The entire world is waiting for a vaccine to fight COVID. The deadly virus which originated in the Wuhan city of China has infected more than 10 million people worldwide, killing over 5 lakh people. While it has exposed the fragility of healthcare systems around the world, India has become one of the hotspots for the disease and has reignited questions about revamping its crumbling healthcare system.
There is a dire need to address the short-term concerns due to COVID, and alongside providing long-term solutions for the structural gaps.
The healthcare facilities have been impacted by a sharp reduction in non-covid patient occupancy as well as OPD footfalls in hospitals. There is also a significant increase in expenses related to additional infrastructure, sterilization, infection control, PPE, staff rotation, and e-consults for both the medical and non-medical staff at the frontline of patient care. On top of it, the rising infection among healthcare staff is a cause of concern. There is a shortage of healthcare workers in the country and the increasing cases within the staff are expected to worsen the situation.
Viren Shetty, Chief Operating Officer (CEO), Narayana Health told The Blue Circle that the biggest factor that limits healthcare delivery is the lack of medical specialists. He added that India’s healthcare system was a disaster long before the pandemic, but it’s obvious that infrastructure shortages weren’t just about lack of beds – it’s lack of trained manpower to manage those beds.
“For 2 decades, there has been systemic and criminal negligence from the gatekeepers of medical education who restricted the number of doctors allowed to graduate as superspecialists,” lamented Shetty adding that India has the world’s largest population of young people and we can infact be the manpower supplier to hospitals around the world.
Our Healthcare System in Numbers
India’s meager healthcare spend of less than 1% of the GDP as per the National Health Profile, 2018 is lower as compared with neighbouring countries such as Bhutan, Sri Lanka, and Nepal.
For large states like U.P, Maharashtra, Gujarat, the per capita spend on healthcare is less than 5 rupees per day. As per the OECD data available for 2017, India reportedly has only 0.53 beds available per 1,000 people as against 0.87 in Bangladesh. The numbers have not changed in the last four years of available data, showing India’s stagnant allocation to the public health care budget. To compare, one of the best performing states in the current crisis, Kerala, with a population of only 3.5 crore (2018) has over 22,300 available beds in public hospitals/government medical colleges. Whereas, bigger states like Gujarat and Maharashtra with populations of over 6.82 crore and 12.22 crore (2018) respectively, have only 16,375 and 6,970 beds respectively.
Moreover, the significant inefficiency, dysfunctioning, and acute shortage of healthcare delivery systems in the public sector have failed to match up with the growing needs of the population. More than 80% of the population still does not have any significant health insurance coverage, and approximately 68% of the Indians have limited or no access to essential medicines.
Furthermore, the availability of free medicines in public healthcare facilities has reduced from 31.2% to 8.9% for inpatient care, and from 17.8% to 5.9% for outpatient care, said Fitch Solutions Country Risk and Industry Research (a unit of Fitch Group) in its outlook for India’s pharmaceutical market.
The Situation is Critical
India’s public hospitals have only 7,13,986 beds, including 35,699 in intensive care units and 17,850 ventilators, according to a recent study by the Center for Disease Dynamics, Economics & Policy (India), and Princeton University. This shows a lack of attention by the Indian governments, for decades towards healthcare. Despite private hospitals accounting for 62% of the total hospital beds as well as ICU beds and almost 56% of the ventilators, they are handling only around 10% of the workload.
Maharashtra has taken control of 80% of all private hospitals’ beds in the state till August 31 where prices have been capped at Rs 4,000 in the case of the simple ward and isolation beds, Rs 7,500 per day for ICU beds without a ventilator and Rs 9,000 for those with a ventilator. The bigger question is how will the private hospitals be compensated. One way to do it, for the governments (Union and state), would be to pay crores of dues they owe to private hospitals for treating patients under the Central Government Health Scheme (CGHS) and the Ex-servicemen Contributory Health Scheme (ECHS).
According to the Association of Indian Medical Device Industry (AiMeD), India’s medical devices imports were around Rs 39,000 crore in FY2019, up by 24% from the previous year. These imports were said to account for around 80% of India’s medical devices requirements, with the bulk of the devices coming from the US, China, Germany, and Singapore.
All this suggests how difficult it would be to fight the crisis with fragile infrastructure. India also needs to build on its pharmaceutical and biotechnology sector, where it has established a name for itself in delivering low-cost drugs and vaccines to over 120 countries.
What has been Done
The government of India has established a “COVID-19 Taskforce”. It has already identified over 500 entities to map various technological advancements in the fields of medicines, ventilators, and protective gear. The current funding landscape for collaborative research includes grants that vary from Rs 50 lakh to Rs 1 Crore, depending on whether it is an early-stage proposal or an advanced solution.
The National Research Development Corporation (NDRC) offers financial support up to Rs 10 lakh for necessary infrastructure and innovators involved in the development of eco-friendly sanitisers, rapid test kits, PPEs, ventilators, medicines, and vaccines.
The Department of Science and Technology (DST) has also set up a rapid response centre CAWACH- Centre for Augmenting WAR with COVID-19 Health Crisis- to provide support to 50 innovations and startups addressing various challenges posed by the pandemic. The scale of funding required however is significantly larger than what is currently available.
The Defence Research and Development Organisation (DRDO) which has developed ventilators is collaborating with the industry to scale up production to 10,000 units per month. Various companies are entering into partnerships with the government to employ drones, making large-scale ventilators and building testing kits that provide results within three hours.
Resolving the Concerns
Shetty suggested that the issue of the dearth of specialists can be solved with a simple policy measure that unshackles healthcare education from the License Raj, and allows any institution to seek domestic or international accreditation and train 1 million additional doctors over next 5 years.
Vikram Thaploo, CEO, Telehealth & Government Businesses, Apollo Hospitals reckoned that increased access to equitable healthcare is the need of the hour, and taking into account the pandemic and the current shortage of doctors and allied health professionals, scaling up telemedicine services is the way forward.
“State governments should establish telemedicine facilities in the 750 district hospitals, 1024 sub divisional hospitals, 5260+ CHCs, 25000+ PHCs, and medical colleges. Their quantum is large and their spread is vast,” said Thaploo to TBC.
He recommended having a ubiquitous high speed network backbone infrastructure that can converge all the extent and future technologies like National Knowledge Network, National Optical Fiber Network, and Satellite Communications.
States can go for public private partnerships – more specifically a transaction based operating model, a rental based operating model or a build-operate-transfer model.
Private Partners can help set up telemedicine and diagnostic labs, provide manpower for operations, provide services to the patient as per the rates fixed by the government, coordinate with super-specialty hospitals for teleconsultation services, and incentivize doctors in consultation with the state government.
Thaploo said that they have made considerable headway with regards to both directional and policy inputs. The practice guidelines laid down by the center will help standardize the quality of telemedical care. Also, the IRDAI’s mandate to insurers to treat telemedicine charges as any other claim as part of the settlement policy will help garner greater institutional and cultural acceptance.
We also need to streamline the extant institutional structures and capacities to implement telemedicine facilities by defining operating models and funding requirements in close consultation with governing bodies, reaching a consensus on monitoring and evaluation approaches, setting up the desired ICT infrastructure at public healthcare facilities, and ensuring that there is enough skilled manpower needed for the task.
(Edited by Anu Choudary)
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