The healthcare sector, one of the largest sectors in India - both in terms of revenue and employment - is undergoing drastic changes. The upward economic mobility of a large section of the populace has triggered a wave of demand for access to quality healthcare but the country’s infrastructural inadequacy, scarcity of skilled professionals and dearth of standardized systems and protocols have been a major concern. The disparity between aspirations of people and preparedness of our systems has led to the continuance of inaccessibility and unaffordability of quality healthcare facilities and better healthcare facilities should not be a luxury anymore but one of the fundamental rights.

Some of the critical indicators that are often used as yardsticks to discern the health of this sector like doctor-population ratio and density of hospital beds present some interesting challenges to the various stakeholders in the industry. For instance, the physician density in India is pegged at 6.5 per 10,000 population which is way below the global average of 14.2. The skewed nature of urban-rural divide, both in terms of infrastructure and availability of skilled personnel complicate the challenges further. Smart innovations and comprehensive intervention across the ecosystem of the industry is the need of the hour to realize the vision of healthcare becoming a fundamental right.

Vicious cycle
The government has a huge responsibility to remove the impediments plaguing the industry by redrafting some legislations that would better suit a globalized economic scenario.

Seventy to seventy five per cent of India’s demand for medical devices is met by imports. The industry is marred by adverse regulatory policies and duty structures and such factors continue to keep the cost of healthcare high. Government should also address the concerns of the Indian manufacturers as the odds are heavily stacked against them. The oddity of higher import duties for raw materials than finished goods has just not been detrimental but highly retrogradive in nature. High costs have a direct impact on the demand and accessibility which in turn slow the growth prospects of the industry. Disproportionate costs arising out of such factors is usually offset by keeping the pay and the working conditions of professionals and nurses at an abysmal level; thereby disincentivizing people from choosing this profession and pushing a section of medical fraternity to look for greener pastures outside India. This sort of ‘skill-drain’ is manifested at two different levels, one is a drain from the healthcare sector as a whole and the other is the shortage of skilled professionals in the rural areas. This is a vicious cycle which needs to be addressed expeditiously at multiple levels.

Regulatory regime
To begin with, medical devices need to be decoupled from the Drugs and Cosmetics Act. This will pave way for distinguishing medical devices from drugs and classifying it under various categories depending on the risks associated with them which would be at par with the European Union and United States medical device regulations. Government should also actively pursue and encourage global companies to set up manufacturing in India. Foreign direct investment in this sector will also give a major boost to the industry. ‘Make in India’ campaign that is being driven by the government of India needs to have a special wing for medical technology companies. Entrepreneurs and innovations in India in the field of medical devices need to be supported and incubated by the government. All these measures can not only contribute in raising the affordability quotient by bringing the costs down but also significantly contribute towards better standardization, establishment of protocols and its adherence.

Reverse ‘skill-drain’
Government spending on infrastructure and decluttering the regulatory regime does not necessarily guarantee a quick fix in the healthcare industry. There needs to be a thrust on Skill development and capacity planning to make the overall industry lucrative. A comprehensive road map for forecasting the future requirements of skilled workers in the medical field should be the basis for increasing the number of medical institutions in the country. Such proliferation of new institutions often has an impact on the quality of education and sufficient care such as rigorous training for faculty staff, installation of simulation laboratories needs to be taken to counteract it.

Government and the private sector should also work towards a face lift for the medical professionals and nursing community by bringing the working environment at par with the international standards in terms of pay, work timings and opportunities for professional development.

Realizing the vision
Medical insurance is still at its nascent stage in India but will be one of the most important cog in the wheel to achieve universal access to healthcare. Governments’ ambitious roll out of the National Health Assurance Mission will have to be augmented by participation of private players through public–private partnership (PPP) model to accelerate the reach and penetration of such initiatives. India on the cusp of a major transformation and universal healthcare, has a long term mission that would require steadfast commitment from stakeholders across the board.