The Indian healthcare sector is on the cusp of major transformation today with accessibility and affordability becoming major determinants of a sustainable healthcare care delivery model. 2019 ushered in a new era in the Indian healthcare as the year saw a series of policy measures which will bring tangible difference in enhancing and enriching healthcare in 2020 onwards. Mukul Kumar Mishra of Elets News Network (ENN) encapsulates major policy decisions which prove worth taking in coming years.
From National medical Commission to Fit India Movement and Scaling up Ayushman Bharat, the Government it seems is working on a mega plan to bring reform in the healthcare sector and several key decisions undertaken this year speaks volumes about its intent to make giant leap in the direction of universal health coverage.
Off-course, coming years will be ruled by technology including AI, and modern tools helping people to take charge of one’s own health, nonetheless policy measures will hold key in determining fate of overall evolved healthcare system.
“The future of Healthcare will be primarily driven by digital technologies such as Artificial Intelligence, Robotics, 3D printing, augmented and virtual reality. Digitization will bring increased efficiency and accessibility to healthcare services. AI has already become an intrinsic part of many Clinical decisions made by medical professionals. Data-based decisions help improve quality of care, clinician productivity and address the challenges in scaling healthcare delivery to rural areas and make a huge impact for the masses,” Dr Geetha Manjunath, CEO & CTO, NIRAMAI, believes.
PERSONALISED HEALTHCARE NEEDED IN LIGHT OF BURGEONING NCDS
In the backdrop of burgeoning NCDs along with lifestyle diseases which are affecting even youngsters nowadays, people residing in urban areas go out of way to avail personalised and quality healthcare. Even those who don’t fare well on economic parameter seek best care despite having fair idea that it will push them further in the vortex of poverty. Satish Kannan, Co-founder & CEO, DocsApp, says, “The year gone by has witnessed an extensive usage of online healthcare by urban, semi-urban and rural people alike. 2019 saw an increase in acute disease manifestation from Dengue to Acute seasonal infections. More and more Indians have now started using online platforms because of the ease and anonymity that it offers.” Though the Indian healthcare sector has evolved to an unprecedented manner in last some decades courtesy cutting- edge technology and innovations, it still needs to further calibrate its strategy to offset challenges on front of infrastructure, affordable model of care, delivery of services in rural areas, skilled workforce including doctors, nurses, and technicians, and integration of modern tools to improve overall outcome. “The technological advancements in healthcare have benefited overall industry including the diagnostic market. In 2020, genetic testing will further shape the preventive healthcare segment. Recent findings in our genomic study and the significant decline in the costs of genetic testing will change the game completely. The industry will use these techniques to transform the way personalised healthcare is delivered in the country,” Amol Naikawadi, Joint Managing Director, Indus Health Plus holds opinion.
Here’s the list of major policy decisions undertaken in 2019 to augment delivery of healthcare services:
MAJOR REFORM IN FORM OF NATIONAL MEDICAL COMMISSION ACT
In August President Ram Nath Kovind gave assent to the National Medical Commission (NMC) Act, 2019, which provides for a system that improves access to quality and affordable medical education and ensures the availability of adequate and high quality medical professionals in all parts of the country, among others. The new law provides for setting up of an NMC in place of the Medical Council of India for development and regulation of all aspects of medical education, profession and institutions. Professor Suresh Chandra Sharma, the chief of Delhi AIIMS’ ENT head-neck surgery department, has been appointed its first chief recently.
INDIA VOWS TO REMAIN HEALTHY WITH ‘FIT INDIA MOVEMENT’
With an objective to encourage people to include physical activity and sports in their everyday lives to keep themselves healthy in the long run, Prime Minister Narendra Modi launched Fit India Movement on the occasion of National Sports Day on 29 August last year.
Launching the people’s movement on the birth anniversary of Major Dhyanchand, India’s sports icon, he said that ‘Fit India Movement’ should become a national goal and its aspiration.
