Collaboration to deliver a vision for healthcare in India

As the pandemic plays out in the country, much of the recent conversation has been focussed on the lack of ICU beds, ventilators and safety equipment

The ongoing COVID pandemic has put the spotlight on one of the most critical sectors in the economy – healthcare. The sector, however, faces an interesting dichotomy. On the one hand, it is viewed as one of the fastest growing sectors on the back of rising income level, greater health awareness, increased precedence of lifestyle diseases and improved access to insurance. On the other, the sector continues to be grossly inadequate to meet the demands for the population.

As the pandemic plays out in the country, much of the recent conversation has been focussed on the lack of ICU beds, ventilators and safety equipment. However, it must be acknowledged that gaps in the system run much deeper. Looking at the scenario more holistically, there is an opportunity to leverage this narrative as a trigger and truly deliver on the opportunity for quality healthcare in India.

Data from the National Health Profile 2019, shows that India has a little over 11.57 lakh allopathic doctors who are registered with the state medical councils and the Medical Council of India. Assuming 80 per cent availability as per information presented in the Rajya Sabha, approximately, 9.26 lakh doctors may be actually available for active service. Further looking at the number of beds in the country, the national average stands at 0.55 beds per 1000 population – WHO recommends 5 beds per 1,000 population . A further analysis of the data, reveals that states accounting for close to 70% of the population fall below this national average. It is also a well-known fact that health infrastructure tends to be skewed towards urban cities leaving yawning gaps in access to healthcare in rural areas. Moreover, healthcare workforce prefers to work in urban centers due to higher pay and other facilities. With changing disease patterns, a need for better integration of the primary, secondary and tertiary levels of care is critical.

Over the years the Government has put into place a number of programs to address these very concerns. The ambitious Ayushman Bharat program envisions rolling out of 1,50,000 Health and Wellness Centers at the primary level as well as extending hospitalisation services to close to 50 crore beneficiaries.The Government has also announced programs aimed at creating infrastructure at the tertiary level including the setting up of new AIIMS and Medical Colleges as well as upgrading infrastructure for diseases such as cancer. The

National Health Policy 2017 provides the policy framework and proposed role of stakeholders in the ecosystem.

Going forward, we believe there is an opportunity to build on past efforts and deliver healthcare services for the new normal, focussed on three pillars – access, quality and affordability. With programs such as Ayushman Bharat, the demand for health services is set to grow – the supply side must be equipped to deliver. Further, the ongoing COVID pandemic has reiterated that neglecting the need for robust health systems can cost economies dearly. We believe, an integrated approach across various levels of care that places the patient at the centeris the model that will deliver across these three pillars.

How do we get there? Let us begin by taking an example of cancer care. Today a cancer patient is hindered in access to timely diagnostics and treatment. Typically, patients travel long distances to large urban centers for treatment. Patients also face a massive financial burden, that in many instances wipes out entire households and leaves them saddled with debt. There are a limited number of institutions that patients trust and the winding lines outside the Tata MemorialCenter, Mumbai, only reiterate this. With the number of layers that patients have to navigate, they end up in a confused state of mind, feeling helpless and desperate – a considerable portion drop out of treatment.For services such as radiotherapy, less than 20% patients receive treatment – this against, the 50-60% who require it.

What is needed then is to relook at the patient journey and place people at the center, rather than institutions. As a starting point, communities must have access to opportunistic screening at the primary level. Beyond this, the referral chain needs to be robust with availability of appropriate infrastructure and trained manpower at each level. Services have to be brought closer to people, building their trust in institutions and building an ecosystem without fear of diseases such as cancer.

The vision to remedy this situation has already been laid out by the Government – across disease areas. From here, the need of the hour is dovetail government programs that are run in silos and ensure they feed into a single comprehensive vision. Integration of existing policies and programs that address issues across the value chain right from the National Health Mission to Skill India to the Make in India Program. Simultaneously, programs that look to upgrade Tertiary Care Infrastructure must be revisited - can we begin to build in elements of centralised procurement to achieve greater efficiencies in allocation of financial resources? Going forward, policies need to sing the same tune – this will create the framework for stakeholders, public and private, to commit to delivering the very vision for an equitable robust health system.

While the vision for delivering healthcare in the new normal has the potential to transform the sector, we must not forget – implementation will be the key piece. As the starting point – health is a state subject. Delivery of healthcare involves a multitude of stakeholders. In fact, our past experience has shown–models that createcollaborationswithin this complex ecosystem make the difference. Given this, we believe Public Private Partnerships (PPPs) is the implementation model for the future. Leveraging the strengths of the public and private sectors, PPPs are seen as an effective way to capitalize on their relative strengths to address problems.

It has been encouraging to see steps taken by the Government.The Task Force on the National Infrastructure Pipeline (NIP) recognised the need for greater private participation through the public-private partnership (PPP) route to improve primary healthcare facilities at the district level. Coupled with this, the NITI Aayog continues to see value in the approach– most recently the agency asked states to accelerate the process of setting up of medical colleges on PPP model and augmenting district hospital facilities with private partners. In a move to encourage private sector viability the Government has also encouraged use of Viability Gap Funding (VGF) - for social infrastructure projects an enhancement of the quantum of VGF to 30 % of the total project cost was announced. While these are critical first steps to encouraging PPPs, models that are collaborative and place minimal financial burden on public resources are those that will find acceptance within the system. We believe, the recent move by Bharat Heavy Electrical Limited (BHEL) inviting multinational companies to use its facilities to carry on manufacturing and supply chain activities – are worth exploring.

Revisiting our three pillars, a comprehensive uniform policy vision backed by a collaborative implementation model is the way forward.Social distancing due to the COVID pandemic, has put pressure on traditional delivery mechanisms to reboot – within this, technology has a critical role to play in leapfrogging to close gaps rapidly. Artificial Intelligence has the power to drive greater efficiencies and quality care – public private partnerships can deliver immense value in bringing this to the last mile at an affordable cost. Matching demand and supply elements, we believe, the need of the hour will be to deliver on innovative models that can be scaled quickly.

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