The second edition of FE Healthcare Summit 2022 stood out as a truly unique healthcare conclave marking several firsts in terms of breadth of verticals covered and depth of expertise gathered. From key government officials and policy makers led by Union minister Mansukh Mandaviya and minister of state, health Dr. Bharati Pravin Pawar to industry A-listers and public health experts, there was a rare readiness to introspect, evaluate the present and envision the future.
Anant Goenka, executive director of the Indian Express Group, set the tone in his welcome address looking back at the policy responses during the pandemic and the entrepreneurial abilities to combat challenges with two crucial lessons learnt from the pandemic. One key learning being around the stellar outcomes that become possible if a government puts its mind to it. This, he said, was amply evident from what the Indian government could achieve with its vaccination coverage. The second lesson was the display of the power that public-private partnerships could unleash. The development of the first indigenous COVID vaccine was in itself a great symbol of the outcome that this alignment could produce. To Goenka, it was also heartening that Union minister Mansukh Mandaviya, who despite pressing official engagements and a busy travel schedule chose to attend the summit in person and share his insights at the FE Healthcare Summit. Later in the day, minister of state, health, Dr. Bharati Pravin Pawar, did not let her travel come in her way and opted to digitally connect and share her thoughts with the participants at the summit.
Focus not on token but total: Minister Mandaviya
Minister Mansukh Mandaviya pointed to the models that different countries adopt and saw the future for India closely aligned to its ability to build on its low cost of medication backed by initiatives that expand the footprint of healthcare access. In line with these, he pointed to some of the measures taken by the government that were showing results thereby backing these as the imperative in future too. To him, the current approach to policy-planning was way beyond addressing electoral needs but was really about ensuring long-term national interests. Therefore, as he put it, measures that were not token in nature but total in terms of perspective and goals.
Measures beyond vaccinations: MoS Dr. Bharati Pravin Pawar
The minister of state, health, Dr. Bharati Pravin Pawar, despite not being in town, took time to digital connect and spoke of the measures that were transformational such as the vaccination coverage and she then also shared her thoughts on the changing landscape, which to the many gathered conveyed the weight that healthcare was now getting within the government.
High profile gathering
To get a sense of the high profile gathering at the summit, it may be worth mentioning that some of the government officials who have played a major role during the pandemic were Dr V K Paul, member, Niti Aayog, Dr Balram Bhargava, the Chief Cardiothoracic Centre, AIIMS, New Delhi & former Director General, Indian Council of Medical Research (ICMR), Dr Anurag Agarwal, dean, Biosciences and Health Research at the Trivedi School of Biosciences at the Ashoka University but also hugely respected for his stellar role during the pandemic as the then director of the Institute of Genomics and Integrative Biology, a national laboratory of the CSIR.
Also, sharing their insights were leaders from the Indian pharmaceutical sector like Satish Reddy, chairman, Dr Reddy’s Laboratories, Glenn Saldanha, chairman, Glenmark, Dr Krishna Ella, the founder of Bharat Biotech, who along with the ICMR brought out the COVID vaccine – Covaxin, which the Indian prime minister took as the first indigenously made COVID vaccine. Apart from Dr Renu Swarup who played a major role until recent as the Former Secretary, Department of Biotechnology Ministry of Science & Technology, Government of India.
To lend their voice from the Indian diagnostics sector were Thyrocare founder Dr A Velumani, Ameera Shah, managing director of Metropolis Healthcare and K Anand, the CEO of SRL Diagnostics. From leading hospitals were Dr B S Ajaikumar, founder of HealthCare Global, Dr D S Rana from Sir Gangaram Hospital, Dr Tarang Gianchandani, CEO, Sir HN Reliance Foundation Hospital, Dr Anupam Sibal from Apollo, Anil Vinayak from Fortis Healthcare and several others. Public health expert Dr K Srinath Reddy, president of the Public Health foundation of India, who despite pressing personal demands and a medical emergency at home, spared time to share his insights.
Ayushman Bharat & it’s four pillars: Rajesh Bhushan
In his address, health secretary Rajesh Bhushan said the government’s flagship programme of Ayushman Bharat rests on four pillars – the health and wellness centres addressing elements of health screening, treatment, remote access through the digital mission that provides for Ayushman Bharat Health Account or a health ID. Currently there are 24 crore health IDs in India and given its 137 crore population, still a long way ahead. He also reminded the audience of the India Hypertension Control Initiative and the efforts at stroke management that led India to win the 2022 UN Award.
