India has a huge potential, but it needs to be appropriately tapped!

The indian healthcare market is quite complex and is unlike any other global market. It is almost like USA and Africa combined together. It consists of predominantly five categories:
Medical colleges. Most western countries provide quality care in most medical colleges, which are research centers too in a way, but in India, most medical colleges provide basic medical care except for few. Most patients there are treated for all practical purposes, by students and interns. The type of patients who go there are aware of the basic healthcare available there.
Government hospitals. The quality of government hospitals in the country vary from sub-Saharan type to most flourished autonomous government hospitals. These provide reasonable care within the resources they have, and the patients who go there are usually aware of the standards of care available there.

Neighborhood nursing homes. These are small 5 to 20 or 30-bedded hospitals, typically run by mom and dad, doctors, with or without duty doctors – and the cost is usually reasonable – and they generally provide basic medical care for the neighborhood area. They are not the places where tertiary care is provided or expected. Charitable hospitals. These are typically established by charitable institutions – and they have philanthropy associated with it – notably – Tata Memorial Hospital, Mumbai; B.J. Wadia Hospital, Mumbai; St. Martha’s Hospital, Bangalore; CMC Vellore; and so on. They provide reasonable care in most places.

Corporate/private hospitals. These are typically owned by corporates or PE investment-backed institutions – where tertiary care may be available in most places – like transplantation, transportation (mobile ICU), and so on.
India needs a multitude of approaches suitable to these hospitals, as per their affordability, quality of care, and so on. One plan does not fit everyone.

On budgetary allocation in healthcare
The budgetary allocation in healthcare is much better in the last few years compared to what it has been since independence. But it is still a drop in the ocean. We need at least 5 to 10 percent of GDP to be allocated to healthcare to make any meaningful impact. But with only 4 percent of tax payers, gross corruption, with political parties and public believing and receiving freebies, we are far away from achieving any meaningful solution in the near future.
Our planned budgetary allocation for the fiscal year 2019-20 is close to `100 crore and 20 percent of this is allotted for the procurement of medical equipment and devices.

On your vision for health and family welfare
Family Welfare – this has a very broad meaning – basically meaning everyone in the family are physically, mentally healthy. Currently, we are talking about only physical health in India – we have not even touched public health, preventive health, and mental health for all practical purposes. We wanted to provide comprehensive health for the new parents – so that the concept of healthcare is achieved – we had numerous problems while implementing the health services in Cloudnine. Broadly, they can be classified into the following categories:
Transformation of our mental thoughts into action requires trained people on the ground, who can deliver our aimed plans – the human resources in India currently is abysmal and very competitive with high attrition rates.

Government and the public does not differentiate from comprehensive healthcare versus simple healthcare – so lot of our so-called competitors provide maternal and neonatal care (of much less standard than ours), and people compare the costs without realizing they are comparing apples and oranges. The licenses required and needing renewals in healthcare are too bureaucratic. A single-window approach would help. Quality of infrastructure to get it – we have to struggle as there are no standards followed by most builders.

On monitoring the quality of private healthcare
I reiterate, that the Indian healthcare system is complex. The quality of private healthcare provided needs to be monitored by an independent body, which understands the private healthcare and cost-analysis need to be undertaken – and monitored for its money worth – so the consumer is the ultimate benefactor. Unless we have this system, we will continue to think the private health sector is being targeted. Similarly, accountability should be part of public healthcare system too with both healthcare professionals and local politicians made accountable for their health standards in their community.

On public private partnership in making healthcare a success
Public-private partnership (PPP) is important in making healthcare a success, especially in India because the Indian government does not have enough resources to cater for the healthcare needs of the whole country. So, the private sector has to pitch in. Right now, there is too much of talk – but no action on the ground. Also important for any program to succeed is the honesty, transparency, accountability – whether it is public or private or PPP. One has to look at why our public sector is so poor – is it because of lack of resources only or lack of responsibility and accountability?

On areas where government should invest to make healthcare available to all
Government should invest in public health and preventive health to make our country a better country. Currently, there is too much focus on acute healthcare needs but very little focus on preventive health. If preventive and public health is focused properly, our acute healthcare needs will drop significantly, saving more money for preventive programs. For example, good sanitation can virtually eliminate water-transported diseases like typhoid, hepatitis A, and so on, which are quite endemic in India. There are no food standards, strictly adhered to in India – see in Bangalore, for example, the only thing that is flourishing is food industry – anyone can open any shop or restaurant in any footpath and block the road anywhere and hardly any one questions them!

On policy interventions that the htealthcare sector in the states needs to align with the healthcare objectives at the national level
We have followed what the British taught us – the healthcare is a state responsibility. But there should be good healthy competition and questions should be asked by the national government – and suitable governments should be rewarded. We have Kerala with an infant mortality and maternal mortality comparable to the West and we have some states where the rates are comparable to Africa. Why? Why is no one asking questions and monitoring the poor states for quality of the healthcare infrastructure, healthcare professionals, etc.? Till education improves and accountability is established, our healthcare needs will continue to be ignored.
Standard healthcare policies governing basic healthcare indices like IMR (infant mortality rate), MMR (maternal mortality rate), and infectious diseases and communicable diseases (which are notifiable) are not monitored properly. Data is scanty or fudged; unless we have comparable data and healthy questions are asked at the national level, this will continue. Budget allocations to the state should be at appropriate indicators by the national government.

Anything else you would like to add
India has a huge potential, but it needs to be appropriately tapped.
Clinical research is something totally ignored at every level. At Cloudnine, we have been wanting to involve ourselves in a quality clinical research with universities abroad, and any good clinical research project takes at least 2 years to get it off the ground with the legislations we have, if we are lucky.
We do not have animal research labs owing to various reasons in India. This limits our ability to test new drugs/modes of treatment.
We have multitude of healthcare systems like Ayurveda, Homeopathy, Naturopathy – if they are combined with allopathy with clinical evidence of its benefit – proven on clinical randomized trials – then we will be the leaders in healthcare in the world.