Healthcare in India

India is one of the world’s largest democracies and the way it makes a mark on the global map being a powerful and emerging economy, it gives positive insight about the future prospect of the country.

Healthcare, being India’s one of the largest sectors both in terms of revenue and employment, has witnessed a huge transformation in the last decade.

The latest technology and innovative digital tools have led the Indian healthcare delivery system to get evolved in terms of providing enriched healthcare experience to masses especially in the front of clinical outcomes.

With the Government undertaking many measures to bolster patient care and private players playing equally pivotal roles, the sector is making giant leaps to enable people at large to avail accessible and affordable healthcare.

The healthcare sector is projected to become 8.6 trillion by 2022. The unprecedented growth of the healthcare sector is due to a range of factors including spike in non- communicable diseases, a considerable increase in income of the middle class, more awareness, quest for quality care, and easy access to service providers.

The government also seems to be determined to provide quality health for all. With this objective, the spending is set to be increased to 2.5% of the gross domestic product by 2025.

Even though the healthcare sector is growing, there is low accessibility and affordability for most of the population as the insurance coverage is less plus the costs of healthcare are also rising.

Some of the biggest factors for limiting healthcare accessibility include:- 

1. We have 7 beds for 10,000 population whereas globally it is 26 beds.

2. There are more medical professionals in the urban area than in the rural areas/villages where a large strata of our population lives with low accessibility to healthcare.

3. The insurance coverage is also very low as compared to other countries leading to an increase in out-of-pocket expenditure taking a toll on the patients.

4. There is a shift in disease patterns from communicable to non- communicable diseases like diabetes and cardiovascular disorders. The cardiovascular diseases are the highest known cause of death especially in the younger age group in India.

The way technology is making an impact, the time has come when just doctor-patient engagement is not enough. With continuous technological growth, the healthcare industry is going to be more based on “Value-based care “ outcomes in the coming days.

New trends as per Vision2024 would be–

1. Healthcare will go mobile.
2. New strategies to deliver low-cost healthcare will be on the rise.
3. New drug pricing models will be unveiled.
4. Behavioral healthcare will see more acceptance.

In a breakthrough in research, IIT-Bombay scientists have developed technology to leverage a patient’s immune system to cure cancer.

Researchers made use of gene and cell therapies to reengineer immune cells to attack and kill cancer cells in the body.

Such immunotherapy using CAR T-cells, a treatment for cancer, which costs Rs 3-4 crore in the US, can be made available for Rs 15 lakh if the technology is developed in the country. 

Purwar's team has been working on CAR T-cell technology for six years. ''It is an autologous cell therapy for personalized medicine, where cells are taken from patients, re-engineered and re-infused in the patient. We got immune cells from volunteers and clinical patients with help from TMH and re-engineered them using the technique. The modified cells were positively tested in laboratories on artificially grown cancer cells.'' said Purwar. 

T-cells (a type of white blood cell or WBC), an integral part of the human immune system, can identify tumors and destroy them. But in advanced stages, the cancer cells adapt to the presence of T-cells and remain undetected. In the new approach in immunotherapy, called CAR (chimeric antigen receptors) T-cell therapy, the T-cells ability to detect and kill cancer cells is restored. CARs are the protein that assists T-cells to recognize and attach to protein or antigen, present on cancer cells. These proteins help to destroy cancer cells.         

''Our team has delved into strategies that would improve the efficacy of the technique and demonstrated that a single injected dose can lead to multiplication of modified T-cells that can destroy cancer cells,'' said Punwar.   

Globally, over 600 clinical trials are in progress for CAR T-cell therapy, many of which are on in China said, Dr. Narula from TMH. 

''It has got huge potential. With the cancer burden, we have, the therapy will be considered a success, even if it is applicable to only a fraction of patients currently. Technologies are being developed globally, but are exorbitant. There are high expectations from this technology as it can create pathways for developing newer technologies, for newer therapies, for more forms of cancer. Thousands of Asians can benefit,'' said Narula. 

Read More: https://timesofindia.indiatimes.com/city/mumbai/iit-bombay-scientists-now-develop-cheaper-tech-to-cure-cancer/articleshow/72483167.cms 

Here is where we have a huge problem. Ayushman Bharat does very little for primary healthcare.

