The COVID-19 pandemic certainly qualifies as a ‘black swan’ chain of occurrences. The term was coined by former options trader Nassim Taleb in his seminal book of the same name to describe an outlier event (or events) beyond the realm of current expectations, and which creates a massive impact. According to the theory, this combination of unpredictability and effect leads us to ‘concoct’ explanations after the fact, to try and explain and create a comprehendible logic for the same.
I’ll leave such speculation for others . . . . the debate will certainly outlive the duration of this virus! My focus is on an issue that is being cruelly exposed by the pandemic, but which has been evident (if latent) for many years in India.
Rising incomes have not just precipitated the emergence of a thriving middle class, over the last 20 years, they have also helped lift millions from poverty. For instance, according to the United Nations research published at the end of the last decade, nearly 273 million Indians moved out of ‘multidimensional’ poverty (encompassing issues such as access to employment, exposure to risk and safety/security, as well as financial means) between 2005-06 and 2015-16.
One inevitable (and welcome) consequence of this shift is the rise in awareness and expectations for people’s health and wellbeing. The evidence that more people are now prioritising their personal and family health is compelling. According to research from Mintel (conducted well before the pandemic), nearly half (48%) of Indian consumers aim to live a healthier lifestyle, while nearly three quarters (72%) report increased happiness as their motivation for leading a healthy lifestyle.
And India’s health focus is also leading to higher expectations and demands from their health service. In effect, while these expectations are growing exponentially, the provision of such services remains on a purely linear trajectory; this divergence is at the heart of India’s ‘health gap’. Over time, this gap is only set to increase (see right).
One of the absolutes of India’s current healthcare delivery is the availability of infrastructure, which remains – in growth terms at least – on a distinctly ‘linear’ trajectory.
The infrastructure shortfall was evident long before the emergence of a pandemic; from ventilators (there are currently 48,000 in the country compared to the 150,000 actually required ), to hospital beds (there are 1.4 beds per 1,000 citizens compared to 4 for China and around 7 for Europe).
None of these issues is the result of COVID-19; they are all longstanding infrastructure shortages; they would have been exposed sooner or later as Indians demand for professional healthcare services continues to diverge from the available supply.
So, now India’s health gap is firmly established on – not just the government – but everyone’s agenda, what can be done to bridge it?
First, the manner in which the country (and the World) mobilised to bridge the infrastructure gap exposed during the second COVID-19 wave demonstrates what collective action can achieve. In particular, the collaboration between public and private sectors. Companies ranging from Google to Tata group have stepped in to fill the breach in supplies of oxygen and ventilators; the type of partnerships that will also be essential if such infrastructure shortfalls are to be addressed over the long term.
These are precisely the type of partnerships that are essential to bridge the infrastructure shortfall. While, in many cases, the private sector stepped into the breach, longer term, planes collaborations will be necessary to anticipate and provision for infrastructure requirements of the coming 10-20 years.
• Secondly, addressing the skills shortfall. According to the National Medical Commission, India possesses 554 medical colleges with an annual intake of 83,075 Bachelors of Medicine and Bachelors of Surgery (MBBS) degrees every year. Despite these unparalleled numbers, skill gaps remain. Today, for instance, over 69,000 Indian-trained physicians worked in the United States, United Kingdom, Canada, and Australia in 2017, according to the Organization for Economic Cooperation; the equivalent to 6.6 percent of the total number of doctors registered with the Medical Council of India.
As an industry – and as a society – we need to incentivise, recognise and encourage trained professionals to exercise their profession in India. Again, this is not the sole responsibility of the health ministry, it will require the health sector (and wider society) to ensure the type of conditions and remuneration that will encourage our professionals to do so.
• Thirdly, technology – not just to discover new remedies and treatment – but to make existing ones more accessible and affordable to all Indians. Data science and artificial intelligence are already helping specialists to make diagnoses remotely – in many cases, over the Internet. A practice that will transform the delivery of healthcare in India.
It will also reduce reliance on traditional infrastructure; more patients can be consulted at clinics (rather than requiring a hospital stay), many will be able to receive pre- and post-operative care from home.
The incorporation of the type of ‘new age’ science and technology will certainly reduce the strain on India’s infrastructure. Again, only a close collaboration between public and private organisations will ensure such benefits are truly realised.
What is clear is that India’s health gap is endemic and predates the emergence of the pandemic. While – in probability terms – the latter could be defined as ‘black swan’, the resulting strain on the country’s health infrastructure was all too predictable.
What is equally evident, is the only close collaboration at a societal level, will bridge the infrastructure shortfalls that have been cruelly exposed.
—Anand Narasimhan is Managing Director, Merck Specialties. The views expressed are personal
(Edited by : Bivekananda Biswas)
First Published: IST