An Immediate Agenda For Health Minister Mansukh Mandaviya

Shri Mansukh Mandavia has assumed charge of two key ministries — Health and Family Welfare, and Chemicals and Fertilisers.

Normally, Health being a State subject, the Ministry in the Centre would have been restricted largely to policy roles and funding Central schemes.

The advent of Covid-19 changed this paradigm and increased the profile of the Ministry. Covid-19 also exposed the chinks in our supply chain, and that increased the profile of the Department of Pharmaceuticals under the Ministry of Chemicals and Fertilisers. Intervention needs increased significantly, kicking off the first Production Linked Incentive (PLI) scheme.

Here we take a look at a list of things that may need the immediate attention of the Minister.

Ministry of Health and Family Welfare:

1. Early stages of Covid treatment: During the first two waves of Covid, we observed that the real bottleneck/problem area is hospitalisation. The key for managing a potential next wave should be significantly reducing hospitalisation or rather the need for it.

Before such a next wave hits, we should have well developed protocols for: – a) home diagnosis,

b) home isolation,

c) home consultation through telemedicine, and home treatment through medicines delivered at home.

Such protocols should vigorously examine all available repurposed medicines such as hydroxychloroquine, ivermectin, budesonide, acetylcysteine, 2DG and incorporate them. Online pharmacies could offer professional telemedicine services, and brick and mortar pharmacies can tie up with groups of doctors offering telemedicine.

A national protocol for telemedicine services, especially for Covid-19, can be developed. Doctors providing teleconsultation should be apprised of the available learning/literature on these drugs fully, so that they can take a call. This should be supplemented by a specific attention on Primary Health Centres (PHCs) for those who cannot be given home diagnosis and telemedicine. Efforts and support by the Minister to get medical services teams to get this in place will be valuable.

2. Atma Nirbhar Swasth Bharat Yojana: One of the learnings that seem to emerge from the Covid waves so far has been that governmental capacity is key in addressing healthcare demands. While the private sector should continue to play its role, heavy lifting will need to be done by the government facilities.

Modernisation of existing state hospitals and Primary Health Centres should be accelerated. Centre has already identified this as a priority and set intervention targets. The Central Ministry should ensure funds allocated are spent by states and if feasible seek to accelerate progress. While at it, it may be worthwhile to explore specialisation areas in some of the PHCs. This will not only have the effect taking healthcare closer to people but also offer an incentive to the medical professional to gain exposure and experience (i.e., not having to deal with only fever and vaccinations all the time!)

3. Expansion of Medical Education Capacity: As a major initiative of capacity building, the Central Government should push for and fund states in setting up a medical college in every district. Some states have already taken the lead, and others need to be pushed. Based on need, it will be useful to have attached Nursing Schools in these colleges, offering degree and diploma courses.

In the recently set up colleges that would have stabilised their operations, postgraduate courses in “high demand” areas can be started. Overall, the increase in medical education capacity should not only serve the increasing healthcare needs of the country but also reduce fee leakages outside the country caused by students seeking to study in countries outside India.

Department of Pharmaceuticals:

1. Bulk Drug Parks and Medical Devices Parks: In July 2020, the scheme for providing financial support in the form of grant in aid to States to set up Bulk Drug Parks was notified. A transparent process for identifying the States’ proposals that would qualify was also detailed. Applications from the States was expected to close by September 2020.

As per the plan, three States were to get approval for grant in aid. A proposal to support setting up Medical Devices Parks along similar lines was also announced in July 2020. Four parks in different districts were to be supported. Quick decision and announcement of the ‘winners’ will enable States to move ahead and woo potential investors. Apart from existing players looking to expand capacities, it will provide a clear location option to PLI applicants.

2. Current PLI due to close on 31 July: PLI for Key Starting Materials and Drug Intermediaries/Active Ingredients was announced in October 2020 for 41 different products. Potential Manufacturers selected for the scheme were announced in four tranches with the last one in April 2021. A more ambitious PLI scheme has been announced in June 2021, which also includes those products for which no beneficiary organisation has been named in the earlier scheme. The last date for this round is July 31, 2021.

The Ministry should ensure that the applications are processed quickly so that operations can begin at the earliest. The department has been taking longer time in processing the applications when compared to other ministries in the matter of PLIs. The Minister may augment resources and follow-up progress closely to get this PLI to be operationalised at the earliest.

3. PLI for Hospital Consumables and “out-of-laboratory diagnostics”: The Ministry should propose and get Cabinet Approval for a new PLI for Hospital Consumables including Needles, Cannulas, Syringes, Non-Rebreather Face Masks, and Gloves. Many existing manufacturers of these items need to increase scales and emerge as players of significance worldwide.

A separate PLI scheme under medical devices covering diagnostic equipment that do not require a laboratory — such as Glucometers, Pulse Oximeters, and BP Measuring Devices, should also be seriously explored.

Cutting down import dependency and promotion of exports under the China plus one sourcing model should be the objectives. The large market in India can be leveraged for scale.

4. Further PLI for indigenisation: Over 60 per cent of India’s APIs are imported, the bulk of which are from China. In some APIs, import dependence is almost 80–90 per cent. Apart from other economic factors, this has serious implications for National Security. Indigenisation of the supply chain should be seen as a critical next step.

The Ministry should initiate work on a new wave of PLI. Given the huge import volumes, a lot of ground can be covered before we run into viability issues. The whole chain viz., Key Starting Material – Intermediaries – APIs should offer enough scope.

Limited relaxations in the Price Control Regime and Tariff Protection can be looked to boost indigenisation. Securing the supply chain is strategically far more important for us now, than pocketing benefits of free trade. The Department of Pharmaceuticals would have done enough background work while identifying the products for the first PLI scheme, so a lot of expertise should be readily available.

5. Technology Missions: Developments in some areas, Fermentation for example, have been running way ahead of India in the rest of the world. As a consequence, despite having a huge market, we remain import-dependent. Technology Missions in critical process areas should be initiated. Centrally funded Technology Development mission involving – a) Department of Biotech/Pharmaceuticals, b) CSIR Laboratory concerned and c) University/IIT/ICT Mumbai, could be a way forward. Focus should be on developing processes, related IPs, and licensing them to private companies.