New Delhi: The government says that it is setting up the All India Institute of Medical Sciences (AIIMS) like hospitals in many states including Chhattisgarh, Madhya Pradesh, Odisha, Assam, West Bengal and Jammu and Kashmir to increase the presence of tertiary care. While decision is based on the intention to bring uniformity in health services across the country, the question of addressing the healthcare needs of huge sections of population still remains unattended. Given the challenges, the steps appear important yet miniscule and not long lasting.
In India, most of the health research happens in the government run institutes rather than hospitals. However, the product outcomes are not sufficient enough to match the expectations. At the same time, innovation is not a subject to be discussed in the big healthcare organizations which are mostly occupied with tedious job of firefighting between product quality and sales targets.
“In a country that has insufficient healthcare workers for delivery of care, is research even a priority?” asks Dr Gangandeep Kang, Executive Director, Translational Health Science and Technology Institute (THSTI), adding “Medical researchers are seen as selfish person. The fact that they are the only ones not out to treat the patients, is not taken in right sense by those concerned.”
Healthcare being a part of society, many experts feel that there is a need to incorporate the health research aptitude in the medical professionals especially doctors. Besides that, the innovation and building on whatever has been achieved so far would help move further in right direction. There is a strong need to develop an enabling ecosystem for facilitating healthcare innovation with active participation from industry, academia and the government. The quantum of funding for R&D has to be increased manifold and the regulatory framework should facilitate indigenous development of medical technologies.
Focused approach for maximum outcome
Slowly but steadily new partnerships at massive scale are being forged between public and private sector to boost health research. While it is a welcome but we need more of this in India. As an example what is being termed as India’s first public-private-partnership (PPP) agreement for research and innovation in preventive health, an understanding on joint efforts has been reached between Indian Council for Medical Research (ICMR) and Sun Pharma which was announced on April 25, 2016 in New Delhi. Sun Pharma will fund and execute this malaria elimination programme over a span of 3 to 5 years covering over 200,000 households in Mandla district. In addition, as part of the PPP, ICMR and Sun Pharma will jointly conduct scientific research for development and testing of medical products (including drugs, biosimilars and vaccines) as well as undertake disease control and elimination programs. Both will expand cooperation in the area of translational health sciences research with the objective of developing new and improved medicines for infectious and chronic diseases.
For Dr Gagandeep Kang, building independent investigator and a clinical research ecosystem in India is crucial. “To build the ecosystem, we have to take few right steps that bring confidence. If you make the clinical research attractive, ecosystem will follow,” she adds.
Rightly so, there is a need to take appropriate steps in the areas of joint biomedical research, medical education, and pharmaceutical manufacturing and trade. Progress in these areas will ensure that critical health products and services are accessible to marginalized and neglected populations at a price they can afford.
The noted heart surgeon and Chairman, Medanta- the Medicity, Dr Naresh Trehan believes that the management of communicable diseases among others is a major challenge before the nation. “If serious efforts are being made for eradication of communicable diseases, then number of patients visiting hospitals would automatically come down and we can work in a more focused way in dealing with dreaded problems like heart ailments and cancer and also on research and innovation,” he said recently.
Even the lavish spending on big hospitals cannot justify quality healthcare feels Dr Devi Shetty, Chairman and Managing Director, Narayana Health. “We spend a huge amount of money on things like lift and marble flooring while constructing huge hospitals. Most of the rural folks visiting these hospitals don’t use the lifts, he says adding further, “Central AC is the main reason for spreading infections in the hospitals. It doesn’t go with the perception of comfort.”
Integration of new research techniques to boost ecosystem
As per Dr Jitendra Singh, noted Diabetologist and Union Minister, not only the spectrum of medical research has undergone a change, but the methodology has also changed. For example, he says, till 1970’s and 1980’s the main thrust of research was on communicable diseases like tuberculosis and sexually transmitted diseases, wherein India made a historic contribution by giving to the world some of the most original postulations. However, in the last two decades, the spectrum has shifted to non-communicable diseases and now the research has to be primarily focused on metabolic diseases like Diabetes with a specific and exclusive Indian perspective. At the same time, he believes, the methodology has also undergone a change and wherein till 20 years ago, a young scholar had to run from pillar to post in search of references and medical journals, today, the best of reference and research papers from the rest of the world are available on internet.
