The Science of Healthcare Delivery can spiral the ecosystem to elevate the health index of citizens, ensuring lower spend on curative. This science has the ability to transcend the challenges through the supplication of basic needs through the layers of the pyramid of the existing systems, also sideways to help better the generic civic amenities available to the community leading to healthy living.
A good start is half-done, but half-done has still a long way to go. And that is the state of our healthcare services today in India, as also in our neighbouring countries from whatever little I know about it through friends working there and other interactions, the condition is the same in well developed countries like the U.S. In some places there is too much healthcare but then there are places that are ignored. As a healthcare worker, I am the competitive image of my institution in the bigger cities, driven by numbers, driving the numbers, every now and then checking what brings more patients to us. If I were to set up business, I would choose the convenience of a bigger city. Most of us have faced the challenges of scarcity of resources in the tier 2 and tier 3 townships and would like to stay away.
On the other hand, as an urban citizen, I am spoilt for choices going over opinions and rankings, and when I am travelling to the rural towns and villages, I am left wondering what if I need medical services and how do these people survive without a doctor close by? And then there are common challenges across the globe that one hears of: availability, and quality. Can we deploy the science of healthcare delivery to transcend these challenges and to create a homogeneity in availability and quality of healthcare services?
As a citizen and a healthcare worker, I am focused on the basic civic amenities for upping the public health metrics. Here is where the science of healthcare delivery can be applied and expanded. While hospitals and clinics support the curative side of health problems, this science can also be applied to the more preventive side. Ensuring clean and sanitised living places reduces the health burden faced by the delivery mechanism. Here are some examples: can I drink water from outlets without worrying about its cleanliness? Can I walk around without worrying about the mosquitoes? The list could be endless! So, let’s look at the delivery side of healthcare.
I wonder how seriously this science is taken in our medical ecosystem today. Is there a method to the madness we can follow? We need to answer questions such as how regulations ensure quality, how the spread of services are monitored and initiated, how we can ensure there is enough skilled manpower and other resources, how the overall ecosystem is tying into the needs of the population, how far do I need to travel for secondary, tertiary and quaternary care facilities, are medicines available for me?
The science of healthcare delivery at the macro level can create the medical ecology required to service the community, support the environment with policy, and regulations. A the micro level it can help institutions in overcoming various challenges by pulling together required resources, focusing on optimal utility in innovative technology, and methodology.
The macro level focus required to bring newer techniques and better penetration of facilities to the inner etches of the rural areas. And this in turn can fuel the micro level growth, by enabling a healthy incubation of individual institutions offering quality care and self-sustaining public health institutions. Self-sustenance is critical to fuel investment for basic provision as well as betterment of the overall quality curative and preventive vehicles of healthcare delivery.
Altogether, Public-Private Partnerships (PPPs) starting at the individual grass root entities and going global can add to the general pool of ideas and practices. In other countries, different health systems have learned concepts that can be cross-pollinated. While the west continues to learn from its own experiences, the developing world stands to gain by evolving good practices that it can connect and contribute for global gains. Especially given that key challenges across the world remain same: increasing chronic lifestylebased diseases like diabetes and cardiac ailments, related kidney diseases, mental health, drug abuse and women and child health, to name a few.
Having operationalised few of these concepts myself, I am examine some factors that I think are critical to the adoption of this science as we create the local ecosystem below.
1. The first is to enable scientific growth of the individual institutions within the local ecosystems with a focus on how these are built and managed to deliver quality care. The policy and regulations are critical to driving and monitoring progress. There is a need for continual evolution of this framework to drive innovation in technique and methodology. The cost vs value will also help in moving in the right direction, which is important for both free medical care provided by governmental institutions as well as private institutions as they drive a large spend from consumers’ pockets.
2. Digital enablement, the second factor, can immensely fuel the science of healthcare delivery in a direction of value and scale from a micro level to the macro. This holds the key to overcoming various challenges, be these geographical outreach where some basic provision of services can be enabled making use of the internet, or enabling an analytical course where the individual experiences can be strung together to create clinical value for better treatment pathways, ease of access and delivery through digitised platforms for availability of goods and services etc.
3. The third would be to look to develop the skills required to run the various delivery organisations. India is perhaps the largest exporter of skilled manpower, especially in the medical arena. The sad truth here is we do not have enough of it for ourselves. There are numerous medical colleges and nursing colleges and other technical training institutes. Can we create more robust training programmes that make the manpower skilling more useful as they step into the real world? The Indian government has done a beautiful job at creating and initiating the Asha healthcare workers across rural India. But more is required. Can we make it mandatory for all medical and nursing educational institutions to have the passouts work in rural government healthcare centres for 2 years, much like the Singaporean mandate for their youth serving the army.
4. The fourth aspect of this science would be to look at the support system of the healthcare delivery ecosystem of how we ensure the supplies such as equipment at a good value, drugs and consumables which are good quality and at an affordable cost, real estate etc. In short, to say the overall infra is built to help the caregivers thrive. The cost of real estate and critical instruments often drive many care delivery concepts. The better we get at managing these and co-creating healthy partnerships, the better the care. For example, there are many primary care concepts that have failed or seen hampered growth owing to high cost of real estate in many parts of our country.
5. The fifth aspect would be to enable continuous improvement in care delivery. With the ball rolling on the basic delivery aspects, how do we enable research and hunt for better clinical care through the advent of new medications, new techniques etc.
All of the above are from the perspective of the environment to support incubation and sustenance of institutions. At the level of the institution itself, how these varying facets are brought together would defines how well it thrives. Being a manpower- as well as resource-intensive mechanism, it is critical to deploy costefficient techniques of delivery without compromising on the quality. Digital innovations today are changing the face of the healthcare delivery. Improved and upgraded equipment calls for more efficient treatment possibilities so also for pharmaceuticals.
In short, we cannot undermine that the macro initiatives ultimately help drive the micro level developments. Thus we need to stress on furthering the science of healthcare delivery.
While the government bodies are expected to drive this, nongovernmental institutions can well be the co-drivers in helping shape this through lobbying. In India we do have many such institutions such as FICCI, Niti Aayog, CII etc. There are numerous successful models of PPPs fostered by the Indian state governments. The Gujarat government set up PPPs with the pharmaceutical players creating a bionetwork for care and research institutions almost 30 years ago; in the recent past the Orissa government has instituted PPPs in 20 districts for provision of care. And there are many more examples. And of course there is WHO and other such institutions driving the global to local concepts.
The cumulative health direction of the communities—national and international—can well be defined by how the delivery and support institutions come together. After all, while they have been at it for years, there are still miles to go before we sleep.
