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Atmanirbhar healthcare – Is India ready?

With the ongoing conversations on the Public Procurement Order (2.0) amid the corona virus pandemic, several questions have been raised regarding the need of an enabling policy environment which encourages more investment in India and improves India’s rank in the ‘ease of doing business’ index. The proposed changes in PPO 2.0 reflect the need for India to become ‘Aatmanirbhar’ as companies with less than 20 per cent of local content in their goods or services would not able to participate in the government tenders. This raises several questions on the accessibility of these high-end medical devices which play a key factor in improving patient outcomes. 

Discussing the role of the new generation lifesaving medical devices, Dr. Gajendra Singh, Public Health Expert, stated, “The government’s plan to modify the public procurement norms to give maximum preference to companies whose goods and services have 50 per cent or more local content to promote ‘self-reliant India’, has highlighted how patients would end up bearing the brunt since they would not be able to access the high risk medical devices in government hospitals. This showcases the need to meet accessibility challenges which are prevalent in the Indian healthcare system. India’s import dependency on other countries for medical devices explains how there is a dire need to fill the infrastructural gaps and build capacity in ensuring quality healthcare for all. We need to think long term and have a vision in place.”

It becomes important to not disrupt the healthcare supply chain while battling Covid-19 pandemic, understanding the role and importance of globalisation w.r.t. India’s import dependency for innovation, life-saving and technological advances in healthcare.  The PPO 2.0 needs to be rationalized as per the public demand, by making high-risk medical devices accessible to patients. A clause about the ‘local content’ might make the innovative high-end medical technology inaccessible in government hospitals. Considering the status quo with the Covid-10 pandemic adding more burden on the healthcare infrastructure, such archaic restrictions on global medical equipment will only worsen the situation.

Deliberating on the ease of doing business and the overall impact on economy, Dr. Amir Ullah Khan, Health Economist, stated, “When we already know that India lacks the capacity and infrastructure to manufacture high-risk critical care equipment, which are the first line of support for critical ill patients, opting for such an inward looking policy would only lead to the lack of access to new generation lifesaving medical devices, also impacting our economy. What about the ease of doing business index? India needs a stable regulatory regime and open market access to foreign investment in healthcare so that its dream of reaching top 10 nations w.r.t. ‘Ease of Doing Business’ can be achieved. The floating PPO 2.0 seems to promote the self-reliant’ India narrative by restricting global players. Monopolistic and duopolistic price escalation is another aspect which should be considered in detail.”

Promoting and encouraging domestic production can undoubtedly make India ‘Atmanirbhar’, but it should not come at the cost of patient safety. Rakshit Tewari, Ex-industry expert and Public Health Consultant, stated, MedTech sector is still heavily import-dependent. PPO does offer a window for exemption, but the value of purchase to invoke the exemption clause is too little and the approval process surely very lengthy- extending right up to the Minister-in charge.  To achieve the goal of quality UHC, the provisions in the Public Procurement Order should reflect advancement and encourage progress. Time to revisit the Order and make it more meaningful to echo new-India’s ambitions.

Expressing his concerns on the impact of PPO 2.0 on patients, Dr. Sanjiv Kumar, Chairperson, Indian Academy of Public Health, Indian Alliance of Patients Groups, stated,  “India needs to strengthen its health infrastructure and tread on the path of medical technology innovations and scale up to save and improve patients’ lives rather than retreating back due to COVID19 setback. Our policymakers need to revisit PPO 2.0 from a patient’s perspective. There is a need to improve limited patient access to appropriate medical treatment by using available technology within India and in other countries. The government must increase public expenditure on healthcare and exploit technology.”  

At a time when we are fighting a global healthcare crisis, there is a need to ensure quality care and robust policies for India to improve its health infrastructure. We need to consistently work on the accessibility and quality of innovative high-end medical technology in order to fill the lacunas in the overall healthcare landscape.

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