The crunch, though, has forced hospitals to get creative. Some, like Max Healthcare, found other avenues for profit. Max took the home delivery route. As of April 2018, Max’s home health business unit was one of the largest players in Indian home healthcare, and their diagnostics arm was one of the largest in the National Capital Region (NCR).
Healthtech startups, meanwhile, went one step ahead and pulled the sector online. Consultation, prescriptions, doorstep delivery of drugs, sample collections for lab testing and delivery—you name it, there’s a startup out there doing it.
The government, too, seemed keen on the digitisation of the healthcare space but seemed to lose its appetite as it focused on Ayushman Bharat. Take the Integrated Health Information Platform (IHIP)—a health data hub meant to digitise personal healthcare information—for example. A senior executive at one of the three consortiums that sought to build the hub told The Ken in May 2018 that the IHIP file stopped moving once Ayushman Bharat was announced.
The IHIP itself had its roots in the Electronic Health Records (EHR) Standards 2016. The EHR required all patient medical data be uploaded so they could be accessed by any medical personnel, thus promoting interoperability.
While the IHIP is now gone, the EHR Standards 2016 are still only voluntary.
In the private space, however, the digital march was unceasing. Today, there are online pharmacies that deliver drugs to your doorstep, websites that facilitate online consultations with doctors, give you basic and accurate medical information in regional languages, and more.
E-pharmacies, in particular, have had an eventful few years. In October 2015, the Indian Internet Pharmacy Association was set up. The association lobbied for e-pharmacies, seeking regulatory change on the part of the government. At stake was the $13.4-billion market for drug sales, traditionally cornered by small, offline pharmacies.
The Association’s work seems to have paid off. The government released a draft policy for regulating e-pharmacies in 2018. Optimism about the future of e-pharmacies soared. However, the policy is yet to be finalised.
Meanwhile, the government’s vaccination efforts hit a number of stumbling blocks. The vaccination programs—Mission Indradhanush and its subsequent iterations—set a goal of 90% immunisation coverage of India with the government-approved list of vaccines by 2020.
But where can these vaccines be bought?
The three public sector undertakings (PSUs) the government leaned heavily on—Central Research Institute (CRI), Kasauli, BCG Vaccine Laboratory (BCGVL), Chennai and Pasteur Institute of India (PII), Coonoor—were shut down in January 2008.
Consequently, the private Indian vaccine sector grew at a CAGR of 18% to Rs 5,900 crore ($907 million) between 2009 and 2016. Pharma major Pfizer led the way by convincing the government to buy its patented pneumonia vaccine.
The government’s attempts to move away from the private sector have not gone so well. Over seven years, it pumped about Rs 600 crore ($84.2 million) into condom-maker HLL Lifecare to develop an Integrated Vaccine Complex (IVC). The cost of the IVC has now shot up to over Rs 900 crore ($126.4 million). All without a single vaccine being produced by the facility so far.
With that being the case, the government turned increasingly towards BMGF. The Foundation ‘fixed’ the supply side of the market by doling out grants to major vaccine producers such as the Serum Institute of India. It is hoping that as it exits the country, the government will step in and fix the demand side concerns by buying the vaccines it helped produce.
The government had also set other targets for itself. Eliminate malaria by 2030. Eliminate tuberculosis by 2025, after previous failed targets of 2017 and 2015. Eliminate polio.
While India was declared polio-free in 2014, TB, on the other hand, was a daunting problem, especially with the rise of the superbugs. In fact, India, for the first time, accepted large donations for bedaquiline and delamanid, the first drugs to be approved in 50 years for drug-resistant strains of TB.
With the superbug war well underway in India — Indians are highly resistant to new antibiotics. But there also seems to be a glimmer of hope (which of course comes with a catch). The country now has a first-of-its-kind test to diagnose TB drug resistance, but it is not accessible enough. Yet. The country is also seeing a resurgence of vaccine-preventable diseases.