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Why tier-2 and tier-3 cities are not included for clinical research

Krutikesh Age, Founder, DPHS. Pvt. Ltd., a Clinical Research, Development, Diagnostics and Data Management Solutions Company

Clinical research in India primarily focuses on Tier-1 cities, neglecting Tier-2 and Tier-3 cities in South India due to various reasons. Challenges include inadequate infrastructure, low awareness and healthcare migration to bigger cities, limited accessibility, complex regulations, and cultural barriers. Addressing these issues requires collaboration among stakeholders to make clinical research more inclusive and beneficial to all regions of the country.


India is rapidly emerging as a global hub for clinical research, with many international pharmaceutical companies and research organisations choosing the country as a site for their clinical trials. However, the majority of clinical research is conducted in Tier-1 cities such as Mumbai, Delhi, and Bangalore, with much less attention paid to Tier-2 and Tier-3 cities in South India.

There are several reasons why Tier-2 and Tier-3 cities in South India are not included in clinical research. One of the main reasons is the lack of infrastructure and resources required for conducting clinical trials in these cities. Clinical research requires specialised facilities and equipment, which may not be available in smaller cities. This can make it difficult for researchers and pharmaceutical companies to conduct clinical trials in Tier-2 and Tier-3 cities.

Another reason is the lack of awareness and understanding of clinical research among people in these areas. Many people are unaware of the benefits of clinical research and the role it plays in improving healthcare outcomes. There is also a lack of awareness among healthcare professionals in these areas, who may not be familiar with the latest research and clinical practices.

Another factor contributing to the exclusion of tier-2 and tier-3 cities from clinical research is the migration of people from these regions to bigger cities for treatment. Many people from smaller cities and towns often migrate to bigger cities like Mumbai, Delhi, Chennai, and Bangalore, seeking better healthcare facilities and treatments for their ailments. This migration results in a reduced patient pool in smaller cities and towns, making it difficult for clinical researchers to conduct trials in these regions.

Accessibility is another significant challenge that prevents people from Tier-2 and Tier-3 cities from participating in clinical research. Many people in these cities have limited access to healthcare facilities and may not be able to travel to larger cities to participate in clinical trials. This is particularly true for people from rural areas who may have to travel long distances to access healthcare facilities. As a result, researchers and pharmaceutical companies often prefer to conduct clinical trials in larger cities that have better infrastructure and accessibility.

Another challenge is the regulatory environment for clinical trials in India. The Indian regulatory framework for clinical research is complex and can be difficult to navigate. This can deter researchers and pharmaceutical companies from conducting clinical trials in Tier-2 and Tier-3 cities, which may have less experience with the regulatory process.

Finally, there may be cultural and linguistic barriers that make it difficult for researchers and

pharmaceutical companies to conduct clinical trials in Tier-2 and Tier-3 cities. India is a diverse country with many different languages and cultural traditions. Researchers and pharmaceutical companies may face challenges in recruiting participants and working with local communities in these areas.

In conclusion, there are several reasons why Tier-2 and Tier-3 cities in South India are not included in clinical research. These include a lack of infrastructure and resources, limited awareness and understanding of clinical research, accessibility challenges, a complex regulatory environment, and cultural and linguistic barriers. Addressing these challenges will

require a concerted effort from researchers, healthcare professionals, policymakers, and other stakeholders. By working together, we can ensure that clinical research in India is inclusive and benefits people across the country.

Why tier-2 and tier-3 cities are not included for clinical research

Co-Founder at DPHS Pvt. Ltd., Dr. Krutikesh Age is a researcher and a visionary committed towards propelling the field of clinical research and healthcare expansion in India. As the Co-founder of DPHS, Krutikesh manages varied key roles including Leadership, developing business and marketing strategies and Networking to name a few. It is through the deep understanding of clinical research and market dynamics that he has been instrumental in expanding the operations of DPHS in the past few years. 

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