Enhancing Health Care in India -What to Expect in the Coming Decade?

Abstract

Understanding The ABCD of the future of health care.

Full text

Editorial
The Indian Practitioner q Vol.73 No.1. January 2020
9
Enhancing Health Care in India – What to Expect in the
Coming Decade?
Dr. Varsha Narayanan *
* Health and Pharmaceutical Consultant, Dr Varsha’s Health Solutions, Andheri West, Mumbai.
Email-info@drvarsha.com
The fastest growing healthcare markets in the
world in the 2020 decade will be Asia Pacic
and Africa, with a Compound Annual Growth
Rate (CAGR) of around 13% as compared to 9% glob-
ally.1 Healthcare in India is expected to reach US$
132.84 billion by 2023 from US$ 61.79 billion in 2017.2
Health care in India represents a wide range from
basic health care and peripheral health services, to
technologically advanced apex and tertiary care hos-
pitals. A number of important factors as below can
and are expected to play a vital role in shaping the
Indian healthcare canvas in the coming 2020 decade.
The ABCD of Health care focus will be on Improving
Awareness, Building a Strong Base, Collaborative and
Combination Approach along with Eectively Using
Data and Technology.
A. Awareness
India’s internet users have registered a 40% inter-
net penetration, and 18% growth to reach 627 million
in 2019 with almost one third users coming from rural
India.3 The available information at hand is enormous
from all kinds of sources making it a challenge to access
credible information in a two-way interactive manner.
Therefore, readily accessible, interactive and health
awareness enhancing information coming from Health
Care Practitioners (HCP) especially doctors with doc-
umented medical background, experience and pub-
lished work, or from recognized medical bodies, and
clinics/hospitals can impart the right knowledge and
guidance to patients that can contribute positively to
improving patient diagnosis, treatment response and-
satisfaction.4
B. Building the Base
The base of Health care in India is built on Family
and Community Medicine with the Peripheral health
care services which cater to the major vast population.
Presently the Primary Health Centres (PHC- approxi-
mately 24,000) functions with the help of several sub
centers which reach remote corners of the country’s
rural areas, while the Community Health Centers
(CHC) are rst referral centers for every 4-5 PHCs. The
CHCs are supervised by district hospitals and tertiary
care government hospitals.5 The key to overall eec-
tive enhancement of Health care in India is improv-
ing the quality of care at the PHCs and CHCs. The
National Health Policy (2017) calls for upgradation for
all 150,000 sub-centres in the country as ‘Health and
Wellness Centres’ to provide improved primary care,
with basic preventive, diagnostic, curative and referral
facilities.6
In a pilot study in Palghar district in Maharashtra,
India, the auxiliary nurse midwives (ANMs) in the
sub-centres were empowered with the best-in-class
technology (a software platform to track patient data
and point-of-care diagnostics), and standardized clini-
cal protocols.7 This has enabled the sub-centers to ef-
fectively act as the Spoke clinics for the PHCs resulting
in more than 300 consultations and 90% patient satis-
faction rate recorded to date. There has also been a no-
ticeable improvement (greater than 40% improvement
in pre- and post-training test scores) in the ANM’s clin-
ical skills, such as providing antenatal care and out-
patient care for minor ailments, fevers, and infections.
C. Collaborative and Combination Approach
Two important collaborative approaches can add
immense value to the Indian health care system.
First is the collaboration between privatized and
government health care, whereby the urban advanced
specialty/super-specialty hospitals can each allocate
some resource for the enhancement of health care in
one particular CHC and its associated PHCs and sub-
centers.8 This can result in improved facilities; training
and updating knowledge and skills of peripheral doc-
tors, ANMs, and health workers on basic patient care
in relevant disease segments and therapies; facilitate a
systematic and standardized approach with account-
ability and appraisal; and give peripheral doctors ex-
posure to new drugs and changing global medical and

Editorial
The Indian Practitioner q Vol.73 No.1. January 2020
10
scientic concepts thereby bringing in more medical
practitioners into the peripheral health care services.9
The second valuable collaboration will be that of
health care with the pharmaceutical industry. This
would involve real world evidence and data genera-
tion for medicines and drugs which will be a key fac-
tor in clinical decision and treatment strategies. Real
world evidence would include not only in-clinic drug
eectiveness but also safety and tolerance in varied
populations and associated clinical conditions.10 There
will also be an increasing collaborative role of the two
industries in developing therapeutic consensus rel-
evant to India, and cascading updated knowledge to
the periphery.
A combination approach to disease management is
gaining immense awareness and acceptance today. A
holistic integrated therapeutic approach, complement-
ing drug therapy with lifestyle, nutritional-dietary,
psychosocial and evidence based indigenous and
natural therapies, can play an important part in more
eective management of chronic diseases, strengthen-
ing peripheral health care, and reducing costs.11 This
will also increase the population wellness quotient and
long term treatment benets. And the last having an
important place in rural health care in developing na-
tions like India.12
D. Data and Technology
The organization, stratication and analysis of the
enormous data (Big data) from the healthcare industry
can help in understanding demographic, epidemiolog-
ical and seasonal disease paerns, patient risk factors,
symptom variabilities, co-existing conditions, factors
aecting treatment response, disease prognosis, and
patient compliance. Big data analysis via Electronic
Health Records (EHR) can thus not only improve dis-
ease prediction and therefore facilitate prevention,
symptom recognition, timely diagnosis, and complica-
tion reduction but also help in beer organizational ef-
ciency and cost reduction.13
India has always been at the forefront of embracing
and adapting to advances and innovations in technol-
ogy which have increased diagnostic, interventional
and surgical precision as well as reduced recovery and
hospitalization time. The 2020 decade will witness rev-
olutionizing of the health care system with Articial
Intelligence (AI) to improve diagnosis and treatment,
patient engagement and adherence, and administra-
tive eciency.14,15 This will help clinicians and HCPs
to focus time on uniquely human skills like empathy,
persuasion, integrating the big-picture and eective
clinical decision making.
AI uses machine learning, neural network and deep
learning which can help in designing treatment strate-
gies and predicting outcomes based on evaluating pa-
tient risk, and recognizing clinically relevant ne fea-
tures in imaging data. Natural Language Processing
of AI will aid applications of speech, text recognition,
translation and simulation for clinical documentation
and reports, as well as patient engagement, interac-
tions and conversations. Robotics, which surpasses hu-
man vision, and angulation to greatly increase surgical
nesse, will soon have AI-based ‘brains’ with integra-
tion of image recognition and Robotic process automa-
tion (RPA). Remote and telemedicine will be yet an-
Fig 1: ABCD of Health Care Focus 2020

Editorial
The Indian Practitioner q Vol.73 No.1. January 2020
other area where AI will have widespread application.
Conclusion
The ABCD focus of Health Care (Fig 1) based on
Family and Community Health in India in the 2020 de-
cade involves improving right patient awareness and
knowledge, strengthening the base of healthcare at the
peripheral level, increasing Collaborations and combi-
nation approaches and moving ahead with using Data
analytics and technology. This will help to chart out
the ‘E’ in healthcare which is enhancement of clinical
decisions and treatment strategies, having best patient
outcomes, and ecient management and reach of the
health care system serving the Indian population.
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