. In rural, tribal and remote areas where men mostly migrate for work (due to climate changes, this migration is ever increasing) to bigger towns or cities - if a woman's health condition is improved, it improves her capacity to support and take care of her family especially children. Our product "Suraksha from 10 NCDs for women", has the potential to lift women out of poverty and allow more women to provide for themselves and their families.

As chief of operations I am working closely with public health system authorities, field staff, ASHA workers to enhance and develop our Suraksha solution in the most robust fashion. Our solution Suraksha is built based on our learning from our solution SAVE™ for CRDs. Our team has learnt from ground realities when it comes to screening and diagnosis of NCDs for women. We have also got insights about the difficulties experienced by healthcare staff in remote, semi-urban and factory settings in helping patients with early diagnosis and offering a treatment plan for CRDs. Our team members are currently based in New Delhi, Pune, Bangalore, Hyderabad and Nagpur in India and Copenhagen, Denmark. 

Personally I have been working on women's health issues for last 2 decades now. I have been doing various community support activities to promote menstrual hygiene amongst girls and women from slum areas. I was part of the 8 women team which hold the Guinness World Records title for to promote menstrual hygiene, destigmatize menstruation and create awareness about sustainable period products. The mosaic image was made using more than 4,500 commercially available biodegradable sanitary pads.

Our scientific board for Suraksha NCD for Women is headed by Dr. Rohini Patil a leading gynaecologist, cancer survivor and breast cancer crusader.

We are already working with various states such as Gujarat, Maharashtra, Madhya Pradesh and Chattisgarh for NCD screening and diagnosis for women.

We are working closely with National Health Mission, Government of India, JanCare program on project implementation. We have signed a MOU with Mahatma Phule Backward Class Development Corporation of Government of Maharashtra to train 500 marginalised youth from SC/ST community as SAVE Coordinators. These coordinators will then work closely with the Primary Health Care facilities. We have also partnered with various Public Sector Units like HLF for large scale implementation of our program.

Briota's Point Of Care Test platform SAVE™ - Screening, diagnosis, management Assisted Virtually Early for CRDs with SpiroPRO® for COPD, Asthma, Post TB is already live in India, has benefitted over 100K patients and now is selected for expansion with support from ADB in Bangladesh. Our NCD Suraksha kit for women is fully integrated with our POCT platform SAVE and now supports 10 NCDs. NCD Suraksha kit is now available in India as a comprehensive solution for NCD screening, diagnosis and management at community and primary care facilities. Briota has already received work orders from the state of Chattisgarh to use Suraksha for screening and diagnosis of women in tribal belts of Chattisgarh. We are now working with various state governments (4 in advanced stage of proposals) in India to expand the reach of Suraksha NCD Kits for women.

We fully understand and appreciate the value Solve provides through it's partner network if we are selected as a Solver. We were Solver for 2023 for our SAVE™ platform enabling early screening and diagnosis of CRDs - COPD, Asthma, Post TB in resource constrained settings. While our initial product offering was only for CRDs our new product offering Suraksha covers 12 NCDs for women and is aimed at improving health equity in rural, remote and tribal areas. We believe being a Solver with our new product offering Suraksha will provide us a much larger opportunity to partner with various organisations working towards improving health equity and also with organisations who are focused on women's health. We expect to receive both strategic and financial resources for expanding our new product offering Suraksha not only in India but beyond India - in other Asian and African countries.

Our solution Suraksha is innovative in many ways.

1. Suraksha NCD kit is a bag pack (weighing less than 1 KG) which can be easily carried by Suraskha ANM or ASHA worker traveling on feet, by 2 wheeler or traveling in mobile medical unit - a van. 

2. Suraksha NCD kit is first of a kind 10 NCD comprehensive POCT kit designed for women which acts as a single window, single seating, single technician solution in remote, tribal and rural areas - the woman patient does not need to travel to multiple facilities spread over several days or months for the 10 NCD screening and diagnosis.

3. Suraksha NCD kit includes "easy to use" Suraksha screening cards and use locally relevant and "time efficient" workflows - for example we use a "color bindi" model to standardise breast examination process by an ANM or ASHA worker without overtly complicating the process.

4. Suraksha kit is integration ready with digital portable X-ray system. X-ray is useful for confirmation of certain CVDs, lung cancer, ILD and post TB lung diseases.

5. Suraksha kit comes with a mobile phone/tablet device which has Suraksha app which works without internet for some specific screenings and with internet allows remote tele-consultation with expert doctors

6. The C-BAC (community based assessment checklist) survey in mobile app Suraksha, along with screening data from POCT devices is analysed by our AI software to generate specific health scores. 

7. These health scores are derived by Machine Learning models developed using "real world local data" collected by Briota from various states in community settings in India. These health scores and diagnostic parameters from POCT devices are further analysed by our AI software to generate diagnosis or risk score for the 10 NCDs . These health scores are Lung Health Score (LHS), Breast Health Score (BHS), Cardiac Health Score (CHS) and Oral Health Score (OHS).

