Glimpses 2019: Violence against doctors, Ayushman Bharat dominated discourse in healthcare

One of the most notoriously memorable television images of 2019 involved a prominent TV anchor thrusting her mike on the face of an on-duty doctor and demanding from him answers about the poor state of healthcare in Bihar! The Muzaffarpur Encephalitis tragedy claimed the lives of over 100 children, but the behaviour of the news anchor was symptomatic of the country at large where doctors often find themselves at the receiving end of public anger.

Truth be told, it is the poor state of public healthcare, and not doctors, that are to be blamed for lack of accessibility of healthcare. Violence against doctors was a burning issue in 2019. Some of the instances of attacks involved goons tying a doctor to a tree and abusing his wife and daughter in Sondhia village of Bihar’s Gaya district, owners of a Labrador assaulting a veterinary doctor in Peroorkada, Thiruvananthapuram, and relatives of a patient assaulting a paediatrician in Himayathnagar, Telangana. In Assam, tea estate workers assaulted a 73-year-old medical officer so brutally that he succumbed to his injuries. In many parts of the country, doctors joined a strike against rising instances of violence, reigniting debate over safety laws and safe working environment for them.

In the year gone by, India also celebrated one year of the completion of the ambitious Ayushman Bharat scheme aimed at providing health cover to as many as 50 crore people. Prime Minister Narendra Modi also announced a ‘Fit India’ campaign to spur Indians towards fitness and health.

Here's a look at the healthcare industry in 2019 and the way forward:

One year of Ayushman Bharat: Achievements and loopholes

As Prime Minister Narendra Modi’s flagship Ayushman Bharat Yojana or National Health Protection Scheme completed a year, the role of private hospitals in making it a success continued to remain a point of contention. The continuing friction between the government and private hospitals over treatment packages and rates has been hampering the promising scheme which helped as many as 46.4 lakh people receive treatment through hospitalisation in its first year. The government announced revisions to a number of packages, increasing rates of 270 of them. However, the Indian Medical Association expressed dissatisfaction at the revised rates, saying participation in the scheme was still not viable for private hospitals.

Ayushman Bharat is a potentially game-changing scheme for Indian healthcare but the government and private hospitals have to reach a common ground if it is to turn really successful. We expect the government to arrive at a genuine understanding with private hospitals over the treatment packages so that private participation under the scheme is increased. Apart from ironing out differences with the private sector, the government must also boost efforts in the coming year to improve awareness about the scheme on the ground while also ensuring that frauds under the scheme are kept under check.

Niti Aayog adviser Alok Kumar also likened India’s healthcare system to a “sinking ship” and said it desperately needs more private participation in smaller towns to run the Ayushman Bharat programme efficiently. This is why, the need to incentivise private sector to open more hospitals in tier II and tier III cities cannot be underlined enough. This can be done by offering tax breaks and helping private sector in procuring land. Empanelment of small hospitals and nursing homes in PMJAY must also be accorded due priority because a majority of Indians still seek treatment at such centres, particularly in smaller towns.

In the coming year, we expect more private hospitals look out of their comfort zones in top-tier cities to enter tier II and III cities across India to make quality healthcare more accessible and equitably distributed.

Violence against doctors in 2019

As mentioned in the opening, rising instances of violence against doctors hogged the limelight in 2019, resulting in a nationwide strike by healthcare practitioners. According to a study conducted by the Indian Medical Association a few years back, a whopping 75 per cent of surveyed doctors had suffered some form of physical violence while on official duty. While the issue of violence on doctors is not new, the incidents of the year helped create a situation of urgency and need for action. A bill was drafted by the health ministry to check violence against doctors and healthcare professionals. However, the Home Ministry shoved it under the carpet, stating that there was no need for a separate law. In the past decade there have been several attempts to legislate a law on this issue but they have not succeeded.

In the coming year, both hospitals and city administrations must initiate strong strategic measures to curb acts of violence. Some of the solutions include adequate checking of visitors upon entry and their mandatory registration, restricting the number of attendants for every patient, strong action against people who assault doctors, putting an evacuation plan in case of major violence as well as setting up grief counselling stations that help bereaved families cope up with the loss.

