Covid-19: private sector plays key role in battle – analysis
Countries across the development spectrum are dealing with an unprecedented situation in which an apparently innocuous viral disease, coronavirus disease (Covid-19), has become a global pandemic in less than 90 days. It has infected more than 1.7 million people in more than 200 countries, claimed more than 100,000 lives, and paralyzed most of the world.
In India, the authorities have responded decisively with a strong government-wide approach. However, given the magnitude of the challenge, we also need a response from the whole of society.
According to the World Health Organization, a critical lesson from the Ebola crisis in West Africa 2014-16 is that both the public and private sectors must work together to respond to epidemics on a large scale. In Covid-19’s response, the country’s private sector – for-profit and non-profit segments – has an even more important role to play, as it is the dominant provider of health services. Data from the 71st round from the National Office of Sample Surveys show that private hospitals, clinics, and nursing homes provide more than 70% of medical care. Data on the almost 10 million treatments received under Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) corroborate this finding.
Currently, most testing and treatment of Covid-19 is performed in public facilities. As the epidemic progresses, both services will need to expand multiple times, and the private sector will need to intervene as a major partner and actor.
First, creating a large and accessible testing infrastructure is a key weapon in fighting the virus. Countries such as South Korea, Singapore, Germany, and Japan have managed to control its spread and reduce mortality through early detection and rapid containment.
This has been possible only through widespread testing. India has opened the tests to private laboratories and the payment for the tests is also covered by ABPM-JAY. We need to substantially expand our testing capacity, something that is not possible without the active participation of the private sector.
Second, as the government deepens its containment efforts, the number of quarantine units, isolation rooms, and intensive care unit (ICU) beds in dedicated Covid-19 hospitals must increase rapidly. You will also need to ensure a greater and continuous supply of essential medical products, from test kits, masks, and other items of personal protective equipment (PPE) to oxygen and ventilators. According to a recent study by the Indian Council for Medical Research (ICMR), about 5% of those infected will require intensive care and half of those in the ICU will require mechanical ventilation. The study was based on the global epidemiological parameters available from the initial phase of the outbreak and the comparison with other countries with similar transmission dynamics. These projections translate into large numbers that greatly exceed the capacity of the government health system.
During the current crisis, the activities of the private health sector should be the central part of national health efforts. Private hospitals with adequate infrastructure should be converted to dedicated Covid-19 hospitals. This process, of course, will have to be led by the government through a clear policy framework for designated hospitals, reporting and referral systems, and an appropriate payment system. The experience of purchasing health care services through ABPM-JAY may be the template.
Some private hospitals can help manage the treatment of non-Covid-19 patients. Since many government facilities are becoming dedicated Covid-19 hospitals, a large number of non-Covid-19 patients will need facilities and providers to serve their healthcare needs.
ABPM-JAY has begun a process to incorporate more hospitals to respond to such needs. It is helping state governments to temporarily assemble additional health facilities to provide emergency care and treatment for other serious illnesses to all citizens, especially the poor and vulnerable.
Third, as more private providers join this fight, a major concern that will surely arise is to prevent healthcare workers from becoming infected. It is of utmost importance to ensure that doctors, nurses, paramedics, laboratory technicians, and other health care facility personnel are protected from infection. Companies manufacturing essential medical products such as ventilators, masks, face shields, clinical gloves, hand sanitizers, and sterilization equipment will need to increase their production lines. Direct bank support may be necessary for this.
Fourth, the private sector will need to vigorously support the large ecosystem that powers the health system, as the blockade and ongoing epidemic restrict movement and normal economic activities. The production of essential medicines and medical products, the logistics to maintain a fluid supply, the transport of health workers and the delivery of food and other essential items must continue and also accelerate. Support for community activities such as night shelters and community kitchens should be strengthened.
Finally, an adequate response in stages to the pandemic and its economic, social and political consequences will require filling many knowledge gaps. Government, private, and nonprofit research institutions must collaborate to understand the nature of virus transmission, the factors that help slow its spread, the most exposed communities, or the optimal period of quarantine.
The fight against Covid-19 involves the ongoing management of an evolving public health crisis that threatens to create economic and social disruption. This is an appeal to all private and charitable health institutions to join this effort for our people and humanity. It is time to embrace reality and play our individual and collective roles in the fight.
Indu Bhushan is CEO, Ayushman Bharat PM-JAY, and National Health Authority.
The opinions expressed are personal.