8. Our Machine Learning models generate risk stratification for all the 10 NCDs and also provide diagnosis confirmations for CRDs, CVDs, Anaemia, Diabetes, Hypertension. For common cancers - Lung, Oral and Breast - our AI software provides recommendations for next set of tests such as mammography, biopsy, clinical examination or consultation with an expert. This helps in prioritising the "high risk" women for further diagnostic tests instead of sending every "eligible" woman for diagnosis at secondary or tertiary care. 

Current approach for NCD screening and diagnosis in rural and remote areas is either focused only on diabetes and hypertension screening at primary health care centers or is provisioned through large health screening camps conducted in towns and districts headquarters.

Our solution is primarily serving women in rural, tribal and remote areas who do not get screened early and diagnosed early for 10 NCDs. Especially those women who can not afford to go to district hospitals or expensive private practices for early diagnosis. Most of the screening and diagnosis tests 

Girls and women who are studying, working on daily wages, working in unorganised labor market, working as agriculture labor or are uneducated or are socially deprived do not travel to Secondary or Tertiary care for screening of NCDs. In most cases such girls and women are either misdiagnosed or never diagnosed with correct condition in primary settings and get only symptomatic assistance. Over a period of time as the disease progression increases, these girls and women then reach to Secondary/Tertiary care and need to be put on more expensive treatment, with increased out of pocket expenditure and end up loosing their daily earnings or studies.

For 10 NCDs, a woman on average will need to travel 10 times and visit at least 5 healthcare facilities. Considering the cost of travel, loss of pay, loss of school, referrals to private laboratory etc. the out of pocket expense for each woman could be $50 to $200. The average symptom to diagnosis confirmation time for each of these 10 NCDs after the patient has reached a healthcare facility is between 2 weeks to 1 year. This means in many cases such as Cancer - the 

Apart from costs the availability of Spirometry test is a huge constraint for rural population, tribal population and underprivileged sections of the society. With Briota's Spirometer - a normal healthcare worker such as ASHA worker can also perform the screening and then the full spirometry can be conducted at Primary Healthcare Center by the regular healthcare staff. Even spirometry could be conducted in health check up camps with diagnosis and treatment plan made available. Our calculations show that the complete spirometry test could be now offered for less than US$1 per patient. 

Early diagnosis means a lot to every patient but especially for the underserved - early diagnosis of COPD, Post TB Lung Impairment, ILD and Asthma means how long they could remain productive and reduce loss of wages or loss of school days. This also means the disease progression could be slower than in normal scenario. With slower disease progression, optimal disease control is a possibility which means less hospitalisation and reduced deaths.

We are on a mission to screen 100 million people for NCDs by 2030. A significant at-least 50% of this will be women. 

Some of the specific indicators we track are below -

1. How many health workers - midwives, nurses, PHC staff can use Suraksha NCD kits to do 10 NCD screening

2. How many At Risk women from rural, tribal and remote areas are benefitted with Suraksha NCD program

3. Reduction in pressure on secondary and tertiary care, reduction in Hospitalisation and Deaths

4. How many patients could be managed at Primary Care versus Speciality Care

5. Increased lifespan and health related quality of life for women patients

6. Confirmed diagnosed patients for all 10 NCDs

Our solution uses No Contact AI, IOT, Web and mobile technology. We use Machine Learning models to generate health scores developed using "real world local data" collected by our team from various states in community settings in India. These health scores are Lung Health Score (LHS), Breast Health Score (BHS), Cardiac Health Score (CHS) and Oral Health Score (OHS).These health scores and diagnostic parameters from POCT devices are further analysed by our AI software to generate diagnosis or risk score for the 10 NCDs . 

Our Machine Learning models generate risk stratification for all the 10 NCDs and also provide diagnosis confirmations for CRDs, CVDs, Anaemia, Diabetes, Hypertension. For common cancers - Lung, Oral and Breast - our AI software provides recommendations for next set of tests such as mammography, biopsy, clinical examination or consultation with an expert. 

For Suraksha we have an engineering team of 12 engineers, field operations team of 18 technicians and trainers.

Suraksha NCD kit is being designed and developed with concentrated efforts of last 9 months, however our core technology platform SAVE (initially designed for CRDs only) is being in development for last 3 to 5 years.

Our team in India is led by our chief of operations Ms. Aditi Pais and Dr. (Mrs.) Rohini Patil and more than 60% staff is women team members.

We work in B2G and B2B space. We offer Per Test Model under Test As A Subscription or Test As A Service to Government Agencies, Hospitals, Corporates, Social Enterprises. We charge between US$3 to US$10 per patient for a full services model - technology, consumables, technician, diagnostic report, treatment plan recommendations etc. Our key customers include state exchequer responsible for public health. We already have recurring revenue and signed contracts from government agencies for Suraksha from NCDs for Women.

We have received multiple grants, prizes worth US$750K+ both in India and Denmark so far. These grants and prizes have come from BIRAC Govt Of India, JanCare Department of Health Government of India, ADB, MIT Solve, J&J impact innovation fund, Department of Science Govt of India, Qualcomm, Bayer Pharma, Innovation Foundation Denmark and Danish Life Science Cluster Denmark. We have already clocked $60K and $115K as revenue in last 2 financial years. We are now in process of executing various contracts with Government agencies in India. Beyond the Government work, we will also soon expand Suraksha NCD screening - test as a service with general practitioners, universities and industries.