Fit India movement

Non-communicable diseases such as cardiovascular diseases, cancers, chronic respiratory diseases, diabetes, and hypertension are estimated to account for 60 per cent of all deaths in India today. This puts the spotlight on the need for motivating Indians towards healthier lifestyles, including adequate physical activity. Physical inactivity is estimated to be the main cause for approximately 21–25 per cent of breast and colon cancers, 27 per cent of diabetes and approximately 30 per cent of ischemic heart disease burden. With lack of physical activity emerging as a major concern in India, the prime minister’s initiative to launch the nationwide ‘Fit India’ movement was a welcome step. The initiative is aimed at motivating people to make fitness a part of their daily lives through sports and physical activities. A special committee was also formed to further the agenda of the campaign. However, for the movement to translate on the ground, it needs to be much more than a slogan. Schools, colleges and universities must be actively involved in the campaign to make a sport or physical activity mandatory for all students. Similarly, workplaces must also be spurred to induce employees to indulge in physical activity, sport, gym or yoga on the office floor every day.

Medical devices regulation

Another noticeable development of the year was the government’s initiative to strengthen and streamline the regulation of medical devices. The Union Health Ministry released fresh draft notifications to regulate all medical devices in India under the Medical Device Rules, 2017. The new regulations promise to streamline the highly unregulated medical devices sector in the country. The move is also expected to significantly increase the level of compliance required by manufacturers or importers of medical devices. This will help in boosting quality control and will also serve as a motivation to Indians manufacturers to improve their quality controls to international standards.

Encephalitis tragedy of Bihar

In June 2019 an outbreak of encephalitis occurred in Muzaffarpur and the adjoining districts of Bihar which resulted in the death of more than 100 children. This tragedy once again highlighted the poor state of health, malnutrition and healthcare in India, particularly in poor states such as Bihar. Unfortunately, encephalitis outbreaks have been recurrent in this region of Bihar, with different causes have been attributed to it. Some experts have linked Acute Encephalitis Syndrome to consumption of unripe lychee that causes hypoglycemia in malnourished children who couldn’t have an otherwise full meal in the day. The high temperature in the state along with humidity, malnutrition and is believed to aggravate such instances. On top of it, poor accessibility of healthcare facilities compounds the problem. The tragedy reminds us that improving nutrition and health standards are closely intertwined with our healthcare goals.

Healthcare sector expectations from the year 2020

Ayushman Bharat and the role of private hospitals in making it a success continued to remain a point of contention in 2019 even as the government’s flagship healthcare scheme completed one year. The continuing friction between the government and private hospitals over treatment packages and rates has been hampering the promising scheme. While Niti Aayog clearly stated that more private participation is desperately needed in smaller towns to run the PMJAY programme efficiently, the Indian Medical Association expressed dissatisfaction at the revised rates of packages, saying participation in the scheme was still not viable for private hospitals. Ayushman Bharat is a potentially game-changing scheme for Indian healthcare but the government and private hospitals have to reach a common ground if it is to turn really successful. We expect the government to arrive at a genuine understanding with private hospitals over the treatment packages so that private participation under the scheme is increased. Apart from ironing out differences with the private sector, the government must also boost efforts in the coming year to improve awareness about the scheme on the ground while also ensuring that frauds under the scheme are kept under check.

Another noticeable development of the year was the government’s initiative to strengthen and streamline the regulation of medical devices. The Union Health Ministry released fresh draft notifications to regulate all medical devices in India under the Medical Device Rules, 2017. The new regulations promise to streamline the highly unregulated medical devices sector in the country. The move is also expected to significantly increase the level of compliance required by manufacturers or importers of medical devices. This will help in boosting quality control and will also serve as a motivation to Indians manufacturers to improve their quality controls to international standards.

In the coming year, we are expected to see more healthcare companies turn to expansion in tier-II cities as competition and market saturation impedes growth prospects in top-tier cities. In 2020 and over the next few years, tier-II cities such as Patna, Lucknow, Dehradun, Bhubaneshwar, Jaipur, and Jodhpur are set to emerge as hotspots of healthcare business expansion. These smaller cities are also likely to become the breeding ground of new startups in the health tech domain. The year-end analysis will be incomplete without talking about the impact of economic slowdown. With the slowdown impacting incomes particularly in rural areas, the government must take measures to boost its healthcare spending to be able to assure basic healthcare to the deprived sections of the population.

Nagar is MD, Paras Healthcare

The opinions expressed in this article are those of the author's and do not purport to reflect the opinions or views of THE WEEK.