A New Dawn

Times of crises are also windows of new opportunity. We are travelling through one such time, unprecedented in its suddenness and impact on global health. Cruising on the road to achieving the sustainable development goals by 2030, the COVID-19 pandemic has subverted our collective journey towards that goal on to a totally different trajectory. This off-road experience over the last 18 months is set to redefine the basic tenets of healthcare in the world and India in particular. Many of the assumptions made in health planning stand side-lined in the middle of the present crisis. That notwithstanding, this is a golden opportunity for the stakeholders of health in India to revisit and repurpose our collective health vision for the future.

The COVID-19 pandemic has unmasked some inherent weaknesses of India’s healthcare system. The foundational need of a robust primary healthcare platform to buttress the upper layers of secondary and tertiary care cannot be highlighted more than it has been through this ordeal. The frailty of the secondary care network, both in quality and quantity, has cost India dear in the number of lives lost. The tertiary care front has put a gallant frontline battle catering to the intensive needs of hypoxic patients both in the first and second waves of the pandemic. The strength of the private sector in its ability to provide world-class ICU care has been exemplary. And to understand that the intensivists and specialists have done this amidst increasing paucity of oxygen and critical drugs speaks highly of their clinical acumen and commitment to care. No amount of clapping and public adoration will be enough to compensate the lives of 800 doctors lost in action.

What lies ahead? Without a doubt this too shall pass. There is a time for everything and to everything there is a season. So shall it be for the pandemic in question. But it will be akin to a tornado that leaves behind a trail of destruction. The healthcare fraternity would be required to pick up the sticks and stubbles and set the house in order. That indeed is a huge challenge. The large and empowered corporate sector, the highly talented IT domain, the patriotic Indian diaspora overseas who are both resourceful and influential, and the political leadership who could be catalysts for change, all need to converge onto a common platform for a common vision – to resurrect the injured healthcare ecosystem for social good.

What have we learnt from the tumult of this pandemic?

• There is a serious flaw in the governance paradigm of healthcare in India, whatever be the constitutional rationale behind it. It has not worked in this crisis and is time to question the concurrency of health as a state and central entity. The confusion over oxygen allocation, bed availability and the high decibel whataboutery witnessed in New Delhi points to the fundamental flaw in the equation. In a country as large and heterogenous as ours where cooperative federalism is theoretical, Healthcare must be decentralised to the states, completely. States that have held up in this pandemic have exerted that dominance despite the compulsions of the federal structure. It may be time to amend this for the future. Central involvement must remain confined to registration, accreditation and standards.
• Even the notional enhancement of a 2.5 percent GDP for health announced in the current budget will not meet the huge dent made by the pandemic. Many countries have accepted the reality of health having now being the cornerstone of all economic progress. It cannot be different for India. Specifically, the enhancement of primary and secondary remains the responsibility of the government and not the private sector. The latter must be invited into collaborative partnerships to share their expertise and professional resources into this enhancement model. Not for profit, but as part of social responsibility.
• There is an urgent need to reconstruct the organogram of healthcare with a much larger representation of primary and secondary healthcare. The new triangle must have primary and secondary care forming the strong angles below and tertiary care at the apex. The bulk of common ailments can be dealt at the base while only the needed complex illness be filtered up to apical tertiary care. Had this been the case, the Indian COVID public health response would have been different. The costly lessons from the bed crisis, oxygen famine and a botched vaccination framework are cues to act upon.
• Balancing manpower, clinical skills and technology is a crucial priority. The thrust on expensive technology to solve India’s mundane healthcare problems is misplaced. Instead, India needs to maximise healthcare human resource for the future by recasting its vision on medical and nursing training. The current meritocratic, exam-oriented training leaves a lot to be desired in terms of manpower availability for India, in times of crisis.
• Last but not the least, our re-casted vision for health cannot ignore the huge hospital-patient trust deficit that has built up over the pandemic period. There are significant changes in the epidemiological profile, patient expectations and practice formats. Sea changes are evolving in the way healthcare will be delivered. It is paramount to brainstorm on these with patients in the centre of all future interventions.

Only then will we find ourselves better equipped for the challenges of the future.