Building the ecosystem & the emerging models
The first panel with tertiary and quaternary care providers looked at ways in which the footprint could be extended with deeper linkages with the primary care hubs. Dr Tarang Gianchandani, the CEO at the Sir H N Reliance Foundation Hospital for instance shared her perspective on how the power of 5G could be leveraged. Apparently, the Reliance group’s presence and strengths across telecom and retail were proving handy. Similarly, Anupam Sibal, Group Medical Director, Apollo Hospitals Group articulated how focussed initiatives by the group in Aragonda in Andhra Pradesh were showing results in improving the overall health profile of the people in the region. Anil Vinayak, Group COO, Fortis Healthcare talked of the approach to enhance scale and reach as a key option to bring down costs and the lessons learnt in this from the pandemic.
Dr Santosh Shetty, Executive Director and CEO, Kokilaben Dhirubhai Ambani Hospital referred to the clear message ahead on how hospital designs will now need to be flexible and be better-equipped to handle range of patients and fresh ailments. To Dr Anurag Agarwal, Dean (Biosciences), Ashoka University, what could now not be missed is how India has taken a lead globally in digital transformation. “In digital transformation we are almost a global-north and way ahead of others.” Along with this, he said, the message of why and how analogue interventions have a crucial role in healthcare was also made amply clear during the pandemic. The need for an enabling policy environment and moving in the direction of one-health was the way forward with concerns way beyond human health alone and also getting to weave in concerns for environment, animal health and other stakeholders.
Preconditions for effective Digital interventions
In the session that looked at ways to leverage the digital power, Dr K Srinath Reddy, president, Public Health Foundation of India (PHFI) reminded that all the digital innovations cannot compensate or substitute for structural weaknesses and functional failures of the system. So beginning with strengthening the primary care could be followed by building the linkages with the secondary and tertiary care with adequate focus on surveillance, design and financial resources. “It is important to contextualise digital innovations and the health problems we need to prioritise and address,” he said. These, he pointed, needed to be backed by community-based studies which ensured solutions were applicable at scale and not limited only to pilots. His important message was that it was crucial to realise that it requires a multi-disciplinary approach and not just a technology-based approach. There was need for public health inputs and expertise right from the ASHA worker in the field to the policy-maker level. Also, when looking at the digital component, he emphasised the importance of realising that solutions has to address local and customised as no two regions and conditions could ever be identical and therefore algorithms developed in one geography could not be fitted onto a different geography. However, every new solution or innovation, needed adequately trained healthcare workers for effective deployment. Echoing the point made by Dr Anurag Agarwal in the earlier session, Dr Srinath pointed out that while our legs may be strong, we equally need the hands that deliver quality healthcare.
Agreeing Dr D S Rana from Sir Gangaram Hospital, pointed to the crucial role that talent has to play and while this issue was being addressed by more medical colleges being opened, there is still the challenge of shortage of well qualified faculty that has to be confronted. Based on his experience at Sir Gagaram, he articulated some of the ways in which leading tertiary care hospitals could consider to strengthen primary care.
Why low cost medication needs outcome monitoring
Dr B S Ajaikumar, founder chairman & CEO of HealthCare Global reminded that while it is important to offer low cost healthcare this should not be at the cost of quality. Based on their internal analysis, it was revealed that about 44 per cent of the patients that get such low cost treatment encountered more morbidity and mortality, therefore every low cost treatment outcome also needed tracking and measurement. He felt the need of the hour was to leverage the digital medium to ensure greater emphasis on proper gathering of data, especially on follow ups after medical interventions. Once this is documented and published, this in itself could emerge as a big service towards improving the quality of healthcare delivery. One way to handle this effectively, he felt, was possible if the government were to play the role of only an effective monitoring agency and not that of a service provider. He said the government should focus on what is the total cost to the treatment and not just confine itself to micro details such as cost of a glove or that of a needle.
Priority to primary care & the path to progress
Reflecting on his reading of the primary care in the session that focused on the trials and tribulations in the primary healthcare journey, Dr Balram Bhargava, the Chief Cardiothoracic Centre, AIIMS, New Delhi & former Director General, Indian Council of Medical Research (ICMR), felt the opening up of the Indian economy in the 1990s, saw the pendulum swing a bit towards tertiary care and largely into urban areas. However, there were subsequently more broad based improvements and this was evidenced in the better health indicators though there is still a long way to go because while the infant mortality numbers were down they were still not in the single digit, as one would expect them to be. The mindset of people, he felt, had also changed and more inclined towards leveraging innovation. He saw improvements on the ground with more health and wellness centres being set up but all still needed to function at their optimum levels.
Why Primary healthcare will be the space to watch
Dr Paul however wanted the audience to reflect on the journey thus far and consider the fact that from a life expectancy of 27 years at the time of Indian independence it had now moved to about 70 years, poverty had also reduced and more recently there was great emphasis on hygiene with the Swachh Bharat Abhigyan with about 10 crore toilets built and 52 of rural households provided with clean tap water, up from 17 per cent just three to four years ago. This was coupled with large expansion in the cooking gas connections.
