6 Best Things Government Did for Healthcare in 2020

By Arunima Rajan

Healthcare Executive asks experts about six key policies or initiatives that supported the system to handle the turmoil.

Months-long lockdown. Shortage of PPE and protective equipment. Loss of lives of healthcare workers. Healthcare industry could be pardoned for believing they had witnessed it all in 2020. But there were few policies which helped India's health system to survive.

Hospital admissions for COVID are falling across India, raising optimism that the country has come through the most critical phase of the current wave. What are the policies that have helped the healthcare sector to overcome the hurdles of 2020?

Dr Harish Pillai, CEO, Aster India, Aster DM Healthcare suggests that National Digital Health Mission ( NDHM ), is one of the critical policies of 2020, that will set the entire digital ecosystem and future proof the sector.

I. National Digital Health Mission

"In itself, the NDHM stems from the National Health Policy 2017 that has set upon itself a transformative road map in both services delivery and provide equity in accessibility," he adds.

The National Health Agency-NHA has been made responsible for both the flagship Ayushman Bharat, the world's largest Universal Health Insurance scheme and NDHM. The key pillars for the roll-out of NDHM are Health ID, Digi Doctor, Health Facility Register, Personal Health Records and Electronic Medical Records.

Pillai also adds that the scheme offers many opportunities and benefits.

"Firstly, NDHM will create a holistic healthcare ecosystem that can increase equitable access, improve outcomes and reduce costs. Secondly, it will enable policymakers to use the experience of Ayushman Bharat digital architecture to develop an interoperable system, that will empower and connect all stakeholders. Thirdly, it will lead to compliance with data privacy and security norms. Patients will securely store and access records such as drug prescriptions, diagnostic reports, and discharge summaries and share them after due consent with healthcare providers to ensure appropriate treatment and follow up. Fourthly, there will be options for remote access for healthcare services through telemedicine, e -pharmacy or home care services. Fifthly, it will increase the use of evidence-based pathways and algorithms and ensure transparency in pricing models. Sixthly, it can help digitalise all claims processing and enable faster reimbursement. Policymakers will have access to accurate data that will aid in focussed interventions. Seventhly, it will generate spatial patterns for morbidities and help develop preventive health programmes," he adds.

Pillai believes that the NDHM can surmount existing human resource supply chain and infrastructure challenges and bring about transformative changes with the aim of quality and affordable healthcare for all.

II. Telemedicine Practice Guidelines 2020: Strengthened health services delivery during COVID-19 Pandemic

Dr Oommen John is a clinician-researcher and Digital Health expert at George Institute for Global Health India. He has also contributed to the WHO guideline recommendations on digital interventions for health system strengthening.

"Telemedicine has been pilot tested in India for two decades," he says. "In 2001, the Department of Space (DoS) through the Indian Space Research Organization (ISRO), initiated a nationwide telemedicine program. COVID-19 pandemic triggered a new era of healthcare delivery through telemedicine in 2020. Early into the pandemic, Government of India introduced 'Telemedicine Practice Guidelines 2020' as an amendment to the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002 to permit Registered Medical Practitioners in providing virtual healthcare.

These guidelines outlined the principles for telemedicine covering "consent", outlining that both the provider and patient need to identify and verify each other before the consultation. It also mandates the practitioners to maintain the patient's health records, categorising the medicines prescribed based on the type and mode of teleconsultation. Moreover, mandated the completion of an online course for all the registered medical practitioners."

MoHFW launched its flagship eSanjeevani OPD telemedicine service during the pandemic. John adds that the scheme provides a robust, comprehensive telemedicine platform that witnessed over 1 million consultations during 2020 and served patients across 550 districts in India. "Moreover, eSanjeevani Ayushman Bharat-Health and Wellness Centre module enables doctor-to-doctor teleconsultations. It is being used at 6000 Health and Wellness Centres which are being served by specialists and doctors across 240 hubs that have been set up by States in District Hospitals or Medical Colleges. It is envisaged that these policy interventions coupled with the government led telemedicine "platform as a service" offering under the National Digital Health Mission will help India's march towards Universal Health Coverage through the digitally enabled strengthening of primary health services delivery," he says.

III. The National Education Policy

Karthik Subbaraman is a Program Director at Center for Public Health and Development, Kenya. He points out that the National Education Policy appears like a ray of much-needed sunshine during the pandemic.

While COVID-19 did not discriminate between different demographics, certain population groups disproportionately felt its effects, especially children. "There is a need to develop more inclusive models of healthcare that includes non-traditional actors/stakeholders. An initiative that seemed to move in the direction is the National Education Policy (2020). NEP seemed to move toward shifting the responsibility of health to non-health actors," he says.

