India’s healthcare system is unique, complex, and multifaceted involving both the government and private sector to cater to the health needs of its 1.4 billion population. Insufficient infrastructure, inadequate funding, and a shortage of trained manpower have impacted healthcare delivery for decades. Coupled with these issues, the sector is also dealing with the complex needs of an aging population; the need to keep up to date with evolving advances in technology and medicine; heightened patient expectations; cost consciousness — all this against the backdrop of the economic setback of the pandemic.
Prevention first!
Adopting a prevention-first mindset is vital not only for alleviating the burden on the healthcare system but also for its aggregated socio-economic gains. As per studies, 86 percent of healthcare costs are associated with managing chronic diseases. A bulletin of the World Health Organization (WHO) mentions that “diagnostic testing has become necessary for diagnosing and monitoring disease”.
India is undergoing a rapid health transition with the burden of Non-Communicable Diseases (NCDs). NCDs are estimated to account for 63 percent of all deaths in India of which cardiovascular diseases lead to 27 percent overall mortality. As per the National Programme For Prevention And Control Of Non-Communicable Diseases report 2023, the estimated loss of economic output due to NCDs, excluding mental conditions, will be $3.55 trillion for India for 2012-2030.
Advanced diagnostic solutions enable patients and physicians to make critical decisions earlier, accurately, and with greater precision. These solutions help reduce hospitalization, enable targeted treatment, and control costs. For example, diseases such as cervical cancer can largely be prevented by early screening for human papillomavirus (HPV).
The power of collaboration
Along with recognizing the criticality of diagnostic access, we also need to realize the power of collaboration between government and policy agencies, healthcare providers, regulatory authorities, and patient advocacy groups. The most pertinent example of private and public collaboration would be the massive drive done during COVID both for screening and vaccination. India’s fight against HIV is another sterling example of public-private partnership (PPP).
The pandemic has underscored how prioritizing and investing in diagnostics facilitates prompt detection and effective disease management. From focusing efforts against mycobacterium tuberculosis, multi-drug resistant bacteria to developing treatments for the top three Gram-negative bacteria identified by the WHO as number one Priority Pathogens, diagnostics can be gatekeepers to future health crises and pandemics.
Quality and safety
Expanded access to diagnostics must be accompanied by robust systems to ensure safety and quality. Without these systems in place, expanded access may yield questionable value, potentially leading to harm and resource wastage. A national regulatory and accreditation framework is crucial to address safety and quality concerns. Simplification of regulations can be achieved through harmonization or the expansion of programs like WHO pre-qualification. Implementing quality services requires regulation of laboratory accreditation and professional standards and competencies.
Adequate infrastructure is indispensable for the provision of diagnostic services. Several approaches can support improvement in this area, including more efficient resource utilization through better management practices, regionally pooled procurement, and equipment standardization, enhancing manufacturing capacity, and developing public-private partnerships with service providers. Creating more integrated networks will enhance patient access to care, connect decentralized or community-based models with centralized resources, and leverage the benefits of digitalization.
Public-private partnerships needed
Active engagement with the private sector will also encourage innovation in screening tools, particularly low-cost, high-volume testing technologies that are essential for local clinics, including those in rural and remote areas. This approach will help raise awareness and alleviate the burden on the overall healthcare system.
The significance of diagnostics has long been overlooked, resulting in chronic underfunding for access to diagnostics. Reassessing the country’s progress towards internationally agreed elimination targets should serve as a strong motivation to address this issue. Furthermore, going forward, ‘health checks and early diagnostics’ should be mandated as part of Ayushman Bharat, an initiative aimed at achieving universal health coverage in India. Establishing a robust mechanism for performance-based reimbursement systems, including diagnostics services, is crucial.
The journey ahead of us is arduous but can be immensely rewarding once we realize the value that can be delivered to the system and patients.
About the author: Dr Sandeep Sewlikar is the Head of Medical, Scientific and Regulatory Affairs at Roche Diagnostics India.
Disclaimer: The views and opinions expressed in this article are those of the author only and do not necessarily represent the official policy or position of Healthcare Radius.
