Public healthcare in India, in the last decade, has been a low priority with just 1.29 percent of the country’s GDP in 2019-20 spent on healthcare whereas the global average is of 6 percent. Ironically, we are the same country that is known for our success in eradicating small-pox and polio through targeted public intervention. And India’s Universal Immunization Program is renowned as one of the largest public health interventions in the world.
Today, healthcare sector across the globe is reinventing itself faster than ever, working on evolving, innovating and modifying care delivery models for integrated and value-based care, which will shape the future of healthcare. And despite the challenges emerging economies like India have to tackle, like the challenges of rising costs, inconsistent quality, inaccessibility to timely care, as well as confront the dynamics of globalization, consumerism, changing demographics and shifting disease patterns with increase in lifestyles and chronic disease, along with the proliferation of new treatments and technologies, the healthcare sector in India is bound to flourish.
Growing incidence of lifestyle diseases, rising demand for affordable healthcare delivery systems due to the increasing healthcare costs, technological advancements, the emergence of telemedicine, rapid health insurance penetration and government initiatives like e-health together with tax benefits and incentives are driving healthcare market in India. And with the launch of Ayushman Bharat – the Indian government has demonstrated its strong commitment to providing healthcare for all, aligned to the SDG 3 goal. Healthcare in the last few years has also been included as a key parameter in the country’s development plan through various comprehensive initiatives including Swachh Bharat, Digital India, Skill India, Start-up India, Make in India, and now National Digital Health Mission. However, as compared to some of the developed nations we still have a long way to go.
On budgetary allocation in healthcare
One thing COVID has taught us is that the country needs a robust healthcare system available to every citizen across geography, which would require a sufficient budget spend and strong infrastructure. Compared to spend by India at 1.28 percent of GDP, US spends 16.9 percent and Japan 10.9 percent on healthcare. However, with recommendation by the 15th Finance Commission to increase the combined outlay by the centre and states to 2.5 percent of the GDP, the steps are being taken in the right direction. With vaccine distribution to be organised at a national level, the challenge will be to have a distribution strategy in place. While we are on the way to progress, a long way is ahead of us.
On monitoring the quality of private healthcare
The COVID-19 pandemic has put the healthcare segment in the front and has made the world realise how important is it to have a robust fully equipped and battle-ready healthcare system. While there is a requirement for public private partnership in the healthcare segment, an equally important area of focus is diagnostics sector. Diagnosis is the first step towards any treatment and fighting a pandemic and hence, it needs to be given adequate impetus and be a focal point of healthcare in India.
The current crisis has brought the diagnostics segment out of the shadows and has shed light on the importance of a need to establish a robust regulatory body to standardise and regulate the industry. While there is a Clinical Establishment Act, adopted by few states, largely there is no regulation or guidelines monitoring technical competence and ensuring adequate quality control procedures in labs.
One of the biggest risks is the proliferation of mom-and-pop pathology labs in the country. A large number of diagnostic labs are being run by under-qualified technicians, in India. In case of medical diagnostics, there is a huge emphasis on the quality protocols and procedures followed within the lab as the pathologists handle highly sensitive machines which require daily calibration and controls.
While the diagnostics sector has great potential to grow as more and more people are becoming aware of the segment, owing to COVID, lack of regulations is a major concern. Accreditation of laboratories in India is currently voluntary, and only a few major laboratories comply with it. Government needs to focus on this aspect and have an immediate policy intervention as wrong diagnosis not only leads to inaccurate treatment but larger spends by the patient.
On public private partnership
Public Private Partnership (PPP) allows private players to come together with the government to provide a stable platform where people are benefitted by world-class infrastructure offered by the private sector. Diagnostics is an essential pillar of the healthcare ecosystem. The importance of diagnostics can be understood from the fact that as per US CDC, laboratory tests results play an important role in 70 percent of medical decisions. Deeper penetration of healthcare services, say for instance, with Ayushman Bharat – National Health Protection Scheme or National Digital Health Mission, into tier 3, 4, 5 cities and the rural areas, will only be impactful when diagnostics services are available and accessible to the local population. Therefore, just like healthcare services, there is a need for government and private players to join hands and make diagnostics services accessible at the national level.
As for SRL Diagnostics, we hold a dominant position in Public-Private Partnership (PPP) space. We are providing diagnostic services in states of Jharkhand, Himachal Pradesh, and holy pilgrimage site-Tirupati in the past two years. SRL has emerged with certain models that have made testing accessible say for instance there are SRL diagnostic centers in rural Public Healthcare Centers in Jharkhand, where we have provided diagnostic services to 2.9 plus lakh people and conducted 8.2 lakh tests of communicable and non-communicable diseases in FY 19-20.
On areas where government should invest to make healthcare available to everyone
The on-going pandemic in the country has revealed the fragility of the healthcare system and created additional pressure on the already overworked system. Challenges like lack of infrastructure, limited accessibility, and unaffordable medical care were brought in front. While the step by the government to double the healthcare spends is in the right direction, there is a need for a strong integrated healthcare system which can ensure quality healthcare, accurate diagnostics and speed to the masses at an affordable cost.
Today, there is a substantial increase in demand for modern healthcare facilities, digital services, health consciousness and awareness about diseases, processes and quality services. There is a growing trend witnessed by the industry toward digital with increase in online bookings and tele-medicine. With the country moving towards strengthening their response to the pandemic, a drastic shift has been seen in use of apps and digital tool for medical and essential purposes. The digital healthcare market is expected to increase exponentially both from demand and supply side. With the government’s focus to digitize the economy, tele-medicine and digital expansion in healthcare can also be key investment area. There is an increased focus by government to encourage start-ups in healthcare space, however more financial support is required to develop innovations and tools that can enable easy interface and affordable doctor-patient consultations; connecting doctors, patients, pharmacies and diagnostic clinics. And National Digital Health Mission is an essential step by the Central government in the same direction. Also, this will make healthcare services more flexible, accessible and affordable to masses and can help make healthcare on the go a reality for India’s 1.3 billion population and bring doctors to even remote areas of India.
The pandemic in the country also opened doors to various innovations and techniques which can be leveraged to provide on the go healthcare services, especially in rural and Tier 3, 4 and 5 towns of India. One such way is Mobile Units, which can be fitted with ESG, ultrasounds and various other elements and can be made accessible to smaller towns and cities, which face a challenge of infrastructure and human resources. Such units were made a reality during COVID sample collection across the country, where even buses were transformed into mobile units enabling collection of samples and testing for other non-COVID treatments as well.
Albeit slowly, the country is moving towards building a stronger healthcare system and owing to pandemic myriad avenues and opportunity has been unravelled for India to take point on.
In India, while health is a state subject, during the nation-wide pandemic, the state and centre have aligned themselves largely on approach to tackle the virus. Currently there are various different national health programmes initiated by government which aligns the goal of state with national level and collaborate with them to create state wise policies. Under the 2011 policy, the National Health Mission 2012-17 proposed to establish a State Health Systems Resource Centre (SHRCH) which will provide technical assistance at the state level.
Several schemes on health issues such as polio, HIV-AIDS and tuberculosis has been developed by central government and directed to states to comply and thereby playing an active role in defining strategies. Mission Indradhanush is another such scheme by central government where states and centre play a collaborative role to effectively create a healthcare system in the country.
However, with the pandemic, the need to have a dedicated technical advisory body and disease monitoring cell at a state level has been highlighted. As each state experienced a different graph of cases, it becomes vital to have state specific bodies to monitor the movement and provide course corrective measures. These can further better enable states to manage local public health emergencies as well in the future.