Recovering from COVID-19- the long road ahead

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It's time to forget the world as we knew it. What Covid-19 has offered us is the opportunity to think long term. It will be a pity to let the crisis go waste.

It is evident that Covid-19 will transform the world in tectonic ways, just like World War 2 brought in major cultural and economic transformation like new technologies and business models, including accelerated entry of women into the industrial complex as labour. Unfortunately, we are on shaky ground, because a large part of decision making is based on past examples and comparatives; past precedents will not guide our trajectory in the technology and knowledge-driven society of today. I am confident we will find viable new decision making models.

I shall focus on healthcare and pharma as together, they are one of the largest employers in the organised sector and will play a vital role in the post Covid-19 world. Like most countries, the pandemic has exposed serious lacunae and at the same time great opportunities for India.

1. Reimagining Healthcare Policy: In India, you cannot win an election by talking about health. Hence, our healthcare policies are non-existent or at best, archaic. But, as Bill Gates says, it is time we plan and practice our capability and preparedness with regular germ warfare games (just like military war games) with proper command structure. In the future, the greatest threat to the country or humanity will less likely come from war or nuclear bombs, but from germs. There have been three near-pandemics (Sars, Mers, Ebola) and one pandemic (Covid-19) within just 20 years. Hence,

a. We must change the archaic MCI rules to bring medical education standards to the 21st century, and allow private hospitals to give training like elsewhere in the world. This will bring down the cost of medical education drastically and increase manpower without any additional spend by the government. Our ratio of 0.7 doctors per 1,000 population is among the lowest in the world; and is primarily because of outdated rules restricting medical education and extremely high cost of private medical education.

b. As per WHO, India stands at 184 out of 190 countries in terms of healthcare spending as a percent of GDP, with a measly 1.15 percent of GDP spent by government on healthcare; another 2.4 percent of the healthcare spending tab is taken up by the private sector or out of pocket expense. This pushes millions to bankruptcy from healthcare-related debts. On an urgent basis, the government healthcare spending must increase substantially with the largest provision in the healthcare budget reserved for prevention and public health including building infrastructure.

c. Technology has changed the definition of teaching, including the number of teachers required. This should substantially improve quality, reach and as I have mentioned earlier, the cost of healthcare education.

d. We have to improve the ease of doing business and allow medical innovation to become mainstream. India is 63rd on the ease of doing business rankings among 190 countries, despite the fact that we are the home of IITs, IT and jugaad.

e. Of the total spending on healthcare, only seven percent is spent on preventive healthcare, while more than 80 percent is spent on treatment and cure as of FY17 (National Health Accounts). This has to change.

2. Building Capacity: This will be in the areas of infrastructure and manpower both.

While we always knew we were not equipped to handle a pandemic, Covid-19 has laid our failings threadbare.

The government cannot pass on the role to the private sector and has to spend more on health. Only 1/3rd of hospital beds are located in rural areas to serve 69 percent population, while 75 percent beds are in the private sector mostly in urban or semi urban areas. About 65 percent of all health expenditure in India (approx. 2.5 percent of GDP) is borne privately by households, despite the fact that they cannot afford private healthcare. In the post-Covid world, we need a robust public health system with private healthcare providers playing a secondary role. The government has to build more public hospitals and focus more on health management, rather than disease management.

Not only do we have a serious shortage of doctors but equally the shortage of other paramedical and technical staff like nurses, pharmacists, laboratory technicians, etc., to manage various functions of the hospital. We need to create training programmes for them, which will also help solve the unemployment crisis.

The good thing is that in India, every family wants to make their child a doctor. We should turn this sentiment into a massive opportunity and open up medical education to fill the massive need of doctors.

3. Boosting Manufacturing: There is a palpable ‘boycott-China’ sentiment the world over, which India can turn to its advantage, to become the healthcare manufacturing hub to the world. Unfortunately, even today, much of the key equipment for the Covid-19 crisis—testing kits, personal protective equipment, ventilators, masks—all come from China. We have only 25,000 ventilators in the country, whereas the requirement is ten times that. This could be a huge fillip to good quality Indian manufacturing.

India is totally dependent on China for 70 percent import of APIs; even as common a medicine like paracetamol is 100 percent imported from China. This is in contrast to the fact that pharma has been a silent winner for India.

We are the world’s largest supplier of generic drugs and control around 18 percent of the global market. India accounts for about 10 percent of world’s pharmaceutical production by volume but only 1.5 percent by value. This can change in a post-Covid-19 world. In fact, Doctors Without Borders, a humanitarian organisation, estimates that treatment of AIDS using generic Indian drugs is two to three times cheaper as compared to treatment using branded drugs.

Without ‘health for all’ there is no progress.

One good thing that has come out of this horrible pandemic and all this suffering, is that finally, everyone is realising the importance of healthcare and application of technology like tele-health, telemedicine, remote connectivity and communication.

The old adage ‘health is wealth’ stares at us in the face as we have to ramp up on the four pillars—nutrition, immunisation, prevention and adequate public healthcare facilities to build a post-Covid India.

The writer is Cardiovascular Thoracic Surgeon, Vice Chairman & Managing Director at Asian Heart Institute, Mumbai

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The thoughts and opinions shared here are of the author.