India is both at an exciting intersection as well as faces a challenging period in healthcare. Making healthcare affordable and accessible for all its citizens is one of the key focus areas of the country. However, the challenge is immense—of the 1.34 billion Indians, 72.2% live in rural areas and 27.8% in urban areas. On one hand, India lacks strong healthcare infrastructure, and on the other hand, the country has inherent weaknesses in its healthcare system. Private sector dominates with 70% of the healthcare delivery segment. And organised infrastructure is confined to metros or tier-1 cities, with not many making inroads into tier-2 and tier-3 towns. The country is, therefore, faced with a challenge as well as an opportunity to not only increase the penetration of quality health services, but also be the growth driver.
As a great step, the government, in its National Health Policy 2017, decided to increase healthcare expenditure to 2.5% of the GDP, giving priority to healthcare and making significant investments to improve the infrastructure and delivery mechanism, jointly with state governments. However, it need not be the responsibility of the government alone to meet infrastructural, capacity building and delivery shortfalls in healthcare—a balanced participation from the private sector under PPP will be beneficial. Challenges exist—state governments are hesitant about the success of these partnerships, and they somehow seem reluctant to commit towards this area of development.
Even as the government is spearheading various programmes to ensure institutional deliveries, primary healthcare centres are still poorly equipped to handle emergencies, leading to cases of mortality. While affordability remains one of the core challenges in ensuring universal healthcare, with more diseases and services coming under government funding, we need to look at ways to improve existing services. For this, we need innovative drugs, latest treatment modalities and trained medical staff to use all of it efficiently.
A major-cost cutting strategy is to use new drugs that are cheaper to manufacture, yet are medically more effective than those they replace. But the fact remains that with the public expenditure on health remaining low—it was just 1.1% of GDP in 2010—the health sector is highly reliant on private players when it comes to drug innovations.
Therefore, to help the pharmaceutical and medical devices industry to sustain business and recoup costs, it is important to create a healthcare ecosystem, wherein investors are encouraged for more research and clinical trials. Bringing transparency and certainty in drug clearance policies and ensuring strong intellectual property rights will also help and encourage investors to sustain innovations.
Even if women make it to primary care centres for deliveries, they are not assured of absolute care due to poor technical support. Arrangements to tackle emergencies during childbirth in primary care centres in villages and availability of advanced treatments—at least for prevalent diseases like cancer, cardiovascular and diabetes in tier-2 and tier-3 towns in secondary health set-ups like medical colleges—will increase access to quality healthcare and reduce mortality and treatment costs.
But when it comes to high-end devices and technologies, the industry is at a nascent stage and most medical devices are still imported. To bring advanced devices and equipment in public health domain and build capacities of healthcare professionals, we need robust PPP. This will help alleviate the financing burden for the growth and development of the healthcare sector.
To enhance technological penetration, we have to increase investments in the segment, attract more foreign investors and build capacities of healthcare professionals.
According to a Central Bureau of Health Intelligence 2010 report, only 23.5% of urban and 30.6% of rural people choose government facilities, reflecting the lack of confidence in public healthcare system. This also implies that only those who could not afford to go to private set-ups choose public hospitals.
To bridge the resource and infrastructure gap in both the sectors, apart from accommodating public and private funding, it is important to work around improving doctor-patient ratio and bed-per-patient ratio, maintain the quality of care and improve the basic indicators of healthcare.
Indian health sector is fragmented with many stakeholders, including medical devices companies, pharmaceutical firms, hospitals, diagnostic clinics, insurance companies and clinical trial organisations. Considering high infant and maternal mortality rate and rising burden of communicable and non-communicable diseases, it is time the government and private sector work closely and leverage upon the growing health industry.
The author is public health expert.