If you are an auto enthusiast, TOPGEAR is a television show that won’t need any further introduction. Just in case you are not, Rolls-Royce is a name that will surely ring a bell. Considered an epitome of ultra-luxury and perfection, the anchor at a recent episode of TOPGEAR, was detailing the unique features of the recently launched Rolls-Royce model: “Seats made from the leather of Bavarian bulls that are raised in the mountains, where the climate is too cold for mosquitoes to survive, thereby avoiding any blemishes on the leather due to insect bites. This leather is further processed to be soft, thus ensuring the car-seats are free from squeaking sounds”. Phew! That’s some attention to detail. For a moment, leaving aside issues like animal rights and carbon footprint, what fascinated me is the extent to which one pursues perfection.
A little more than seven decades since independence, Indian healthcare may be far from being perfect. However, it’s also true that we have done many things right. Even as the unfurling of flags and I-Day celebrations are over, let’s have a look at some commendable achievements in our health care since 1947. When it comes to identifying a ‘top list’, it’s never easy to decide how many, and which are to be prioritized. It’s been a little more than seven decades from that ‘Tryst with Destiny’ speech, and on that count, here is my list of Seven from the past Seventy years.
1. Three-step Approach: It was the pre-independent Sir Joseph Bhore committee report (1946) that sowed the seeds for most of our health policy and systems. There is general consensus that one of the greatest assets to have emerged is our network of three-tier healthcare system. There may be flaws at the functional level, but without this framework of Primary, Secondary and Tertiary -care centers, we may not have achieved even the current health status and indices.
2. Marvel of Vaccines: The focus on disease prevention in the post-independence period probably started with the establishment of the BCG vaccine laboratory followed by other national institutes. Eradication efforts continued till the country became smallpox free in 1977, which also left a legacy of improved health system, trained vaccinators, cold chain equipment and a network for surveillance. Riding on this wave, the Expanded Program of Immunization (EPI) (1978) and then the Universal Immunization Program (UIP) (1985) were launched in India. In early 2012, the WHO removed India from polio endemic countries. Recently the central government advanced the deadline to achieve 90% immunization from 2020 to 2018, through the ‘Intensified Mission Indradhanush’. Despite the striking success of immunization drives, reluctance and a slow acceptance of vaccination remains a characteristic in many parts of the country.
3. Pharmacy to the World: Millions of people around the world, both in developing and developed countries, rely on affordable medicines made in India to stay alive. India is also one of the biggest suppliers of low-cost vaccines to the world with exports to almost 150 countries. One of the most important factors contributing to this remarkable development was the abolition of product patent protection for pharmaceuticals in 1972. This spurred the local Indian industry to become a formidable supplier of generic medicines through strong innovation capabilities, cost-efficient processes and significant capacity in setting up manufacturing plants that satisfies international quality norms.
4. The ‘inverted’ Red Triangle: An advertisement campaign on Doordarshan featuring erstwhile actors Nargis and Raj Kapoor, in the backdrop of the mesmerizing song ‘Pyaar hua ikraar hua’ probably epitomized family planning for a generation. In fact, India was the first country in the world to have launched a National Programme for Family Planning in 1952, which initially covered birth control programs and later added under its wing, mother and child health, nutrition and family welfare. Total Fertility Rate or TFR (average number of children born per woman during her lifetime) for India has been declining steadily over the years. From 5.7 births per woman in 1966, and 2.2 in 2015-16, the figure is inching close to the ideal target of 2.1. While issues like gender equality, age-old cultural and behavioral aspects still linger, there is no doubt that our family planning programs have played a significant part in creating healthier generations along with stabilizing economic condition of families.
5. Enter the Corporates: We live in times with a lot of distrust among the general public about doctors, hospitals and healthcare providers, and many may blame this on the ‘corporatization’ of healthcare. However, it is an undeniable fact that corporate entry in the 1980s has improved the overall quality of healthcare services in the country. As demonstrated by leading institutions, privatization has brought in access to quality care and infrastructure, reduced waiting time and many a time at competitive costs. An engineer friend who has spent many years living abroad summarized, “I got this perspective after living in the Caribbean. The cost of healthcare in India is very low when compared to the west. An ultra-sonogram will cost anywhere between eight to ten thousand rupees in the Caribbean. My diabetic medication was seven to eight times costlier.” In fact, private entry in to medical education is one of the reasons that unlike many countries, India never had to ‘import’ health care professionals.
6. The AYUSH alternative: The WHO estimates that most people in developing nations receive the bulk of their health care from traditional or indigenous health systems. Estimates suggest that almost 50% of the population even in the United States, the United Kingdom, and Australia report the use of alternative medicines. Right from its inception, National Rural Health Mission, the health project of Govt. of India, has accorded an important role to alternative systems of health care. Indicating a major policy change, since 2014, we have a dedicated ministry to ensure the optimal development and propagation of AYUSH (Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy) systems of health care. There may be challenges like limited evidence based research on therapeutic aspects of AYUSH, and also issues in integration of alternative systems into mainstream. However, the relevance of AYUSH has definitely increased in the current health paradigm.
7. Long live India: The burden of healthcare expenditure on Indians is so high that almost 67% of all health expenses are borne directly by individuals. Private health insurance and schemes of local bodies may contribute to about 11% and only the remaining 22% is from government sponsored health insurance. The number of health insurance policies issued in India is about 13 million thereby leaving a huge opportunity to plug the gap. Hence, the recent announcement of Ayushman Bharat- National Health Protection Scheme, aimed at providing insurance coverage to 500 million citizens is widely hailed as a step in the right direction towards reducing the burden of spiraling health care costs.
In the past two weeks, we have witnessed the fury of nature that has left indelible marks on the lives and psyche of vast populations in the southern parts of the country. Amongst other aspects, health will also need special attention in the weeks and months ahead, and many aspects from the ‘sevens’ mentioned above is bound to make a difference. And without doubt, this is also an opportunity to all stakeholders to set the path with impactful steps and policies. Some weeks back, one of my taxi journeys in the Persian Gulf offered a great opportunity to converse with the friendly driver hailing from Peshawar, and a lot of time was spent on listening to his perspectives on the new administration in Pakistan. As I was getting out of the car, young Mudassar’s parting lines were “Ärey Saab, yeh duniya hi tiki hai ummeed pe. Hamaara mulq bhi” (this world exists on hope, our nation is no exception). Absolutely, isn’t it?
The author is Co-founder & Director @ BioQuest Solutions Pvt. Ltd, a Bangalore based MNC that has been partnering with clients across the life-sciences knowledge value chain since 2005.