Private players can play a key role through corporate social responsibility initiatives in adopting wellness centres
The Ayushman Bharat programme, perhaps one of the most ambitious government initiatives in the health space in recent years, has created several opportunities for private sector engagement and participation. There are two key pillars of this programme – the health and wellness centres which will deliver comprehensive primary health services and the Pradhan Mantri Jan Arogya Yojana (PMJAY) which will provide an annual cover of Rs 5 lakh per annum to 10 crore families (approximately 50 crore citizens) for hospital-based care. PMJAY currently covers around 1,350 medical and surgical packages across the categories of cardiology, oncology and neurosurgery, among others.
Adopting Health And Wellness Centres
It is well known that India faces a double burden of disease. On the one hand, we accounted for 34 per cent of the world’s tuberculosis burden in 2016 as well as 26 per cent of premature mortality due to common infectious diseases and diarrhoea, on the other non-communicable diseases (NCDs) are responsible for 55 per cent of illness and premature deaths in the country. Estimates suggest that India could lose $4.58 trillion before 2030 due to NCDs. Clearly, this substantial and growing NCD burden is a matter of concern for all stakeholders.
The primary health model in India has historically been focused on delivering pregnancy and child care along with some services related to national health programmes. However, these services account for merely 15 per cent of all conditions for which people seek care. The expenditure on health has also been skewed towards curing people (51 per cent of total expenditure) as opposed to preventing disease (6.7 per cent).
Evidence points to the fact that a comprehensive and well-functioning primary health system is a must for a country that aims to provide universal health coverage to its citizens. In the US, a focus on primary health brought down the number of days spent in expensive, hospital-based care by 36 per cent along with a 42 per cent reduction in emergency admissions. Additionally, there was a 25 per cent increase in childhood vaccination rates. Similar results have been reported from countries like Brazil and Estonia. Unsurprisingly then, developed nations like the UK, Canada, Australia, Sweden and Netherlands spend as much as 80 per cent to 90 per cent of their federal health budgets on primary care.
Recognising the criticality of a strong primary health system, the government has approved the setting up of 25,000 health and wellness centres thus far, of which 5,000 are currently operational. The centres will focus on health promotion and disease prevention along with ensuring that chronic conditions are detected early, when costly and life-threatening complications can be averted. Such an approach is especially appropriate for tackling NCDs. If implemented well, this network of health and wellness centres can play a significant role in lengthening the average life expectancy, reducing the disease burden as well as averting avoidable morbidity.
While the government allocated Rs 1,200 crore in the 2018-19 budget for establishing the centres, there is an important role that can be played by the private sector through corporate social responsibility initiatives in adopting these centres. Private players can also collaborate with the government for operationalising NCD screening at the centres.
Providing Secondary And Tertiary Care Services In Supply Deficit Areas
As per the NSSO 71st Round Household Survey, the public-sector share in outpatient services has increased by 6.3 per cent in rural areas (from 22 per cent to 28.3 per cent) and by 2.2 per cent in urban areas (from 19 per cent to 21.2 per cent) at an all India level. However, if we examine the state-wise disaggregated data, we find that in a majority of states (15 out of 21), the share of public sector facilities in outpatient care has either declined or improved marginally while there have been impressive gains in six states. These gains have been largely concentrated in areas that have relatively less developed infrastructure in the private sector. With respect to in-patient care, 12 out of 20 states in rural areas and 17 out of 21 states in urban areas have registered a decline in the share of services provided by government-owned facilities.
Undoubtedly, therefore, the private sector constitutes a major part of India’s health delivery system, however, it is extremely variable in terms of location (concentrated in large urban centres in certain states) and quality. The Ayushman Bharat programme has created unprecedented opportunities for the private sector to participate in expanding access to quality secondary and tertiary health services for hitherto underserved parts of the Indian population.
According to the National Health Agency, the implementing authority for PMJAY, the average hospitalisation was around 4,000 per day after the scheme was rolled out on 23 September 2018. This could increase to as high as 100,000 per day once the scheme is fully accessed by beneficiaries from underserved states like Bihar, Uttar Pradesh and Madhya Pradesh. Currently, while these states have poorer health outcomes, the reporting of illness by citizens from these areas is much lower. Thus, following the launch of PMJAY, one can expect the latent demand for hospitalisation to be triggered. The private sector can step up and help the government to meet this demand. Of course, while the government is putting in place various checks and balances such as mandating pre-authorisation for nearly half of the 1,350 packages covered under the scheme to curb unnecessary procedures, private players will also need to self-regulate and ensure that the highest ethical standards are upheld.
Boosting Production Of Medical Devices
It is envisaged that diagnostics will be provided free of cost at the health and wellness centres. This, along with the coverage of implants and diagnostic tests under the PMJAY, will enhance the demand for indigenously produced and affordable medical devices. It is estimated that approximately 75 per cent of the current demand for devices is met through imports. The imports, however, have numerous problems including quality issues (e.g. phased out legacy devices) and limited suitability to the clinical needs and healthcare infrastructure in the country.
The government has taken several steps for boosting the manufacturing of medical devices in India. While a lot more remains to be done, the increased demand for devices under the Ayushman Bharat programme should definitely give a much-needed fillip to the industry. It also makes a strong case for setting up manufacturing hubs or clusters in the public-private partnership mode where the government invests in capital expenditure to develop the infrastructure and private players bear recurring expenses proportionate to their usage.
Skilling Healthcare Personnel
In addition to the development and deployment of non-physician health care providers for managing the revitalised primary health care system, the Ayushman Bharat initiatives will also give an impetus to the training of nurses and allied health professionals for delivery of skilled support services in secondary and tertiary care. Additionally, personnel will be required for digitization of family records and information from the community to the facility level. This will create opportunities for private hospitals and private medical practitioners to collaborate with the government for skilling technicians, nursing and para-nursing as well as para-medical staff, for instance, under the National Skill Development Corporation’s Healthcare Sector Skill Council.
A well-coordinated and responsible partnership between the public and private sectors can ensure that the implementation of Ayushman Bharat and other flagship programmes is successful and India is firmly on the path towards improving outcomes in health radically.
Disclaimer: The views expressed are personal.