The current outbreak should be a wake-up call, as it exploits our country’s vulnerabilities associated with income inequality, health disparities, and our slowness to recognize threats.
By Arindam Haldar
The COVID-19 pandemic has exposed the overlooked weaknesses of our country’s healthcare system—weaknesses that has persisted for many years but ignored with the less widespread outbreaks are now made vivid by this invisible threat. The current outbreak should be a wake-up call, as it exploits our country’s vulnerabilities associated with income inequality, health disparities, and our slowness to recognize threats.
Past few months have taught us that we can curb the spread of the virus by rapidly expanding critical care and scaling-up testing. We have seen most governments and central banks rapidly induce stimulus and liquidity measures to cushion the economic impact. Yet, as per a recent PWC report, COVID-19 is likely to shrink the Indian economies by 4.5% in 2020. This means the economic disruption caused by the COVID-19 pandemic could cost Indian economy over USD 130 billion if one assumes the 2019 nominal GDP base, much more than the projected cost of preventing such future pandemics. It’s uncanny to see how as humans we tend to overreact to problems that are facing us right now but under-react to long-term threats that build slowly. We’re willing to take heroic measures to treat a heart stroke, but slower to prevent heart strokes from happening in the future. So, too, we’ve been derelict in spending the money needed to prepare for pandemics. We panic, but we don’t prepare.
We live in a country where investments in public health and diagnostics are sorely undervalued and investments in preventive measures, whose success is invisible, even more so. The public health system in India today is under-resourced, both from infrastructure and staffing sides. The public health expenditure in India has remained constant at approximately 1.3% of the GDP between 2008 and 2015, and increased marginally to 1.4% in 2016-17. Meanwhile, China spends 5.6 times more, and the US 125 times more. Indians meet more than 62% of their health expenses from their personal savings, called “out-of-pocket expenses”, compared with 13.4% in the US, 10% in the UK and 54% in China.While Hon’ble Prime Minister’s call for investment in healthcare sector and government’s aim to gradually increase the public health expenditure to 2.5 per cent of the nation’s GDP by the year 2025, is in the right direction, the goalpost might be tad delayed if the pandemic is anything to go by. The current crisis has reiterated the fact that healthcare is the biggest opportunity for a country like India. The government needs to seize this moment to redirect its focus on life science, diagnostics and healthcare, and work together with the private sector.
Correct and timely diagnosis is the first step in any medical intervention and forms the first line of defence in health security. Diagnostic tests influence close to 70% of all healthcare decisions and yet, they constitute a meagre 5% of the total health system costs in India. However, this long ignored industry segment is now coming out of the shadows and is becoming more and more prominent amongst the overall healthcare industry. The recent pandemic has opened up awareness of tests using RT-PCR technology and also expanded the availability and capacity across the country. There has also been a shift towards preventive testing for the general public. At an overall level, health awareness and consciousness amongst customers is on the rise, and large private chain labs are also improving market accessibility, making sure the highest level of tests are available at all market through their hub & spoke model— opportune time for the Government to invest heavily into this sector and at the same time get more and more people under health insurance so that out of pocket expenses are reduced.
Constructive policymaking and reforms at the government level will further accelerate growth for the diagnostic industry and propel India to become a global genetic testing and device manufacturing hub. Going forward, it is essential that we reduce import dependency and make emerging technologies such as personalized genomic treatment affordable and accessible to the masses. Government initiatives such as Ayushman Bharat provide a great opportunity for the sector to make diagnostic services accessible to the underserved sections of the society merely with an Ayushman ID. NHA and SHAs will have to work hand in hand with a common objective to make this happen.
As the Government makes investments in healthcare infrastructure as a defense against terrifying new pathogens, those investments might very well pay off. While it is nearly impossible to predict what the next pathogen threat will be, from where it will emerge and when it will strike, by adopting a preventive mind-set we can strengthen our healthcare system to fight better such battles against infectious diseases and thereby reduce the chance of future pandemics.
(The author is CEO, SRL Diagnostics. Views expressed are personal.)