Health to the forefront
The present COVID-19 crisis has allowed India to course-correct its floundering healthcare infrastructure and policies to better meet inevitable challenges in the future
The global COVID 19 pandemic that spread like wildfire across the world and is currently proliferating in India has raised many pertinent questions such as: Is India's healthcare infrastructure adequately prepared to manage a pandemic of this magnitude? What could have been done and what steps can be taken to spruce up the existing care infrastructure?
It must be noted that, in India, affordable access to quality healthcare has always been a challenge. A Lancet study published in 2018 indicated that India ranks 145th out of 195 countries in terms of access to quality health services, lagging behind China (48), Sri Lanka (71) Bhutan (134) and Bangladesh (132). A large chunk of the populace can't afford quality private healthcare as they are too cost-intensive and therefore, public healthcare facilities are the only viable option available for them.
To understand the latter better, let us look at some numbers. India's spending on healthcare stands at 1.28 per cent of its GDP and it is expected to increase by 2,5 per cent by 2025 according to a KPMG report. This is the lowest amongst all developing countries. As per data from 'National Health Profile–2019', there are just 713,986 beds in government hospitals, i.e., 0.6 beds per 1,000 patients. Also, 0.8 doctors for every 1,000 patients. Further, primary healthcare centres and community healthcare centres also lag in numbers by 22 per cent and 30 per cent, respectively. Rural regions still grapple with a shortage of medicines, instruments, care providers and even basic utilities.
The COVID 19 pandemic has mirrored these gruelling aspects more starkly than ever. Till today, the administration is struggling to arrange for isolation wards, ventilators and beds for Coronavirus patients. GOI outlay for health is Rs 623.9 billion of which Rs 317.5 million is for the 'National Health Mission' and Rs 64 billion is for 'Ayushman Bharat' while and allocation of Rs 150 billion is in place to tackle COVID-19, according to the KPMG report. Healthcare infrastructure in India provides 10 beds per 10,000 people against a global average of 29. India has around 45,000 ventilators which is abysmally low, considering the number of COVID patients who need ventilator support and for other respiratory diseases. Further, these cannot be imported as global supply chains are also overloaded.
When it comes to out-of-pocket (OOP) expenses for healthcare services, that individuals pay to care providers directly, without any involvement of insurance company or the State, India ranks 62.4 per cent compared to the global average of 18.55 per cent. This is an important indicator and thus, provisioning of quality affordable healthcare and insurance cover for vulnerable groups is truly indispensable for mitigating this dismal scenario. A whopping 80 per cent of India's population does not have any well-entrenched health insurance coverage and over 68 per cent lacks passable access to essential medicines.
It is crucial to take cognisance of the fact that no modern economy can be established upon the foundation of a dilapidated healthcare infrastructure. It is imperative for India to develop an efficient healthcare system and here, public investments in building medical colleges, nursing schools, training for medical staff, manufacture of specialised medical equipment, synthetic biology, drug or vaccines manufacturing and a well-crafted, as well as integrated structure of primary, secondary and tertiary care hospitals that use telemedicine to optimise the utilisation of capacity, is a welcome move. Some of these can be privatised over time. To build a futuristic system of healthcare delivery, the triple helix model of innovation suits India, for ensuring greater transparency in the research collaborations. The Government, academia and industry need to come together and work in tandem more than ever before, in research and manufacturing. Many such are currently underway.
Funding from the Government and an integrated open innovation model in the healthcare sector, particularly in areas of biomedical research and drug discovery, will be a stellar move in improving the current healthcare machinery of the country. GOI and various state governments are coming up with greenfield hospital projects, states are upgrading speciality hospitals plus medical colleges with OPD annexe. States are also upgrading district hospitals to medical college cum hospitals (100-500 bed/100-250 seats) with an approximate investment of Rs 50-100 crore per project. There is an opportunity for approximately 20 government hospital projects. Also, to add better connectivity like highways, railways and airports connecting all hospitals and medical facilities is a must for improving the healthcare infrastructure in India.
A conducive business ecosystem, topped with light-touch regulations and well-implemented healthcare reforms can go a long way in enabling India to hold a key place in the healthcare delivery map. Given the pandemic at play, it is all the more important to relook at strategies to revive India's moribund healthcare sector. Experts opine that a fiscal package of Rs 2.1 lakh crore is needed to catapult India's healthcare infrastructure and facilitate more R&D and innovation in the healthcare space.
The need now is to initiate structural changes in India's health policy, introduce increased technology deployment in the sector, reduce dependency on import and encourage domestic manufacturing of healthcare equipment and devices, and create a stronger native healthcare infrastructure to assist the country's quest towards economic revival.
The writer is the MD for Egis India. Views expressed are personal