The country — indeed the world at large — is facing the century’s biggest crisis. Countries across the development spectrum are grappling with an unprecedented situation in which a viral illness, COVID-19, has spiralled into a global pandemic in less than 90 days, bringing most of the world to a standstill.
The government has responded quickly, decisively and comprehensively, putting in place a strong and effective whole-of-government approach. However, as the epidemic progresses, this may not suffice. We will need a whole-of-society response.
According to the WHO, a critical lesson from the 2014-16 West African Ebola epidemic was that both the public and private sector need to work in tandem in responding to large-scale epidemics. In the COVID-19 response in India, the private sector — which includes the for-profit and not-for-profit segments — has to play an even more important role, as it is the dominant provider of health services in the country. The NSSO 71st round data on social consumption of health show that private hospitals, clinics and nursing homes provide over 70 per cent of healthcare. Data on the nearly 1 crore treatments received under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) corroborate this finding, showing that over half of all treatments are being availed of from private providers, accounting for over 60 per cent of total disbursements.
Currently, much of COVID-19 testing and treatment is being done in public facilities. As the epidemic progresses, both these services will need to be expanded several-fold and the private sector will need to step in.
Creating a large and accessible testing infrastructure is the first weapon in the armoury. Countries like South Korea, Singapore, Germany and Japan have been successful at controlling the spread of COVDID-19 and reducing mortality through early detection and quick containment. This has been possible only through widespread testing. India has opened testing up to private labs. Testing has been included under the AB PM-JAY as well. We need to substantially expand testing capacity. This cannot happen without the active participation of the private sector.
Second, as the government deepens its containment efforts, the country will need to rapidly surge the numbers of quarantine units, isolation wards and ICU beds in COVID-19-only hospitals. It will also need to ensure increased and continued supply of essential medical products — from testing kits, masks and other PPEs to oxygen and ventilators. According to a recent ICMR study, around five per cent of those infected will need intensive care and half of those in intensive care units will need mechanical ventilation. These projections translate into large numbers that considerably exceed the capacity of the government health system.
During the current crisis, activities of the private health sector should be the core of national health efforts. Private hospitals with adequate infrastructure will need to convert into COVID-19-only hospitals. This process will, of course, have to be steered by the government through a clear policy framework of designated hospitals, reporting and referral systems and an appropriate payment system. The experience of purchasing healthcare services through implementation of the AB PM-JAY can provide the template and know-how to work in partnership with the private sector.
Some private hospitals can help in managing the treatment of non-COVID-19 patients. With many government facilities being converted into COVID-19-only hospitals, a large number of non-COVID-19 patients will need facilities and providers to take care of their other urgent, critical or continuing healthcare needs. The AB PM-JAY has started a process to bring on board more hospitals to respond to such needs. It is assisting state governments in temporarily empanelling additional health facilities to provide emergency care and treatment for other serious illnesses to all citizens, particularly the poor and vulnerable. States like Madhya Pradesh and Punjab are leading this endeavour to strengthen their medical infrastructure through private sector partnerships and nimble purchasing models.
Third, as more private providers join this fight, a major concern that will arise is keeping healthcare workers from becoming infected. In addition to being at a high risk of contracting the virus, healthcare workers are also potential carriers. Ensuring their protection is of paramount importance. Besides, companies manufacturing essential medical products such as ventilators, masks and face shields, clinical gloves, hand-rub, and sterilisation equipment will need to crank up their production. Direct support from banks may be needed to keep production and supply chains going.
Fourth, the private sector will need to vigorously support the large ecosystem that drives the health system, as the lockdown and ongoing epidemic restrict movement and normal economic activities. Activities such as the production of essential drugs and medical products, logistics to maintain smooth supply, transportation of health workers, and delivery of food and other essential items will need to not only continue but also accelerate. Support for community activities such as night shelters and community kitchens will need to be strengthened.
Finally, an adequate stage-wise response to the pandemic and its economic, social and political aftermath will require the rapid filling of the many knowledge gaps. Government, private and not-for-profit research institutions need to collaborate to understand the nature of transmission of the virus, the factors that slow its spread, the most at-risk communities, or the optimal quarantine period.
The fight against COVID-19 is not a race to a hilltop. It involves the continuous management of an evolving public health crisis that threatens to spawn economic and social crises. These multiple dimensions will require a whole-of-society approach that goes beyond the government alone.
Consider this as an appeal to all private and charitable healthcare institutions to join this effort. This is the time to play our individual and collective roles in the fight against COVID-19. In this moment, like King Lear, “(t)he weight of this sad time, we must obey,” because “nothing will come of nothing.”
This article first appeared in the print edition of April 16, 2020, under the name ‘Making Bharat Ayushman’. The writer is CEO, PM-JAY
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