The country can look forward to adopting the best practices from other developing nations like Mexico, Vietnam and Malaysia in order to boost the public healthcare
By Ashvini Danigond
The public healthcare ecosystem in India leaves immense scope for development, without a doubt. In this regard, taking a leaf out of the best practices adopted in other developing nations such as Mexico, or for that matter South Asian countries like Vietnam and Malaysia, would prove to be beneficial for India, which can look forward to making the most of the available resources while delivering value to a broad spectrum of the population.
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Take the case of Mexico, every medium to large city has at least one first-rate hospital. In fact, the cost of healthcare in Mexico is considered generally half or less than what an individual might expect to pay in the US, this includes prescription drugs as well. Mexico has the Centennial Care 2.0 which looks to implement new, targeted initiatives to address certain gaps in healthcare as well as to improve outcomes for the most vulnerable of its citizens.
On the other hand, apart from encouraging the private sector, a country like Vietnam is also requiring healthcare facilities at central and provincial levels to help scale up the capacity of those at the district and commune levels. The country has designed its policy to focus on technical skills transfer, aiming to reduce reduce the stress of those at higher-level hospitals.
Along the same lines, the healthcare system in Malaysia is advanced because of the extensive support from the government through investment in hospital’s medical infrastructure. The improvements in the last decade or so are significant enough to be on par with well-developed countries, comprising both well-trained medical staff and excellent hospital facilities.
In the Indian context, however, despite considerable economic growth in the past few years, the country’s spending on healthcare hovers at a mere 1.26% of the Gross Domestic Product (GDP), which is way below than any of the developing nations mentioned above, resulting in serious supply-side deficits of facilities and medical professionals.
However, in a recent development, the 15th Finance Commission (FC)’s recommendations on health, accepted by the Centre in its action-taken report, have put forward many first-time financial and non-financial measures to re-prioritise public health expenditure to reach a targeted 2.5% of GDP by 2025. As per the recommendations of the 15th FC, a considerable portion of federal healthcare grants will for the first time be routed through urban local bodies, or municipalities, and, at the rural level, through panchayats. This may prove to be a step in the right direction if implemented at the ground level.
Stronger push for policy and regulation
While it is only now that the government has started to introduce newer initiatives in the healthcare sector, there is a need for giving that stronger push in terms of policies and regulations.
The latest National Health Policy (NHP) 2017 highlights ‘Health for All’ approach to providing assured healthcare for all at an affordable cost. However, there is scope to do much more under the NHP 2017, including meeting the doctor-patient ratio as per the prescribed limit of the World Health Organisation (WHO).
Also, in the case of the government’s Ayushman Bharat scheme, the Pradhan Mantri Jan Arogya Yojana (PM-JAY), the universal health insurance scheme, has received considerable attention and resources than the health and wellness centres (HWCs) component. In order for the healthcare system to grow in the future, this asymmetry needs to be suitably addressed.
A 2019 NITI Aayog report underlined the fact that states had unequal public health systems. This imbalance exists primarily due to restricted technical expertise and fiscal constraints. On a crucial subject like health, coordination between the centre and states must exist.
There are also issues related to lax standards and operating procedures in healthcare. There is scope for the government to do more to introduce better transparency in healthcare delivery models/schemes if the country aspires to achieve global standards of excellence. In addition, strong health laws will help build societal resilience to pandemics and public health emergencies in the future.
Sustainable healthcare model for primary, secondary and tertiary care
The Indian healthcare system introduces a three-tier structure: primary, secondary and tertiary care services. As per the Indian Public Health standards (IPHS), the delivery of primary health care is designed to provide an integrated curative, preventive, and palliative care to the rural people, through sub-center, primary health center (PHC), and community health center (CHC); secondary care is delivered through district and sub-district hospitals, while tertiary care at regional/central level institutions or super-specialty hospitals.
Ideally, healthcare should not be restricted merely to medical care but cover aspects of preventive care and wellness as well. The crucial elements of health like sanitation, vaccination, health education and primary healthcare have large positive and negative externalities and, therefore, need public funding to be provided at optimal levels. Of late, a lot of public funding has been directed to improve the secondary and tertiary care systems that mostly provide private benefits. While there is a need to work at all three levels of primary, secondary and tertiary healthcare, the main focus needs to be driven towards bridging the gap between rural-urban healthcare.
The government can look towards the private-public partnerships (PPPs) scheme in the healthcare for primary and secondary care setting. This PPP model can be implemented for setting up digital infrastructure and training for health workers in primary health centres and other medical care facilities, including the building of healthcare infrastructure in the form of new medical and nursing colleges.
Promote research in healthcare
There has always been a need for India to focus on research and development (R&D), especially in the healthcare segment. This would enable us to reduce the country’s dependence on foreign drugs, knowledge and technology. Enabling and funding of R&D will lead to inorganic growth of the research-based economies and also prevent brain-drain to other parts of the world where people move due to better facilities that support research initiatives. R&D is the most important pillar for Atmanirbhar Bharat Abhiyan or other similar initiatives on these lines for driving growth for people, industries and communities. Strengthening and motivating education institutes with a research mindset is key in seeing sustainable growth in this space for India by giving more facilities, grants and operational support is the key.
Promote adoption of technology and incentivize care providers for harnessing the power of digital healthcare solutions
There is no doubt that technologies such as artificial intelligence (AI), machine learning (ML), natural language processing (NLP), Internet of Things (IoT) and Big Data Analytics are making significant advances in healthcare delivery. According to experts, over the next decade, it may become mandatory for doctors to use health tech solution software to provide second opinions about procedures for patients. In the future, a software platform could emerge as the biggest provider of healthcare, creating a bed-less hospital.
The government has planned for a universal, interoperable, and mobile-compatible electronic health record (EHR) for every Indian by 2025, along with an Integrated Health Information Platform—technology-enabled remote healthcare in public and private health centres and hospitals, besides, developing a universal public health insurance platform to support the national health-protection scheme, Ayushman Bharat.
There is also the need to build an integrated Health Information Platform to create and provide access to electronic health records for every Indian, which promotes one nation, one health record.
The government is in the process of framing policies to mandate EHR adoption. Take, for instance, the Ministry of Health and Family Welfare (MoHFW) through the proposed Digital Information Security in Healthcare Act (DISHA), plans to set up a statutory body in the form of a national health authority for promoting and adopting e-health standards, enforcing privacy and security measures for electronic health data and regulating the storage and exchange of electronic health record (EHR). Additionally, the National Digital Health Authority (NeHA), under e MoHFW, is a proposed authority that is intended to be responsible for the development of an integrated health information system in India. It is proposed to be a promotional, regulatory and standard setting organisation to guide and support India’s journey. DISHA is the legislation that seeks to formally establish NeHA and facilitate the online exchange of patient information with the view to prevent duplication of work and streamline resources.
(The author is Executive Director & CEO of Manorama Infosolutions Pvt Ltd (MIPL). The views expressed are personal.)