Public healthcare in India needs a genuine check up

India’s low public spend on health and low prevalence of insurance coverage are driving a large number of Indians to poverty as they have to bear high out-of-pocket expenses


New Delhi: On healthcare front, the Modi government had begun on a very positive note. Last year, the union health ministry declared that it wants to make healthcare a fundamental right and ensure that its denial is punishable by law. It wants to make health a fundamental right just on the same pattern on which education was made a fundamental right in 2009. Among other programmes that the health ministry is giving attention to include Mission Indradhanush that aims at increasing the immunization coverage to children like the hugely successful pulse polio program.

What is exciting to find that now the public private partnerships on disease research are slowly becoming a reality. Termed as India’s first PPP agreement for research and innovation in preventive health, an understanding on joint efforts has been reached recently between Indian Council for Medical Research (ICMR) and Sun Pharma on elimination of Malaria. Joint Working Group of both the organizations will conduct scientific research for development and testing of medical products (including drugs, biosimilars and vaccines) as well as undertake disease control and elimination programs. 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 Madhya Pradesh.

A first of its kind Current Good Manufacturing Practices facility at Central Vaccine Institute, Kasauli has been activated recently by the health ministry. Besides that a Zonal Office of Central Drugs Standard Control Organization (CDSCO) at Baddi has been made operational. The facility is expected to help the pharma units which face problems due to non-availability of regulatory support at times and also will help in boosting the communication between the important stakeholders.

The central government has launched the Jan Aushadhi Scheme to make available generic medicines at affordable prices to all through Jan Aushadhi Stores (JAS).While focus on generic drugs, a huge populist measure by the government seems to be well received, it now demands scaling up of the project. Since the public health has been a state subject in India, the union government has maintained that under the National Health Mission (NHM), it gives an incentive of upto 5 percent additional funding  to those states that implement policy and systems for free essential drugs (in generic form) to all those who access public health facilities.

To provide relief against catastrophic heath expenditure, the government has announced the launch of a new health protection scheme which will provide cover upto Rs 1 lakh with additional top up of Rs 30,000 for senior citizens in those families.

Unattended health challenges to get complex with time 

Yet despite a number of good steps, there are few issues of priority that have to be catered to on time. The promise of universal health scheme is yet to be realized but the government still has three years to go. While the ministers are tight lipped about its possibility as of now, there have been quite a number of suggestions including the one that a contribution of Re 1 should be taken from all the Indians to create a fund to drive it. Well we leave the nitty gritties to the economists.

There is hardly anybody who can deny that the primary healthcare in rural areas is still in shambles. While the union government has taken few steps but it has laid more onus on state governments. Health Minister, Mr J P Nadda says that to address health inequities, 184 high priority districts have been identified for enhanced fund allocation and focused attention.

One of the key challenges India is facing today are: low public spend on health, a disease-centric approach over patient-centric approach, and a method of treatment that focuses on curative care rather than preventive care. If the government makes a policy shift to preventive care, long-term impact of diseases such as diabetes, cardiovascular disease and cancer can be checked at the primary stage of onset by ensuring timely diagnosis of patients.

As per Prof Vivekanand Jha, Executive Director, The George Institute for Global Health, “Healthcare related issue do not find resonance in public conversation and debate. A few important issues are to try and find evidence-based models of innovate health care delivery, generation of data around the healthcare burden in India, development of innovative financing models, insurance reforms to prioritize disease prevention and legislative solutions.”

Over the next 10 years, one area where India has the potential to make a real global impact is in reverse innovation: bringing technologies that are developed for resource-constrained or remote healthcare settings in India to the rest of the world. An example of this is the development of portable ultrasounds in India, now used internationally.

The absence of a separate regulatory framework is one of the biggest challenges facing the medical technology industry in India. Presently, medical devices are governed by the Drugs and Cosmetics Act, 1940 and Drugs and Cosmetics Rules, 1945. The current regulatory structure has its own barriers and limitations such as complex rules and guidelines, high capital investment, lack of active participation from the government and low penetration.

The industry associations in India have been asking for the department for medical devices, a separate ministry for healthcare products to act as facilitator and regulator and coordinated plan between central government and state governments to aid existing manufacturing clusters and new medical device parks. Creating a separate regulatory framework for medical devices will be the first step in addressing the needs of the med-tech sector.