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Public Procurement In Healthcare Experts find new policy worrisome

Health cess concept. Medical diagnostic and research in India, 3D rendering isolated on white background. Medical devices bill illustration. Image credit: alexlmx / 123rf. Press release re: public procurement order.
Image credit: alexlmx / 123rf

New Delhi, December 23, 2020: With the economy reeling under the coronavirus snare, PM Modi’s ‘Make in India’ vision is picking pace. In its recent initiatives, the Government of India released the revised Public Procurement Order (PPO) 2017 to encourage the self-reliance rhetoric, giving domestic players the impetus that promises to withhold the government’s Atmanirbhar dream. The revised version of PPO 2017 is all set to give preference to companies “with goods and services containing 50 per cent or more local content”. A clear bias or a step towards a self-reliant India? Experts share their perspective on the overall objective, keeping patient safety at the core of healthcare.

The one thing that PPO seems to have missed is the fact that most critically ill patients in India are referred to premier government medical institutes like AIIMS, PGIMER and R & R as the last resort for survival. Now, when the new Order will restrict the access of world-class devices to these hospitals, they will not be able to treat the patients with the latest life-saving technologies, implants and monitoring systems. They have to refer back the patients to private hospitals, leading to patients incurring the heavy cost of critical care.

Others assert that when we speak about medical devices, the first and foremost objective should be patient safety states Dr. Sanjiv Kumar, Public Health Expert, Chairperson, Indian Academy of Public Health, Indian Alliance of Patients Groups. He adds, “While the Procurement Order is a boost to local manufacturers, the big question we should be asking is if it will benefit the patients. India’s healthcare infrastructure gaps were glaring through the pandemic. We were struggling even with basics like ventilators and those manufactured locally failed quality tests. There is no denying that we are gearing up to be a country which is self-reliant, but we are still heavily import dependent. Before we build capacities in the healthcare sector, we should discourage policies that could potentially dent provision of essentials like high risk medical devices to government hospitals.”

Public Procurement refers to the purchase of goods and services by state-owned enterprises or the government. How it essentially works is that when the government releases a tender for any goods or services, both domestic players and international players are invited to participate and offer their products. Now, with the government tilting towards “local content” in medical supplies, experts are questioning if the rationale would still allow India to procure high-end medical devices for its government hospitals. 

Elaborating on the need of healthy competition that is quality driven, Dr. Pratheeba John, Health Economist, Population Foundation of India, said, “Monopolistic and duopolistic price escalation is another aspect which should be considered in detail. The monopoly and duopoly pricing can become inefficient and less innovative over a period because it does not have to compete with other producers/products. This is a possible case scenario w.r.t. the revised PPO order since with limited market competitors, it can be challenging for a monopoly or duopoly to self-regulate and remain competitive in the long run. 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.”

Deliberating on securing the health of about 1.4 billion citizens with medical devices, it is crucial to reflect on the Indian market share in the global medical devices market which stands at 1.6 per cent, whereas India imports close to 90 per cent of the medical devices. This is a clear indicator of how the domestic industry is at a nascent stage and any inward-looking policy might hamper the access to global innovations. This might also make it difficult to manage the domestic industry’s expansion without global collaboration, support and participation. 

While elaborating on the existing challenges, Dr. Sukriti Chauhan, Founder & CEO, ETI and a Public Health Advocate said, “The rationale behind any healthcare policy should be simple— will our hospitals, especially in the public sector benefit from it, where majority Indians seek care. The pandemic exposed some hard-hitting realities about India’s healthcare infrastructure which will be strengthened surely in the time to come. Research is a critical aspect to look at considering the new PPO. Research and comparative studies in the government teaching hospitals may be impacted due to the inability to purchase the latest equipment. Our doctors and students need cutting-edge technologies from across the globe to deliver better, learn better. There are challenges of access and availability of machines and the hope is to look at innovations that promise better patient outcomes. That should be the end goal.”

Voices from the industry stress on the fact that a move like this will limit patients’ access to innovations even more, from India and abroad. The worst hit will be the competitive edge that players could bring to the industry. Healthcare cannot be able making things easy but introducing innovations and promising patient safety.

Read more from the Health Issues India press office here.

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