This is Neelakanta’s third train trip with his family from Chandel, Manipur, to Chennai for the treatment of his late-stage esophageal cancer. It takes him two days and 10 hours to make the one-way trip by train adding to the delays in his critical care and doubling the cost of his treatment.

So, what drives Neelakanta and others like him away from home in pursuit of medical care?

It is the lack of patient confidence in the existing healthcare infrastructure close to home, and the supply and demand gap of specialised quality-based multidisciplinary cancer care in the North East and other Tier 2/3 towns of India. Healthcare infrastructure shortage and the rising skill gap continue to drag down the healthcare indicators that one expects for a billion-strong country.

Consequential demand for healthcare

In India, non-communicable diseases (NCDs) are estimated to account for 40 per cent of all hospital stays and over 60 per cent of deaths. India experiences the highest loss in potentially productive years of life compared to all other countries in the world. One in four deaths in India is because of cardiovascular diseases (CVDs) with ischemic heart disease and stroke responsible for greater than 80 per cent of this burden. The projected incidence of patients with cancer in India is estimated to be one per 1,000 for the year 2020. The North East is documenting double the national cancer incidence rate, making it the national cancer capital of the country. Arthritis is another debilitating disease that affects over 18 crore Indians, and its prevalence is higher than many well-known diseases including diabetes and cancer.

Communicable diseases like TB and malaria are being overshadowed by fast-rising NCDs, but remain critical elements of healthcare policy, upskilling and infrastructure resourcing.

The other key factors that will fuel healthcare demand are: The Ayushman Bharat government scheme that aspires to insure more than 10 crore families, and rising healthcare expectations in Tier2/3/rural India, including acceleration in early-stage detection of lung cancers because of surrogate imaging-based screening for Covid-19.

In summary, India’s demand for basic and advanced quality-based healthcare will be insatiable over the next decade across all segments of society and population centres.

The insignificant supply

The shortage of skilled professionals is a major contributor to the ailing healthcare system in India. The country has a ratio of 0.7 doctors and 1.5 nurses per 1,000 people compared to the World Health Organisation (WHO) average of 2.5 doctors and nurses per 1,000 people. Due to the current pandemic, India is short of 10 lakh doctors and 20 lakh nurses to tackle the soaring healthcare burden and requires at least 1.5 lakh nurses and 50,000 doctors skilled in ICU care over the next one year. Covid-19 has also shown us that the healthcare capacity deployed towards the management of pandemics in urban and rural centres competes directly with the essential diagnostic, medical, interventional, and surgical care for other diseases such as cancer and cardiovascular conditions.

Increasing the number of admissions to medical and allied health colleges in record time is not going to be enough as we need a specialised and highly trained workforce. For instance, in bariatric surgery, low-skill surgeons may have three times the complication rates and five times the mortality rates compared to high-skill surgeons. As healthcare diagnosis and delivery of advanced conditions shift towards Tier2/3 India, the need for upskilling becomes paramount.

In summary, the traditional means of training will fall critically short of achieving scale and quality, unless the entire healthcare ecosystem is activated with disruptive ed-tech thinking and standardised tools for training and assessment.

Closing the skill gap

Covid-19 has kicked the healthcare machinery into high gear by revealing that healthcare is a national security issue. The government and private sector are committed to doubling the healthcare expenditure by 2025 to bridge the gap with Organisation for Economic Co-operation and Development (OECD) benchmarks in excess of 8 per cent of the national gross domestic product (GDP).

In this shared responsibility of upskilling healthcare professionals, National Medical Commission is elevating standards of medical education and research that States need to adopt, complement, and enforce.

This should include mandatory quality standards for skill labs across India’s 541 medical colleges. Healthcare Sector Skill Council, under the ambit of the Ministry of Skill Development and Entrepreneurship (MSDE), is developing and implementing capabilities for quality vocational education. Platforms like Integrated Government Online Training (IGOT) are also increasing the focus on healthcare skills. Large private hospitals are building on-the-job competencies and capabilities to meet growing demand.

In this public-private partnership (PPP) and ecosystem approach to upskilling healthcare professionals, India’s med-tech sector comprising large multinational and domestic companies have a key role to play to close the demand-supply gap by. This includes:

1. Increasing the annual corporate social responsibility (CSR) contribution towards upskilling programs in Tier2/3/rural India to ₹80 crore, or at least a third of the annually mandated CSR contribution,

2. Supporting medical/surgical fellowships for post-graduate students rotating into smaller towns for exposure,

3. Integrating digital technologies to accelerate skill development through simulation-based training with virtual reality (VR), artificial intelligence (AI), and machine learning (ML),

4. Scaling simulation-based education and cadaveric dissections that focus on the detailed practice of surgical procedures prior to live patient operations,

5. Building quality-based competencies in the manufacturing ecosystem with interdependence between local suppliers, MNCs, and domestic manufacturers,

6. Investing in IT infrastructure, logistics and upskilling distribution partners for the last mile delivery of med-tech products into Tier 2/3/rural India,

7. Partnering with regulatory agencies for globally harmonised quality standards, including post-market surveillance and materiovigilance,

8. Educating government regulatory experts in new digital technologies, including surgical and interventional robotics and associated data privacy requirements, and

9. Committing to rational pricing for products and services to balance access to life-changing innovative technologies.

There is a sense of urgency to recruit and upskill India’s healthcare workforce, and it will take a PPP ecosystem with Central and state government institutions, hospitals, med-tech, ed-tech, non-government organisations and corporate India to collectively address the demand and supply inequality and social injustice. Steps that would provide many such Neelakantas the quality of healthcare that they deserve.

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