What is crucial, he felt, at this juncture was to look ahead and look at what he called “the tumultuous changes that are being envisaged including the fact that the national health policy envisages that 65 per cent of public health spending should be on primary healthcare and a clear goal to have 1.5 lakh health and wellness centres in place by December.” On this, Dr Paul said we were on course with 1.23 lakh already operationalised. What was critical in this endeavour, he said, was a clear path with each centre and sub-centre equipped with manpower and with clear provisions on how many medicines and diagnostic services that are to be offered with many free of charge. To support some of the plans of the government, he said, the 15th finance commission had also made provision with Rs 70,000 crore allocation in addition to the routine allocations by the ministry of health. He urged greater partnering and said this was a space that all should be watching as that is where the actions were unfolding.
Mission 2047 for Indian pharma
The following panel discussion focussed on the pharmaceutical sector and what needs to be done at a time when it was clear that breakthrough innovations were the only path to progress for the industry. Utkarsh Palnitkar, Founder, Aarna Corporate Advisors and Consultant, Lifesciences, who moderated and opined that while considerable progress had been made by India there was also an increase in the IQ, which in this context stood for the ‘irritation quotient.’ In about three weeks from now, he said, “we would be celebrating the first anniversary of the release of the draft R&D policy” with all still anxiously awaiting it becoming a policy with its 40 action items seeing the light of day and not just remaining a policy draft. Innovation, after all, he said, rests on four pillars -the scientific temperament, a benign and empathetic government, funding institutions and nurturing institutions.
Policy enablers to fuel the innovation engine
Satish Reddy from Dr Reddy’s began by painting the picture of where we stood and the lead that India had globally in terms of volumes of drugs produced with one in every three generic medicine consumed in the US and one in every four generic drug in the UK originating from India. But given that the way forward was to move up the value chain and move up the pecking order globally as a value player from the 13th to 14th position at the moment to emerge among the top five globally by 2047. This, he felt, required innovation happening at a completely different level. There was ample capability residing within companies be it Indian vaccine makers like Bharat Biotech or leading pharmaceutical companies like Glenmark, Dr Reddy’s or others. What were needed to ensure this were tax breaks and incentives that could embolden industry to take more risks apart from measures that could boost private equity participation. That apart, becoming a member of the ICH or the International Council on Harmonisation, where China has already moved ahead was crucial as clinical trials get a larger global acceptance. Sadly, India has for a long time still being contemplating membership to ICH while time was ticking.
When Focus Matters
Dr Krishna Ella, founder of Bharat Biotech felt there is little doubt on the quality of talent within the public sector scientific institutions but the problem was most getting involved in multiple projects and losing focus. One way out of this was to devise ways to incentivise these scientists to pursue focussed research driven by need to showcase research outcomes. He also spoke of focus on top quality clinical research that had a crucial role for drug discovery alone could not help.
Public-private & setting common goals
To Dr Renu Swarup it was time to blur the lines between public and private endeavours in research and that both be driven by common goals and objectives. That this could produce fruitful outcomes, she said, was evident from the experience during COVID when both the public and the private were driven by a common goal. A similar alignment was on display within the government with several inter-ministerial committees at work. She also spoke of innovation in funding models in the journey ahead and to her the government had already articulated its intent to back high risk innovation through its various initiatives that back start ups.
Innovation & capital
Glenn Saldanha looking back at the experience of Glenmark which from the time he started leading moved from being a Rs 300 crore entity to now a Rs 13,000 crore player. With scale in business without losing focus on research and staying wedded to it for the past 22 years. However, despite having achieved scale, he said, “we still struggle while trying to put capital into innovation on our own because there are pressures in other businesses” such as generics that are still crucial. Therefore, he saw, a clear case for government support in funding or through enabling policy measures. Apart from this, creating a VC environment, which again was linked to enabling domestic environment that could spur cutting edge research.
Testing Time for Diagnostics
The leaders from the Indian diagnostics arena Thyrocare founder Dr Velumani, Ameera Shah, managing director of Metropolis Healthcare and K Anand, the CEO of SRL Diagnostics, were all joined by Deepak Sahni, CEO and Founder, Healthians.
The focus of this session was on the disruptions that COVID had on this sector with no entry barriers, how revenue profile changed and business models transformed. Now, as the sector was limping back to pre-COVID revenue streams, the sector was seeing new competitors emerge – from digital first players seeking to established pharmaceutical companies venturing into diagnostics. There is hyper competition with price wars, talk of consolidation is wafting through the Indian diagnostics firmament and all seeming ready and preparing for the uncertainties. While most established players addressed the illness side of care where people who fell ill needed diagnostic tests, some of the newer and digital players were focussed on wellness with an eye more on the preventive aspects.
The fall in rupee against the dollar has also added to the woes for diagnostics companies with some key imported reagents getting expensive with little scope to pass on the costs to customers.
The day concluded with the presentation of the hospital awards.
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