New Delhi: Before one begins a dialogue on patient-centricity, it is important to first establish what it means. Without understanding the fundamentals, it is difficult to reach a consensus on why it is important, and we will continue to fail to effectively incorporate patient’s views, needs, and priorities in caring for them. India has always lagged in providing healthcare and pharmaceutical services to its citizens as shown by many health indicators which are worse than our neighbours such as Sri Lanka, Bangladesh and Nepal. Providing quality healthcare to all is a long-standing challenge for the government. However, with the COVID-19 playing a pivotal role for the Indian pharmaceutical and healthcare systems, patient-centric solutions are playing a growing role.
The pandemic highlighted five reasons for a people or patient-centric approach:
1. Equity in access for everyone, everywhere to quality health services, when and where they need.
2. Safe, effective, and timely care that responds to people’s needs and care of the highest possible standards.
3. Responsiveness and participation highlighting the care around people’s needs and preferences, through people’s participation.
4. Efficiently providing care that is cost-effective, maintain the right balance between health promotion, prevention, and in-and-out patient care, avoiding duplication and waste of resources.
5. Resilient health system with a strengthened capacity of health institutions to be prepared to effectively respond to the public health crises.
While the Indian healthcare care system is divided into five segments – public health sector; private health sector; indigenous system of medicine; voluntary health services; national health programs – there remain several fault lines in building patient-centric care in India. Even though COVID treatment was promptly included in Pradhan Mantri Jan Arogya Yojana (PMJAY) Ayushman Bharat, non-COVID patients struggled to get hospital admissions as beds, wards and hospitals were reserved for COVID-19. Routine services like Outpatient Department (OPDs), planned medical and surgical interventions, immunisation, antenatal care (ANC), among others were stopped or delayed.
The pandemic exploited the existing burden of non-communicable diseases (NCDs) and the increasing elderly population which are not being adequately addressed by our health system. This urges our entire healthcare ecosystem to move towards patient-centricity across populations and geographies. Health authorities decided to implement five strategies at national, sub-national and at local levels. During the pandemic, the government worked towards – engaging and empowering patients and communities, strengthening governance and accountability, decided to reorient the model of care, coordinating services within and across sectors eventually to create an enabling environment. With this approach, India handled the pandemic much better than most other countries including resource-rich countries. It re-drew attention towards patient-centricity. Nevertheless, the industry was quick enough to mobilise their efforts by providing patients with unmet medical and care needs. This needs to be sustained in the future in the regular healthcare system after the pandemic is over.
Government support to strengthen pharmaceutical systems by infusion of science and technology became a top priority to achieve public health and no government, academia, research organisation, or private health provider can do it alone. Having said that, technology intervention and governance of private service providers will be key to establishing a robust system.
The patient is the most important stakeholder in healthcare. All other healthcare stakeholders exist for the patient and must work only towards his benefit. And build his capacity to take care of his health and access healthcare providers in time without getting impoverished. Hence, a patient-centric approach with patient’s needs, preferences and benefits must remain a top priority for all other stakeholders in the healthcare system.
(Dr Sanjiv Kumar is the Chairperson of Indian Alliance of Patients Groups and Chairperson of Indian Academy of Public Health.)
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