Written by Sanjiv Kumar
The COVID-19 pandemic has not only highlighted the importance of thinking long-term but also of improving India’s overall health infrastructure. The weaknesses in healthcare delivery, starting at the grass roots, need to be addressed by strengthening our primary healthcare ecosystem. India should monitor and improve access to and quality of services including adopting and scaling up innovative technology to address its burden of disease and fill the gaps in healthcare.
The Centre has given more attention to health since 2005 when the National Rural Health Mission was launched. Improving procurement is an area receiving attention. Since the government initiated plans to modify the Public Procurement Order (PPO 2.0), there has been an uproar regarding the need for consistent policies which encourage investment in healthcare technology in India. The proposed changes include preference to companies with 50 per cent or more local content to promote India’s “self-reliance” narrative. This means that companies with less than 50 per cent local content in their goods or services would not be able to participate in government tenders. This will limit “access” of high-end state of the art medical devices which may contribute to improving the quality and longevity of life for those who can afford it. It will stop patient access to new generation lifesaving medical devices in the Indian market and hamper “Make in India” initiative.
Many experts have time and again deliberated on this shift from “Make in India” to “Made in India” — to make India “self-reliant” or “aatmanirbhar”. In the medical devices market, exports were valued at Rs 16,300 crore ($2.1 billion) while the imports were valued at Rs 43,365.9 crore ($6.2 billion) in the FY 2018-19. It becomes important to note how in 2018-19, India’s exports of medical devices grew at the rate of 25.2 per cent and imports at the rate of 23.8 per cent respectively compared to 2017-18.
It is crucial to reflect on the Indian market share in the global medical devices market which stands at 1.6 per cent. This is a clear indicator of how securing the health of about 1.4 billion citizens with medical devices is at a nascent stage, and will become difficult to manage its expansion without global collaboration, support and participation.
India’s import dependency, especially in the medical devices sector, is well known. Our country imports close to 90 per cent of the medical devices. Looking at the statistics in detail would help one understand the top segments of medical devices we are highly dependent on from other countries. This cannot be done away with suddenly till the domestic market matures and is able to meet the current and potential demand in India.
At a time when India lacks the capacity to manufacture critical care equipment for the masses, to support critically ill patients, opting for a sudden switch to inward looking policies such as health cess and PPO 2.0 would only create a vacuum impossible to fill. Therefore, it becomes crucial to perceive how the investment from trusted players helps the small and medium size industries of the country to contribute to research and development (value additions to their medical devices). By opting for abrupt protectionist policies India would only undo the progress made due to globalisation so far, also hampering the country’s economic development and simultaneously, its “Make in India” initiative.
In the wake of COVID-19, the imperative to change the status quo requires robust strategy, a stable policy environment and a well-advised comprehensive plan. The situation calls for the med-tech industry to work in collaboration with policy makers to reinvigorate the provision of healthcare in the context of the demographic, economic and social transformations across the globe to maintain a balance.
Considering the consequences of PPO 2.0 which might backfire, ranging from a rapidly increasing NCD burden to hampering India’s medical tourism, the government needs to work towards a transparent and enabling policy environment for the overall development of the healthcare sector. The primary objective should be to focus on “ease of doing business” by presenting an attractive market opportunity for global medical device manufacturers to support “Make in India”.
We all know how COVID-19 is an additional burden on the health care sector, on the top of our existing disease burden. The fall in GDP by 23.9 per cent in the first quarter also indicates slow economic growth not only in India but across the globe. Hence, it would be wise for the government to chalk out a long-term plan for the health sector based on a detailed analysis of India’s public healthcare needs rather than being driven by abrupt policy shifts led by emotions and expectations.
The pandemic has shed light on the need for adequately resourced, dynamic and versatile healthcare systems and the necessity to go beyond one’s comfort and boundaries to collaborate globally. The country with strong determination needs to face the challenges that come its way to set a benchmark for others to draw inspiration from. India cannot grow without working with other countries for achieving quality healthcare for all, while keeping patient safety at the centre of everything.
(The writer is Chairperson, Indian Academy of Public Health, Indian Alliance of Patients Groups)
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