Takes two to cure

Dr Swati Piramal

India’s health problems are immense. We rank poorly on indices such as maternal health, infant mortality, and general nutrition. One reason for this sickly state of affairs is that the importance of health, and how it affects our economy, is poorly understood.

A partnership between public health institutions and other government bodies, on the one hand, and private industry and organisations, on the other, can change the face of the nation by harnessing science and technology in pursuit of a healthier India. A partnership of this kind can tackle a host of issues that bedevil our health structure: water and sanitation; immunisation; the supply chain of medicines; healthcare delivery systems; and people inefficiency.

Here are two examples of how such an arrangement can work. First, private companies could operate the laboratories of government hospitals and give accurate reports efficiently. Patients visiting these hospitals currently have to take samples to private institutions and end up paying more.

A similar situation exists in the matter of access to and availability of medicines. Here, patients have to go out and buy medicines because the hospital does not have an efficient supply chain. Our health setup can, and should, leverage the economy of scale available to it, pass on the benefit to those who need it most, and make a small profit too.

There are global models that India can use as a benchmark to fashion an alliance between private industry and government to advance our health capacities and capabilities. The GAVI Alliance — a partnership involving governments, private institutions, global health organisations and NGOs, which runs immunisation programmes in some of the world’s poorest countries — and  the Bill and Melinda Gates Foundation, great examples both, are driving innovation, efficiency and funding in the fight against seemingly intractable diseases.

The nature of the challenges India faces on the healthcare front, especially in rural areas and with its primary health centres, is enormous. Expenses incurred are higher in rural India simply because people have to travel long distances to get medical care. Medicines give the biggest bang for the buck — in the government’s scheme of allocations — yet they form only 10 per cent of the healthcare rupee.

Indian pharmaceutical companies have given the country medicines of international quality at some of the lowest prices in the world. Yet our drug policies continue to be tacked to old and obsolete thinking with regards to rural healthcare. Here’s an instance: about 20 million Indian women, the majority of them in rural areas, suffer from anaemia caused by iron deficiency, with calamitous effects on infant and maternal mortality. The cost of an iron tablet is about a rupee, and that is under government price control, which gives the manufacturer a little over production cost; there is no money left to drive awareness or supply to rural areas.

The idea that controlling essential costs drives access misses the point of the failure of delivery. And, going by the government’s new drug policy, this line of thinking continues to flourish. Announced in 2006, this ill-conceived policy seeks to increase the scope of government price control, with potentially serious adverse impact on public health.

The writer is a director with Nicholas Piramal and serves on the Prime Minister’s scientific advisory council.