It has been announced that 1.5 lakh health and wellness centers will be set up, partly to deal with primary healthcare issues including NCDs – but, given the budgetary allocation of less than Rs 1 lakh percenter, this looks more like a very minor upgrading of the existing sub-centers and/or primary healthcare centers (PHCs).

Similar and sometimes more ambitious upgrading, including the provision of some free medicines, has been attempted by a number of states in the past; but, for the most part, there has been no reversal of the trend towards a wholesale exit from public healthcare, especially in North India.

There is now a substantial body of work that documents that, in many states, more than three-quarters of visits to primary care centers are to private providers – even though most of these providers have no medical qualification whatsoever.

This is in part because the sub-centers are open intermittently and unpredictably, and doctors and nurses are often missing from the PHCs.

It seems unlikely that small investments in these sub-centers and PHCs will change all that; the patients will probably continue to stay away, and therefore using these as the basis of outreach for NCDs and other public health interventions probably have limited potential.

The obvious alternative is to make use of informal providers who do have access to the patient population. It should certainly be recognized that they have the potential to be a public health hazard, especially because they abuse antibiotics and steroids – which contributes to rising resistance.

However, the policy response to this phenomenon has been mostly to declare these informal providers illegal and then to ignore their existence. This essentially deprives us of the primary tool for dealing with the very serious health problems that we are facing.

We need to think of ways to integrate them better into the overall healthcare project and give them better incentives, which would be easier if they had something to lose. Based on this we suggest the following steps.

Recognize and train informal healthcare providers.

A randomized control trial that was carried out in West Bengal (published in Science, 2016) shows that training private sector informal healthcare providers to improve their performance (measured by sending them ‘fake’ patients) by a very significant amount. Based on that, West Bengal has already begun training many thousands of informal health providers.

Develop a set of cell-phone-based checklists 

For treatment protocols for these practitioners to use, to react to the common symptoms they face. This is similar to what Atul Gawande has proposed for the United States (but much more basic).

Develop a simple test that allows the government to certify these practitioners as health extension workers.

Passing this test will allow them to deliver various public health interventions and perhaps be paid for participating in them. Moreover, evidence suggests that the patients are aware of the value of such certification and trust those certified more.

Recognize those who are certified

As the front line of defense against NCDs and malnutrition. Think of ways to reward those whose referral leads to the detection of a serious ailment.

Enforce existing laws

That makes it impossible for these practitioners to dispense high-potency antibiotics and steroids. This includes shutting down stores that violate the existing laws about who can prescribe what. At the same time, make it legal for informal providers to prescribe a range of less critical medicines, much like the nurses.

Expand the number of MBBS doctors and trained nurses

Coming out of the system and consider introducing some other intermediate degrees for practicing a limited range of healthcare. This is the model we had before Independence and the one that many other countries have adopted.

In addition, it is not clear that the government should rely entirely on the private sector to deliver tertiary care within PMJAY. There are already complaints from the healthcare sector about the prices the Indian government is proposing, which might result in many hospitals opting out and others selectively refusing to deliver certain treatments (even if that is against the rules). 

PMJAY will probably relieve some of this pressure on these public hospitals. However, it still makes sense for the government to try to simultaneously improve the delivery of secondary and tertiary care in the public sector.

Given that public hospitals will be able to bill their patients to PMJAY, which gives the public hospitals stronger reasons to compete with the private sector, it is a natural moment to expand this part of the government system. Therefore, we recommend, for secondary and tertiary care:

• Build a second district hospital in every district headquarters outside the state capital. Once it is built and is operational, refurbish and modernize the existing district hospital and bring it to acceptable standards.

Finally, it is very difficult to improve healthcare substantially unless we get the customers to demand better care (to fear antibiotics, seek out tests, and so on). This has to be a priority for any government. This is our final recommendation:

• Carry out public health campaigns to raise the awareness of NCDs, immunization and the dangers of overmedication. Recent evidence suggests that entertainment-education may be a very powerful device in this regard.

Read More: https://www.telegraphindia.com/culture/books/nobel-laureate-abhijit-banerjee-on-what-ails-india-s-healthcare-sector/cid/1711667

India has one government hospital bed for 879 people on average, a ratio that starts looking nearly 10 times as bad in a state like Bihar, but improves dramatically in Manipur.

Andhra Pradesh, where every tenth Indian student of medicine studies, has a government hospital bed for every 2,230 people.