Covid-19 has made us realize that India has a long road ahead in terms of healthcare delivery as we still struggle with access to quality medical care. Our healthcare spending was one of the lowest among developing countries and state-level resources remained largely underutilized despite the revised National Health Policy 2017 and the recently launched PMJAY-Ayushman Bharat in 2018. As per the National Health Profile 2019, India’s public health expenditure is just 1.28% of its GDP and there is one government allopathic doctor per 10,926 population. As per the Centre for Disease, Dynamics, Economics, and Policy, India has currently an estimated 1.9 million hospital beds, 95,000 ICU beds and 48,000 ventilators. While private healthcare providers and other domestic manufacturers have been asked to earmark beds and supply additional equipment through orders, imports and local manufacturing, it is going to take time and by then cases will further increase in the country.
Being a public health crisis, the task of managing the Covid-19 pandemic has remained largely and, rightly so, with the Government and public hospitals. Almost all activities from airlifting Indian nationals, screening arrivals at airports, testing, quarantining suspected cases and treating positive patients have been carried out by government hospitals under public authority protocols. The private sector was asked to be on standby, earmark isolation beds and only a few among them designated as dedicated Covid facilities. They have also been asked to report Covid positive cases to the nodal authorities and even shift patients if required. However, despite these efforts, cases continue to increase day by day. Therefore, Government facilities alone will not be sufficient and the involvement of the private sector is crucial to decrease the burden on our resources, address shortages in equipment, beds and also speed up treatment.
A perception bias that private healthcare has faced for the last several years, is of not doing enough or working solely for profit. Gradually among the media and the public, particularly in the present Covid-19 scenario, conversations have increased about the private healthcare sector not offering explicit support to Government, sitting on the sidelines and doing only what the Government is asking them to do. In some states, because of gaps in Centre-State communication, private healthcare providers might need more clarity on guidelines. On the whole, this perception needs to change and healthcare leaders must front this challenge instead of oscillating between total radio silence and weak apologies. As contrary to this belief, time and again, private hospital chains have risen to the occasion. A number of established providers have stepped up their efforts during the pandemic, offering their full support and services, adhering to Government guidelines. Some of India’s leading private hospital chains have set up isolation wards, are treating Covid patients, and helping them recover successfully. It is important to note that many patients opted for private treatment on their own as well. In addition, mission hospitals serving in rural areas, research centres and diagnostic labs have come forward in these times of need. However, this information has largely remained in the sidelines.
Pandemics do not go away overnight and take time and efforts to contain. Covid-19 began as an epidemic in China and it was a matter of time before the virus made its way around the world bringing the world to a standstill. Epidemics do not always turn into pandemics or become so only after a few years. An appropriate example here is HIV, which was considered an epidemic in West Africa for decades before becoming a pandemic in the late 20th century. Advances in modern medicine and multi-sectoral efforts helped contain HIV to a large extent, with the rate of the disease being stable and predictable among certain populations, according to the American Medical Association.
In the current landscape, the onus lies on the private healthcare sector which needs to communicate its role and contribution to the government, media, institutions, the larger healthcare fraternity and the public. A two-pronged approach is required where the providers need to be heard on a singular basis and this can be possible only when more and more sector leaders come forward with their stories on the initiatives taken and the efforts put in. They need to stand the ground and explain their side of the story, voicing concerns that need to be addressed. There also needs to be consistent appreciation within the sector as time and again, the private sector has stepped in to fill vital gaps, complemented Government efforts through investments in infrastructure and employment creation, especially for women. The workforce in private health care has more than 50% of women and provides them with a safe working environment. Private hospitals have helped in bringing cutting-edge technology, equipment, and clinical protocols to India, as well as placing our doctors on the global map. The creation of healthcare infrastructure is expensive, gestation periods for recovery are typically long, about 5-7 years for an operational breakeven and 15 years for recovery. It is time to bust the myth that running a private hospital is a profitable business – it is often not so and pre-bed investment made is huge, including the facilities, clinical expertise, and infrastructure, as per globally accepted standards. There is no formal industry status for private healthcare to enable them to advocate their concerns and put forth suggestions or recommendations.
This pandemic has created a situation where both healthcare and economics are hurtling towards a collision course. There are no textbook solutions available but there has never been a more opportune time than now for India to introspect and move towards a comprehensive structural reform of our public health systems with a spirit of collaboration. Long abused words such as “profit” and “private” in healthcare need to be shed with a fresh focus on sustainability and social relevance. We have strong examples such as the NHS and in Australia where tangible outcomes have been garnered by leveraging the strengths of both public and private healthcare sectors. The lessons learned today will certainly transform the world around us but more importantly, transform us. For this, communication holds the key and the entire sector needs to stand as a united front. Healthcare, like the rest of the world, is truly at a crossroads but not without solutions close at hand.
DISCLAIMER : Views expressed above are the author’s own.