Implications on Health

NEP mainstreams mental health and wellbeing in early childhood and education through cross-agency collaboration. "In June 2020, The National Education Policy (2020) had recommended a radical transformation of the education system through a pedagogical and curricular restructuring through play-based, activity-based, and inquiry-based learning to promote learning, development, and wellbeing. Critical to the transformation is the formal integration of Early Childhood Care and Education (ECCE) into mainstream education. Within the revised NEP, the overall aim of ECCE will be to attain optimal outcomes in the domains of physical and motor development, cognitive development, socio-emotional-ethical development, cultural/artistic development, and the development of communication and early language, literacy, and numeracy. The goals are expected to be achieved through the development of a revised curriculum and pedagogical approach led by the National Curricular and Pedagogical Framework for Early Childhood Care and Education (NCPFECCE), incorporating regional and international best-practices and integrating creative and performing arts that can serve as a framework for parents and other stakeholders (AWWs)," he adds. Treatment delays can be deadly during a pandemic.

Rajinish Menon, CEO of Sukino Healthcare Pvt Ltd, points out that Ayushman Bharat scheme was a relief during this national emergency.

IV. Ayushman Bharat Scheme: Targeting Relief to the Neediest

"The number of free COVID-19 cases treated under Ayushman Bharat scheme in 2020 was remarkable, given India's challenging economic times. By converging multiple fragmented health schemes into the world's most gigantic medical insurance umbrella, India's Government has indeed taken a giant step towards healthcare innovation. The scheme aimed to benefit around 40% of our country's low socio-economic population with quality and affordable medical care. Despite individual states being slow on adopting it, the beneficiaries have already crossed the one crore mark," explains Menon.

He adds that this overall acceptance is highly commendable for an ecosystem where health education and awareness are still struggling to see the light of the day in the rural districts.

India faces three challenges: coronavirus pandemic, economic losses and public health infrastructure.

"The administration's plan to include post-hospitalisation care in medical treatment has introduced continued uninterrupted healthcare services for more families. We are happy to see, the continuum of care, reinforced by the government. This has enabled faster recoveries and reduced the number of fatalities being borne out of an inaccessible, unaffordable, and inconsistent healthcare system. With gravitation towards digitalisation, more fund allocations, and a focus on getting more medical professionals and colleges on board, this flagship scheme has created a significant turnaround in 2020. It is set to create a benchmark in redefining India's entire healthcare landscape in the coming years," he adds.

V. Strengthening Manufacturing of Medicines, Vaccines and Biomedical Equipment

As India anticipates for immunity to wax and infection rates to decline further, experts like Feroz Ikbal, Assistant Professor, School of Health Systems at TISS hope that the pandemic highlights the need for a robust system to handle emergencies.

"2020 was a landmark year for governments across the world. One of the best things the government did was its realisation that there is a need for a robust government system to handle healthcare emergencies. Another initiative by the government is to strengthen the manufacturing of medicines, vaccines, and biomedical equipment. India is the world's pharmacy, but government initiatives may help strengthen its biomedical equipment sector position.

The focus on human resources for health also needs to be mentioned. After a long time, the total number of seats in government medical colleges exceeded private colleges' seats. In future also India will be the supplier of medical professionals in the world," he adds.

VI. COVID-19 Management

For many, the upside of some of the government's measures, practically speaking has been intangible. But experts like Soumyadeep Bhaumik, a public health specialist, believe that it would be amiss if we do not talk about the good things which the central and the different state governments did to control COVID. "The success of the strategy drawn up by Indian scientists was not evident immediately, but in 2021 we are slowly reaping the positives. We took a hit on the economy - prioritising lives over monies, got the pandemic in control, and focused now on livelihoods. It was not a comfortable journey, and there were hardships and lives lost but things improved - it could have quickly gone the USA or UK way(or many more times worse, as we are more densely populated)," he says.

Bhaumik, who works at The George Institute for Global Health, says that in a period of uncertainty and significant confusion on many aspects of COVID-19 transmission, announcing early lockdown was a bold decision. "It helped buy time to prepare the health system. More could have been done in the early lockdown phase, but I guess it needed time for everyone to comprehend the situation's enormity. Investment in massive testing capacity-considering our country's size-was mammoth, and the ICMR played a stellar role in the process. The standardisation of the diagnostic assays was crucial too," he adds.

What about ICMR? "ICMR's role was crucial in sero-surveillance, randomised clinical trials and supporting vaccine development," he adds.

The researcher also adds that the role of indigenous vendors and manufacturers cannot be overstressed.

"Many high-income countries had to be reliant on other countries to buy essential medicines, masks and sanitisers. The economy would have been much worse if Indian business did not stand up to this need. Use of masks was a good move, which helped India quite a bit. Many countries are still trying to grapple the issue," he concludes.