COVID-19: Time to Evaluate the Status Quo

Image by McKinsey

COVID-19 is rapidly spreading its wings and countries around the globe are deploying stringent steps to tackle this menace. As of date more than 380,000 cases have been identified with 16000+ fatalities in more than 164 countries (refer https://www.bing.com/covid for live tracking). Clearly, this is an unprecedented situation which has severe implications and consequences in many ways on the human race. It also provides an opportunity for countries to assess their preparedness to wrestle the turmoil. As even the countries, which boasts of one of the best healthcare eco-systems in the world, are struggling to handle the overwhelming number of cases (US, UK, South Korea, Australia, Italy to name a few)-once again, the paramount importance of having quality healthcare services and infrastructure is doing the round worldwide. So where does India stand in this battle?

First, digest these stats: India has 7 beds per 10,000 people whereas the global median is 27 per 10,000 (Russia stands at 98, China at 38, Brazil 18). India does not even meet the doctor-patient ratio set by WHO (1 doctor per 1000 people) and it’s the worst among emerging economies standing at dismal 1 doctor per 10189 people. Event countries like Vietnam and Brazil have better ratio than India. However, India does recognize the imminent need of having more trained doctors, nurses and healthcare professionals (HCP) to boost the existing healthcare system. In the past few years, India has taken few swift steps to tackle this – 37 new medical colleges have been sanctioned and around 20000 MBBS seats have been added in 2019. India also suffers from massive ‘brain-drain’ in the field of medicine where students who aspire to be doctors study in China, Italy, Russia etc mainly due to the lack of medical seats here in India.

There is a severe shortage of HCPs in our primary and secondary healthcare centres and you can imagine the state of these in tackling rural healthcare issue leave alone the existing pandemic. Evidently, a lot still needs to be done by India to align with WHO norm of doctor-populations ratio of 1:1000. Niti Ayog (India’s think tank) have come up with ingenious strategies such as expanding district hospitals to become medical colleges, implementing PPP (public-private partnership) models and making existing and new medical colleges to adopt community  and primary health centres. An estimated, 50,000 seats (60% increase in our existing capacity) could be added by such steps. But can these strategies by-pass the red tape and see the light or once again will land in archives?

Second, the current pandemic invites deploying more telemedicine centres across cities and districts. 70% of healthcare infrastructure in India is limited to urban areas. Rural India has less than 5 hospital beds per 10,000 people, much worse than even countries such as Vietnam and Thailand (27 beds per 10,000). These ‘cloud hospitals’ can provide remote diagnosis and consultations, augment the access and quality of care to rural areas, and can act as warriors in times of such pandemic outbreak. As per a McKinsey report, if  telemedicine replaces 30-40% of in-person outpatient consultations, India could save up to $10 billion and improve care for the poor and those living in remote areas. Telemedicine can create 1.5 lakhs job in next 5 years. Also, our I robust IT industry is well equipped to cater to these needs and also address the challenges such as security and seamless transfer of health data. Digital transformation in healthcare by adoption of technologies such AI, IOT Cloud and Analytics can effectively democratize the healthcare system in India. (Here are some analytics and digital tools that are available today to track the course of Corona Virus)

Third, serious and drastic measures are required by India to become a manufacturing hub for active pharmaceutical ingredients (APIs). India is proudly known as ‘pharmacy of the world’ – thanks to our massive exports of drugs to several nations. But the novel coronavirus has massively jeopardized India’s reputation. India pharma industry is heavily dependent on China for raw materials (known as APIs or bulk drugs) to produce medicines as basic as Crocin (API here is paracetamol). Around 70% of the total bulk drugs requirements comes from China. In 2018-19, Indian drug makers imported APIs worth $2.4 billion from China. Now, due to lockdown in China, India’s drug production for treating cancer, malaria, HIV and anti-biotics etc is being hit for its citizens’ usage. Need of the hour is to have policies for increasing R&D facilities in the country, providing financial and tax incentives to manufacture APIs and establishing stronger regulatory mechanisms.

Fourth, India needs to widen the insurance coverage net. At present, roughly 20% of India Population is under insurance coverage. Launch of Ayushman Bharat National Health Protection Mission (ABNHPM) in 2018 will have a huge impact in improving this landscape and increase insurance penetration by 40%. However, this faces significant hurdles such as lack of awareness, geographical spread of the coverage and lack of support from industry stakeholders, and huge dependency on technology.

Fifth, healthcare infrastructure in India needs to be boosted on war footing basis. India’s healthcare infrastructure is much below global peers. There is 1 government hospital bed for every 2046 people and 1 state-run hospital bed for every 90, 343 people. In the current scenario, Indian healthcare system will be over-stressed and break, if the number of cases rises due to Coronavirus. You don’t need an epidemic for the public health system to collapse. Public spending on health has remained stagnant or risen marginally in India’s major states since 2000, with the average spend for all states being a dismal 4.9% of state GDP. Indian government spending on healthcare has been less that 2% of GDP, lowest among emerging economies (even lower than Bangladesh). India needs to increase this spending to 5% of GDP, for which states must contribute more than 8% of their budgets on healthcare.

As we stand together in our fight against Covid-19, it also gives nations an opportunity to take a step back, assess, evaluate, devise measures to effectively improve the healthcare ecosystem, and create a safe and secure world for its inhabitants.

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