In 2020, it was imperative for organizations to find innovative solutions to sustain themselves, virtually becoming “Technology companies” by adopting IT as a major enabler in their functioning. Similarly, in 2021, organizations must focus on the well-being of their customers, both internal (employees) as well as external and become “Healthcare companies” to sustain businesses.
As the pandemic unfolded and the outbreak spread all parts of the country, the healthcare sector had to unlearn, learn, innovate and adapt to the evolving disease dynamics. Virtual care and remote medicine became the need of the hour with Tele-consultations and remote monitoring being adopted across geographies to manage chronic ailments. Hospital footfalls dropped drastically with residential emergency centers and home-based care becoming the norm, especially among the vulnerable and elderly members of the community.
Across India, most communities witness high population densities with the ratios getting exaggerated in urban areas. Our government agencies were quick to assess the scale and enormity of the challenge posed by the pandemic.
India, which was not manufacturing even a single personal protective equipment (PPE) kit, became one of the manufacturing hubs and achieved self-sufficiency, producing in excess of 4 lakh PPE kits daily within a few months after the coronavirus outbreak. Similar efforts were put in place towards building uninterrupted supply chains for pharmaceuticals, ventilators, laboratory tests, N-95/ surgical masks, hand sanitizers and essential medical gases.
In the Pre-COVID times, 750 metric tonnes of Medical Grade Oxygen was produced in India. Now, India produces about 3000 metric tonnes of medical grade and about 2000 metric tonnes of industrial grade oxygen that can also be diverted for medical use, with headroom for additional 2000 metric tonnes.
A credit to our Nation lies in the fact that despite demand spiraling many folds, the overall cost of N95 masks, PPEs and Hand rubs have come down and N95 masks have neither become scarce nor more expensive.
Collaboration and partnership to deliver healthcare services to our citizens has been a feature over the course of the pandemic. Through Public Private Partnership (PPP) models, public and private healthcare providers along with payors, pharma and medical technology companies have stood together in this crisis, demonstrating teamwork and problem-solving approach.
One such success story has been efforts undertaken by the Government of Odisha. In lieu of medical infrastructure constraints, a PPP model was put in place with Odisha Mining Corporation and Mahanadi Coalfields being the CSR partners for setting up dedicated COVID facilities. MOUs were signed in the last week of March and by the first week of April the dedicated COVID facilities were ready.
As the scientific community is yet to find a cure for COVID-19, mass immunization and vaccination becomes immediate priority. Globally, India is recognized as one of the major producers of affordable vaccines and once again, our capabilities are drawing global attention in the wake of encouraging Phase ll/ lll clinical trial results. Some of the major private and public enterprises have partnered in projects to develop indigenous vaccines against COVID. Notable among them are:
“Covaxin” is being developed by Bharat Biotech in collaboration with the Indian Council of Medical Research (ICMR). Phase 3 of the human clinical trial of Covaxin is currently underway at AIIMS in Delhi among other centers.
Steps the government should take
Increase allocation for public health expenditure as a proportion of GDP.
At ~ 4%, India’s total healthcare expenditure as a % of GDP is amongst the lowest globally and even less than few of our South Asian neighbors. This includes the government’s expenditure on public healthcare which constitutes less than 1% of GDP or nearly 25% of India’s total spending. Unfortunately, Government of India’s stimulus and response package including allocation under PM CARES may be inadequate to ensure the availability of all basic amenities and drugs in all public facilities, and to recruit all deficient staff at full salaries.
Our Public health strategy must include integration of Preventive and Curative healthcare services at all levels. Higher public health spending could make healthcare more affordable and accessible for common people and address the burden of out-of-pocket expenses. While government strengthens primary and secondary care services, private sector expertise must be leveraged for Tertiary and Quaternary care.
One can hope that the COVID-19 pandemic has brought the importance of public health systems back to the fore and we would be able to achieve the National Health Policy 2017 recommendations of increasing the public health expenditure to 2.5 percent of the GDP by 2025. In order to improve India’s future preparedness, budgetary allocation should focus on 2 key areas among others, namely:
- Improving health infrastructure: physicians and hospital beds to population ratios
- Health expenditure: as a share of GDP and in per capita terms
Ensure recovery and sustenance of healthcare providers
Historically, doctor-population ratios in India have been short of WHO recommendations. In these demanding circumstances, our frontline Healthcare Workers (HCWs) have been relentless and selfless in pursuit of providing high quality medical care. While for the long run, we address a shortage of doctors and medical professionals, more immediate concern is their physical and emotional well-being which has been severely affected by the pandemic. All possible measures must be explored to provide relief to them and their families, including personal tax incentives.
Contrary to popular belief that hospitals would do well in pandemic, private hospitals have been badly hit as non-emergency treatments, elective procedures and medical travel have come to a standstill. Tax incentives on medical devices and International Value travel could enable swift recovery.
Industry status for the Healthcare sector
This decision will help the sector grow in the tier-2 and tier-3 cities, besides helping private hospitals access land/ projects and funding. Governments across India must look at the private sector as a partner for generating employment considering healthcare promotes gender equality, diversity and inclusion as more than 60% employees entering the healthcare sector are women. Higher female education and employment enables a healthy and prosperous society.
Research and Development
Harness India’s capabilities and leverage its competitive advantage in areas such as biotechnology, pharma and epidemiology.
Encourage scientific costing and market based fair pricing rather than broad price capping exercise. Pricing models based on public sector data and findings often discount Infrastructure, Manpower and Maintenance costs being borne by taxpayers. As a result, these hidden costs may not get factored in the price determination process.
Urban planning and infrastructure
India is one of the fastest growing economies in the world and increasing Urbanization is an expected outcome. Although metropolitans are centers of economic growth but poorly planned cities risk being breeding grounds for rapid transmission of diseases and infections. During the current pandemic, densely populated metros such as Mumbai, Delhi, Bengaluru and Chennai witnessed high transmission due to their inability to effectively practice distancing norms.
The national lockdown implemented for COVID-19 was the first-time provisions of the National Disaster Management Act, 2005, were invoked since the law came into being after the 2004 Tsunami. We must reevaluate our urban planning and development models to provision disaster management and climate change in order to make our cities and towns healthier and more livable.
Disease surveillance and preparedness
The current pandemic has underscored the importance of disease surveillance in India. In order to strengthen our future preparedness and ability to effectively deal with such disasters, we need a more responsive and integrated public health surveillance system, one which is based on amalgamation of citizen’s individual Electronic Health Records (EHR). The WHO Constitution (1946) envisages “the highest attainable standard of health as a fundamental right of every human being.” Therefore, it becomes obligatory on both citizens as well as law makers to realize this elementary need and ensure that education and healthcare get included in the electoral agenda of India.