He highlighted how physical activities were being robbed by modern gadgets and technology, making people vulnerable for NCDs.
“Technology has reduced our physical ability and has robbed us of our daily fitness routines and today we are unaware of our traditional practises and lifestyle which could keep us fit. With time, fitness has been relegated to a lower priority in our society. Earlier a person used to walk or cycle for kilometers, today mobile apps have to tell us how many steps we walked,” Prime Minister said. “Today lifestyle diseases are on the rise in India affecting even the young. Cases of diabetes and hypertension are on the rise and even common among children in India. But small lifestyle changes can prevent these lifestyle diseases. ‘Fit India Movement’ is an effort to bring these small lifestyle changes,” he further stated.
DECISION TO CONVERT 75 DISTRICT HOSPITALS INTO MEDICAL COLLEGES
India has a shortage of over 600,000 doctors and two million nurses. As per Indian Journal of Public Health 2017 data, on an average, a government doctor attends to 11,082 people. With an objective to achieve the target of one doctor for 1,000 people by 2024, the Government is working on every front to ramp up the number of skilled professionals in healthcare.
The Health ministry in 2019 initiated the process of converting 75 district hospitals into medical colleges by 2021-22 in under-served districts of the country that do not have any medical colleges. Once completed, it would lead to the creation of 15,700 more MBBS seats in India. Dr Vinod K Paul, Member, NITI Aayog, Government of India has reiterated the importance of human resources adding that India lacks on experts in primary to tertiary care. “The most difficult journey that we face today is about having the right mix, the right numbers, right quality, right skills and the right distribution of human resources in the healthcare sector,” Paul said delivering a speech at Ficci Heal 2019.
INTENSIFIED MISSION INDRADHANUSH 2.0
In an endeavour to immunise children under two years of age and pregnant mothers against eight vaccine-preventable diseases, the government launched new immunization drive on December 2. The Intensified Mission Indradhanush 2.0 is the updated version of flagship vaccination programme Mission Indradhanush (MI) which was launched in 2014. The new mission aims for focused and sharper efforts towards full immunisation coverage in 272 districts across 27 states/Union Territories.
It has a three-month window between December 2019 and March 2020 to achieve the results. The plan is to reach all children below two years and pregnant women who were left uncovered by the routine immunisation programme and to ensure that no child suffers from any vaccine-preventable disease. The drive includes vaccines for Hepatitis B, tuberculosis, diphtheria etc which pose major threats to children’s life and health.
NATIONAL HEALTH STACK TO BOLSTER DIGITAL HEALTH INFRASTRUCTURE
In a bid to develop robust digital and IT health infrastructure, NITI Aayog is working on a plan called National Health Stack (NHS). The National Digital Health Blueprint (NDHB) is the architectural document for the implementation of the NHS. Experts believe the Government’s objective is to manage population health in better manner leveraging analytics platform like Big Data and AI with Machine Learning. As per reports, unique health identification cards (IDs) would be provided to citizens so that health history of a person could be accessed at the click of a mouse. The idea is to aggregate data so that it would help patients, doctors, diagnostic chains and policymakers in order to make evidence-based interventions.
SURAKSHIT MATRITVA AASHWASAN (SUMAN) INITIATIVE
In October, the Government launched the Surakshit Matritva Aashwasan initiative or SUMAN scheme which aims to reduce maternal and infant mortality rate. The scheme will provide dignified and quality health care at no cost to every woman and newborn visiting a public health facility. Under the scheme, all pregnant women, newborns and mothers up to 6 months of delivery will be able to avail several free health care services such as four antenatal check-ups and six home-based newborn care visits. The pregnant women will be able to avail a zero expense delivery and C-section facility in case of complications at public health facilities.
