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  • Sidharrth Shankar

HEAL India First? The Misses!

[Sidharrth is a Partner at JSA. The following article was published in Express Pharma and on Lexology.]

The ‘Heal In India’ initiative may have several pros and wins, but being alert to the cons is even more potent. Cognizance of the impact on the overall approach towards the Indian healthcare model is crucial. My first piece was on the hits. Part II of my piece on Heal In India cuts across the misses that needs to be looked at.

Let's Face Facts

Affordability and Accessibility are the two most deadly threats that deter the healthcare sector in India. This further leads to an inequitable scope of treatment for citizens nationwide. The minimal 2.1% of our GDP that is committed to affordability is a staggering low as compared with the 9.7% in the case of OECD countries. Moreover, more than 50% of healthcare expenses in India are borne by citizens pushing the 55 million poverty-stricken further down the abyss. Today’s infrastructure record has about 28% of the urban population with access to 66% of the beds in hospitals. The remaining 72% has access to only 33% of hospital beds. In the case of the medical fraternity, 67% of doctors are concentrated in the urban areas.

'Glorified' Western Models

That India has yet a lot to learn about healthcare delivery models and systems is a given. However, India has two successful models in the West for valuable lessons. One is the insurance-based model predominant in the US. The other is the UK’s state-controlled National Health Service (NHS) model. It would benefit India to study the positives and drawbacks of both the models to ascertain the features that best fit the Indian polity of states, culture, business aspects and the healthcare delivery.

The Government is doing all to build on the medical education base by bringing in more colleges, new healthcare plans and reforms that will encourage a higher output of medical talent. However, this effort requires a multiplicity of regulatory checks in the education foreground, where merely the cheque-and-fee model should not be the deciding factor. Outgoing medical graduates, postgraduates, doctors, healthcare professionals, experts, etc., should be screened at various levels before they serve the nation or the rest of the world.

India's Health Interests

Healthcare workforce challenges have taken centre-stage in discussion and debate since a long time now. India’s health interests call for serious scrutiny - its political or geopolitical aspects, and sometimes even the cultural mishaps.

Sadly, the Pradhan Mantri schemes, which make the headlines, do not prioritize health care. While it is true that the provision of tap water, housing, electricity, and roads is essential, the crying need is for healthcare advocacy and implementation of the healthcare at the grassroots level.

Similarly, while the Ayushman Bharat Digital Mission (ABDM) and the Heal in India initiatives aim to streamline the country’s integrated digital health infrastructure, the ever-increasing healthcare needs of the neglected masses is overlooked. For instance, while the innovative thought of building an online repository of healthcare professionals will enable foreign patients to access the best-suited treatment line; this in no way resolves the ongoing crisis for a country already struggling with affordable healthcare for its own citizens.

Exchange Best Practices, Not Professionals

Since COVID-19 brought the world to its knees, nations have supported one another with life-saving vaccinations and medical kits. However, the fine line between the import/ export of products and healthcare professionals may have been ignored and taken for granted. The General Agreement on Trade in Services (GATS) in the 1990s also aimed to create a liberal healthcare world, and the results were criticized globally.

A similar impact is caused by an over-dose of medical tourism. When a country's limited healthcare resources are exploited or, more precisely, stretched to the utmost to serve the healthcare needs of stakeholders other than its own citizens, it is nothing short of a massive dent in the country’s health equity. Though such initiatives for growth cannot be belittled, policies that imbalance priorities are a concern.

Healthcare Registry, Not Repository is the Need

Apart from the plus in providing foreign stakeholders easy access to the right treatment matches, a healthcare repository of professionals offers no other answers to any of India’s cries for healthcare demand or supply. India has neither a strong supply side nor a weak demand base that would benefit from such a repository.

Instead, a Registry is required at the national, urban, and rural levels to address the mounting healthcare challenges which are manpower, access, affordability, etc. Such a Registry, coupled with strong public healthcare initiatives, is the urgent need for India’s current healthcare sector.

A Self-Imposed Brain Drain?

The online National Health Resource Repository (NHRR) being planned and built robustly by the National Health Authority (NHA) will require Health Care Professionals (HCPs) to upload their professional details and achievements along with their preferred destinations. This will give foreigners a ready list of hospitals available for the most appropriate healthcare services. About 42 allied healthcare services that have been on offer via this portal have been identified, offering professionals access to serve foreign patients in the country of their choice.

As I said earlier, it is time for prioritizing our nations healthcare needs and move in the right direction for ‘Heal In India’ first and then ‘Heal by India’.

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