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“This is indeed India!" remarked Mark Twain, as he tried to grasp the complex and nuanced Indian society. More than a century later, India continues to be a paradox. On the one hand, its economy is currently the fifth-largest, with aspirations to vault to the top-three club by 2025. On the other, its healthcare systems perform poorly on multiple dimensions, with the country ranking 145 among 195 countries on the Healthcare Access and Quality Index (HAQ). The healthcare infrastructure in India is crippled by several inadequacies including limited access, inadequate capacity, poor quality care, and limited affordability for the less affluent population. As a result, most of India’s citizens have to contend with poor health outcomes. The covid pandemic has further laid bare these prevailing gaps and precipitated the need to rethink India’s healthcare ecosystem.

The burning question now is, what will it take for India to leapfrog its healthcare evolution curve? Considering that India’s healthcare spending, at 3.5% of gross domestic product (GDP), is significantly lower than peers, one would assume that higher government spending can alleviate all the pain points in the healthcare ecosystem. Increased investments are needed for both improved and increased physical infrastructure like hospitals and medical equipment; and more importantly in building medical staff capacity, including doctors, nurses and technicians.

However, empirical evidence shows that money alone cannot move the health needle. For example, Thailand and Vietnam’s healthcare spend as a percentage of GDP is about 3.7% and 5.5%, respectively, which is significantly lower than the US or France where the proportion is about 17.7% and 11.2%. Yet, both Thailand and Vietnam have managed to achieve commendable, and in some aspects better, health outcomes. To achieve the goal of universal healthcare, India needs to not only adopt best practices from across the world but also develop fit-for-India health services. The adoption of digital health services can help India leapfrog its healthcare evolution.

The way forward is to leverage the trinity of data, technology and collaboration. A digital health ecosystem can help mobilize this trinity to improve health outcomes at scale. The journey towards building such ecosystems has already started. An example is the Global Alliance for Vaccine (GAVI). Through public-private global health partnerships, GAVI has accomplished vaccinations of more than 800 million over the last two decades. GAVI underscores how multiple public, private and civil society organizations can come together to deliver tangible impact through clear metrics and data. Similarly, India can work towards creating a Health Open Digital Ecosystem that will elevate the country’s healthcare ecosystem by enabling information transparency, interoperability and innovation. Just like the United Payments Interface brought about a paradigm shift in the way financial services are delivered and facilitated financial inclusion, a digital health ecosystem can ensure ‘healthcare inclusion’ such that every citizen has access to affordable and quality healthcare.

To achieve better health outcomes, India needs three main enablers.

The first is data. Healthcare is one of the most data intensive sectors. It is estimated that the total data generated over the lifetime of an average human is about 1,100 terabytes. However, data on its own holds little value. It must be effectively anlayzed to draw actionable insights. In order to generate optimal health outcomes, the ecosystem needs granular data on patients, doctors, providers and other stakeholders. Access to accurate data can enable health providers to better understand patient history, behaviour and requirements, and establish the relevant treatment protocols. Effective data capture and retrieval helps track treatment and allows for timely interventions, thereby improving the continuum of care. An integrated health database can be leveraged to provide automated, relevant and timely health interventions, thereby ensuring that patients receive the appropriate healthcare at the right time. Consented access to patient data and healthcare history will elevate the quality of care and greatly improve health outcomes—while addressing issues related to data security and privacy.

The second enabler is technology. Technology is not only about mobile adoption and bandwidth that facilitates telemedicine. It is also about genomic sequencing and nanotechnology, it is about IoT connected devices and wearables. From the patient’s perspective, telemedicine can easily resolve challenges related to waiting time, proximity and risk of infection. On the other hand, insurance companies can leverage machine learning and artificial intelligence tools to better assess an individual’s idiosyncratic risk and accordingly price premiums. Additionally, data generated from wearables/smart devices can be leveraged to provide customised health services.

The third lever is collaboration. Data and technology by themselves are important but the most critical element is collaboration. Services implemented in silos will have only limited impact and the healthcare outcomes get amplified when different stakeholders in the ecosystem—both in government and private sectors—work in synch. The Swasth alliance is an early example of such a model where 100-plus health ecosystem players such as hospitals, health-tech start-ups, pharmacies, technology and other organizations voluntarily came together to help improve healthcare access and quality.

A transformation is underway. Adversity has been the crucible for change. It can be catalytic and encourage people, businesses and even the government to not only rethink the status quo but also reimagine the future. The covid pandemic is an unprecedented event that has not only revealed the prevailing gaps in India’s healthcare ecosystem but also created an opportunity to plug them. By encouraging collaboration and combining digital approaches with traditional healthcare models, India can create a powerful antidote that addresses the challenges related to access, affordability and quality of care.

Abheek Singhi is managing director and senior partner at BCG

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