A pertinent problem currently faced by Indian healthcare industry pertains to the access of diagnostic healthcare in rural India. There is an utter lack of good and well functioning licensed laboratory services in rural India. Laboratory services that are present in the rural India are marred with shortages of pathologists, technicians, biochemists, and other staff members. In terms of the availability, the WHO prescribes a 1:1000 doctor-patient ratio, while in India the ratio is about 1:2000. Rural India has one-fourth the doctors and diagnostic facilities as compared to urban areas, which is a huge issue with the chronically ill, who require complex and expensive long-term monitoring and treatment strategies.
Diagnostic testing is one of the most important segments of the medical field. Diagnostic laboratory testing results are applied for almost 60-70 per cent of medical treatments in India. India is home to about 600,000 villages with 70 per cent of India’s population living in rural areas, yet out of the approx 100,000 diagnostic laboratories in the country, majority of them cater to metros and tier 1 cities. As per a survey, there are only around eight diagnostic labs per 100,000 people in India and diagnostic facilities have a very low reach in small towns and villages.
Challenges for diagnostics in rural India Attracting and retaining trained medical professionals in diagnostic facilities is a major challenge for rural public health facilities. Apart from scarcity of qualified health staff, laboratory set-ups of the health centre are not well equipped to support the accurate investigations for diagnosis of diseases. Rural people have to go to urban cities to access diagnostic services, where better diagnostic facilities are available. To prevent the spread of diseases and reduce the mortality rates, the focus should be on the infiltration of healthcare and diagnostic services in rural India.
India’s rural masses deserve access to better health care facilities. However, the current supply of conventionally delivered diagnostic services does not give any hope to keep up with the ever-increasing demand. Ensuring that all citizens have access to quality diagnostics must be a fundamental responsibility and an essential economic function for any government. Diagnostic facilities must be accessible, affordable and responsive, both to the constantly changing medical and clinical needs of patients as well as to the broader demographic, social and cultural dynamics in the modern world.
Providing new means of affordable access to diagnostics, however, is no small task. There are certain factors that need to be addressed.
Affordability: Firstly, services of specialists must not only be accessible, but also affordable to both urban and rural India. Indians have a high willingness to pay for quality health care diagnostics that are reasonably affordable. There is growing health care consumer awareness in India, so demand will continue to grow if care is affordable and accessible.
Certified diagnostics: Secondly, services must be from a trustworthy source. Because of the centuries old dependency on quacks and healers, Indians choose not to trust institutional care and scientific diagnostic services. To gain their trust it is of paramount importance that certified well-regulated and audited lab services should be promoted in these areas.
Convenience: Convenience is a major factor for consumers. Lack of services in rural areas increases dependency and high volume in laboratories of nearby cities, as most of the population choosing diagnostics are directed there. The challenges faced by a common man to reach and get himself tested form a major reason for not choosing to go for tests, thereby making his condition worse.
Allocations for regulation: Mindful of the fact that diagnostics is the first step towards effective treatment, it is important that all our national health programs recognize the importance of quality diagnostics. In order to ensure that quality diagnostics reach people through program verticals, budgetary allocations to diagnostics is much needed. Currently, the diagnostics industry comprises largely of unregulated players. Accreditation is not mandatory and hence the onus of accuracy, quality or reliability of a test reports lies with a lab. Making allocations for such regulation in the budget can empower national bodies like NABL to play a bigger role in regulating the most basic function of healthcare.
Tax relaxations and subsidies: The support from government in the form of tax relaxations and subsidies is quite limited. There are tax exemptions for preventive diagnostic tests below Rs 5000, which do have a positive impact on the demand side of the diagnostic market; however, many more such interventions are required on the supply side, so as to reduce the costs of delivering diagnostic tests. Currently, the taxation levied on necessary chemicals and technology increase the test costs, thereby making it inaccessible to most people. If the costs for life-saving diagnostic tests have to be brought down and its benefits are to trickle down to the common man, reduction on taxation of lab chemicals would have a much more visible effect.
Public-private partnerships: Government collaboration with private players to bring quality diagnostics to towns and rural areas can be beneficial. Sufficient incentives and subsidies should be given to be able to sustain a presence in these areas, while offering the best of services. Today 90 per cent of research and development in diagnostics are done in western markets, which need to be bought and adapted for the Indian consumer. The need of the hour is to create local solutions for problems faced by consumers in India. Public-private collaborations that can boost such healthcare innovations can truly shape the future of the Indian diagnostics system.
It is only through an engaging initiative, spearheaded by the government, but at the same time, bringing a wide array of stakeholders including healthcare providers, public and private diagnostic, local administration, and people together that a robust diagnostic system can be implemented across India, acting as a spine of healthcare initiatives.
(The author is Managing Director, iGenetic Diagnostics)
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