The prominent health experts of India feel that the adoption of new technologies has to be done quickly to extend the research into new disease areas. They point towards the fact that India is already gearing up to make that possible while agreeing that learnings have to be shared through collaborations across regions and nations.
Former Director General, ICMR, Dr V M Katoch suggests the implementation of science in terms of scale up. “The area has to be chosen carefully. Key infectious disease areas can be utilized to share knowledge. Minimum money maximum scale up is the only key. Genomics, proteomics and new sciences are the ingredients. But at the same time we must not confuse things, he says pointing towards controversies adding, “Clinic research is an integral part which has to be taken alongside whatever we do.”
As per Dr M C Mishra, Director, All India Institute of Medical Sciences (AIIMS), “India is already taking major steps though one by one. National Cancer Institute is the biggest medical science project in the history of India. We are introducing Gama Knife Robotic Surgery and targeted therapy through nano-biotechnology approach which is in offing.”
Dr N K Ganguly, former Director General, ICMR recently feels that India must learn from other countries like Africa where there is lot of clinical research happening in the country. “Perhaps India too could accelerate its activities as a learning. Anti-leishmanial and anti-TB fight in India. Nano particle based anti-cancer drugs, 3rd generation biosimilars can be all affordable ones if we try hard here in our country,” he says.
Skilled human resources must be core of any action plan
Dr Jitendra Singh suggests setting up of ICMR units in private-sector medical colleges and institutions. “A mutually rewarding mechanism could be worked out wherein, while the private institutions having ICMR or other registered research body units could be rewarded with certain incentives, on the other hand ICMR would have the advantage of tapping and grooming young medicos with research aptitude,” he added while speaking at an event in Delhi recently.
In order to improve health services, the government on the other hand says that it has identified 187 districts in the country where extension of existing services and capacity building will be done. Also, 58 districts hospitals were shortlisted for upgrading as medical colleges to deal with the problem of shortage of doctors and paramedical staff. As per Dr M C Mishra, the AIIMS at Delhi is in the process of digitizing of patient record with the Tata Consulting Services (TCS). We are trying to solve accommodation issues. 3500 more beds in next seven years,” he says.
Will that really solve the mammoth task in sight. As per the Aarogya Bharat report 2015 of industry association, NATHEALTH, there is a shortfall of nearly 2 million doctors and 4 million nurses in the Indian healthcare system. The numbers of primary health care centers (PHCs) is also limited, 8 percent of the centers do not have doctors or medical staff, 39 percent do not have lab technicians and 18 percent PHCs do not even have a pharmacist. Not only the scarcity of medical personnel; the problem of under-utilization is also a major challenge in Indian healthcare system. Ironically, about 50 percent of the existing medical workforce does not practice in the formal health system.
There is also the basic skilling issue here. Our medical doctors are mostly young and ambitious with no idea or guidance towards serving the public in far flung areas. Dr Gangandeep Kang hits the nail on the head when she says, “We have a systemic problem in India. We send our children to study medical research at a young age whereas in developed nations, the undergraduate courses involve community orientation, community health systems, secondary hospital postings and research internships. These help in preparing them to understand that healthcare is not just a regular job but has broader implications.”
“The Centre is working on an elaborate plan to roll out a blueprint for health services with the participation of the private sector in next two months and is committed to provide it to the last man of the society,” Nadda said, delivering a lecture on ‘Universal Healthcare: Forging Partnerships with the Private Sector’in Bhopal recently. Referring to the availability of health infrastructure in the country, Mr Nadda said the major problem is not availability of resources but its poor implementation.
Dr K K Talwar, noted Cardiologist feels that the time has come that India uses the experience gained over a long period of time. He feels that research is required to find out the ways to develop affordable diagnostic tools and only research is an integral part of way forward for universal health. And one must agree. The appropriate funding to research projects, promotion of skill training and aptitude, facilitating collaborative models of research will not only help in fostering innovation but help in creating affordable solutions for a country like India.
One thing is clear. The government authorities are well aware about the root of the problem but the steps taken doesn’t help to resolve questions of cost effectiveness and in bringing down the out of pocket expenditure through evidence-based technology and health practices after next decade. It is just that the broader vision has to be encompassed with a basic model of collaborative health research and incentive system. The policymakers must realize that the innovation in health services, diagnostics, and equipment has the potential to address not only our basic healthcare issues but make India a global health innovation hub, moving over from the tag of being just the services provider.
Note: The article is based on deliberations held at various forums in last six months.