ROTAVIRUS VACCINE (RVV) EXPANDED IN REMAINING STATES
The Rotavirus vaccine (RVV) introduced in India in March 2016 in 11 states (Andhra Pradesh, Haryana, Himachal Pradesh, Jharkhand, Odisha, Assam, Tripura, Rajasthan, Tamil Nadu, Madhya Pradesh and Uttar Pradesh), to reduce mortality and morbidity caused by Rotavirus diarrhoea was expanded to the remaining states and union territories, thus covering the entire nation. SCALING UP AYUSHMAN BHARAT ON THE BASIS OF BENEFICIARIES’ DATA In 2019, the Government worked on to give fine print to the Ayushman Bharat initiative launched in 2018. On the basis of one year real time data, the Government worked on the strategy on how to take it on mission mode across the country. Many hospitals were lauded with different level of certificate while fraudsters were dealt with iron hands.
Till September 2019, more than 1.22 crores screened for oral cancer, more than 49.79 lakh women screened for cervical cancer and more than 82.45 lakh for breast cancer. Around 90,91,903 beneficiaries availed treatment for hypertension and 45,28,307 beneficiaries availed treatment for Diabetes at these AB-HWCs. A total of 3,65,420 Yoga sessions were conducted in operational HWCs. A total 171 hospitals have been de-empanelled and penalties to the tune of Rs 4.5 crore have been imposed on hospitals till date.
DECLINE IN MMR AS PER SRS SURVEY
System (SRS) released in November by the Registrar General of India (RGI) showed that Maternal Mortality Ratio (MMR) of India declined from 130 in SRS 2014-16 to 122 per 100,000 live births in 2015-17. Assam (229) had highest MMR while Kerala (42) ranked at the lowest. In southern states, MMR has come down from 77 to 72 per one lakh births, while in other states the figure has come down from 93 to 90. The report indicates that India has prevented about 2000 MMR per year.
PROHIBITION OF ELECTRONIC CIGARETTES ACT, 2019
The Government notified the Prohibition of Electronic Cigarettes Act, 2019 on December 6 which makes production, import, export, transport, sale or advertisements of such “alternative” smoking devices a cognisable offence. As per the rule, offenders would face jail term and hefty fine for the same.
NITI AYOG’S PROPOSED MEDICAL DEVICES BILL
Apart from the above initiatives, there is also a proposed Medical Devices Bill in the offing. Its objective is to address the concerns on patient safety and reduce import dependency. The proposed Bill by Niti Aayog is also tailored for promoting Make In India of medical devices and providing users with access to safe innovative devices.
LEGISLATION ON ASSAULT ON DOCTORS COULD NOT SEE THE LIGHT OF THE DAY
The Government toyed with the idea to bring legislation to dissuade violent attack against doctors. The move holds significance in the backdrop of rising number of cases where patients and their relatives resort to violent means to settle score with doctors if outcome goes against them. The Health ministry could not bring in the much-sought central legislation to check assault on doctors and other medical professionals with the home ministry opposing it stating that there cannot be a separate law to protect members of a particular profession. However, the health ministry decided to pursue the proposed legislation in the backdrop of rising instances of attacks on medicos.
INDUSTRY INSIGHT FOR 2020
Industry veterans hold the opinion that in 2020 Indian Healthcare will be more vibrant in terms of personalised and enriched healthcare experience. Digital tools, innovative devices, and mobile apps will rule the roost. Nitiz Murdia, Marketing Director, Indira IVF believes India will become a major hub of medical tourism owing to low service rates in comparision to developed countries. “2020 will bring in more people to rely on online consultations for their first doctor touchpoint due to the availability & the ease of access. This would see a trend in change of attitude towards seeking help, early intervention leading to better health outcomes,” Kannan says.
Though lots of things are happening in the healthcare sector, they need to be integrated in prudent manner to improve overall clinical outcome. Public and private sector should not work in silo, rather they should join hands cohesively to provide patient best value for the money. On the advent of New Year, we hope the Indian healthcare sector becomes robust and sustainable, setting an example for countries across the globe in terms of affordability and quality.