Editorial 1 : Health regulations need a base to top approach
Context
Health regulations are essential but their implementation in India needs to be nuanced and calibrated.
Health care regulations
- The subject of regulation has always been of interest to health programme managers but, arguably, is one of the weakest points in India’s health-care system.
- It is not as if there are not enough health regulations in Indian States. Rather, it is a problem of excess.
- Some States have over 50 approvals under multiple regulations, which need to be followed and complied with by every health-care facility.
- The other challenge is unrealistic health-care quality standards. Governments at every level in India — national and States — are known to draft policies which are near perfect.
- One such case is the Clinical Establishments (Registration and Regulation) Act, 2010, enacted 14 years ago, but not adopted by States.
- This is because State governments, in discussions with stakeholders, have realised that many provisions in the Act are impossible to implement.
- Another example is the Indian Public Health Standards, or IPHS, drafted by the government for its own health-care facilities and proposed as essential in order to deliver quality health services.
- The IPHS were first released in 2007 and have been revised twice since then.
- Yet, in 17 years of existence, only 15% to 18% of government primary health-care facilities in India meet the government’s own standards.
- Clearly, in the efforts to be aspirational, health-care regulations and standards in India have drifted towards unrealistic standards, and are difficult to implement.
India has a mixed health-care system
- There is a binary perception that when it comes to adhering to the rules, the government health sector always does better, and that the private sector always violates them.
- The fact is that India has a mixed health-care system, where private health-care facilities and providers deliver nearly 70% of outpatient and 50% of hospital-based services.
- In most States such as Maharashtra or Kerala, the health indicators are better not because these States have outstanding government facilities but because the facilities and clinics in the private sector are fulfilling the health needs of the people.
- Clearly, for effective regulation and adherence, the stakeholder should not feel they are being targeted.
- In health-care regulation, in the current scheme of things, the burden of responsibility is more on providers and facility owners.
- Most private nursing homes and clinics have often flagged the issue of approvals being delayed by the authorities for months even when these facilities apply for renewal well in advance.
- The sluggish approval process is a main concern as far as facility owners are concerned.
Affordable care is one need
- The private sector is also not a homogenous entity as there is everything from single doctor clinics, small nursing homes and medium-sized hospitals to large corporate hospitals.
- Single doctor clinics and small nursing homes are often the first point of contact for access and utilisation of health services in India by middle-income and low-income populations, and are the real lifeline of health services.
- They deliver a large share of health services at a fraction of cost of that of the big corporate hospitals.
- The single doctor clinics and nursing homes play a key role in health service delivery in India and make services accessible and affordable.
- Clearly, there needs to be supportive and facilitatory regulations to serve the public purpose of keeping health-care costs low and affordable.
Suggestions
- First, ensuring quality of health services is essential and the joint responsibility of all stakeholders.
- Second, in regulatory aspects, what is possible for large corporate hospitals may not be feasible for smaller clinics and nursing homes, without escalated cost.
- Third, representatives of doctors’ associations and the types of facilities for which regulations are being formed as well as community members should be involved in the process of the formulation of such regulation.
- Fourth, political loose talk and sensational media headlines might worsen the mistrust of the common man about doctors and nursing homes and may result in increased violence against health-care providers.
- Fifth, and most importantly, India needs to promote single doctor clinics apart from smaller health-care facilities, and nursing homes.
Conclusion
India’s health-care system is already becoming skewed towards admission based in-patient services. It needs to promote providers and facilities that deliver out-patient care at lower costs. This would contribute to the goal of the National Health Policy, 2017 — to deliver health services that should be people-centric, accessible, available, affordable, and have quality.
Editorial 2 : Will understanding cancer become a data problem?
Context
The World Health Organization (WHO) reports that approximately 33,000 new incidences of brain cancer happen each year in India alone, while Global Cancer Observatory 2020 estimates brain cancer as the 19th most common type of cancer.
Oncology research
- There have been amazing breakthroughs made in oncology research worldwide, the kind that will mitigate some of the challenges experienced first hand.
- The current standard of care for diagnosing cancer often requires invasive and risky procedures such as surgeries to extract tissue samples for analysis.
- Believe it or not, the risks for patients from these procedures range from short-term paralysis to death.
- We have all read about genes, DNA, and RNA as part of our basic high-school science.
- Technically, they are the fundamental building blocks of life, shaping our traits and our health.
- Science today links people’s genes to their susceptibility to diseases like cancer.
- Just like the wrong ingredient can change how our recipe turns out, a DNA mutation can change how our cells grow and function, sometimes leading to cancer.
- Therefore, what we must primarily understand is what are the mutations in the genes causing cancer.
- Research suggests that there are close to 3,000 such cancer-causing genes. With each gene containing thousands of DNA codes, and each code potentially holding vital information about cancer development, the sheer volume of data analysis for a human can become quite overwhelming.And seemingly impossible.
- Next-Generation Sequencing (NGS). Cutting-edge technology that is potentially transforming our ability to decipher the genetic code with speed and precision.
- The Human Genome Project officially began in 1990 and was completed in 2003, taking about 13 years to finish, at a cost of about $3 billion. Today’s technology lets us accomplish the same process in possibly less than a week, and costs a little under $1,000
Liquid biopsy
- The advancements in NGS have the concept of a liquid biopsy, a revolutionary technique that offers a less invasive alternative to surgery.
- Instead of invasive procedures like surgery, they collect a small sample of patient’s blood, which is like the evidence at a crime scene. Within this blood sample, they look for genetic patterns that indicate the presence of cancer cells.
- These genetic biomarkers are like the fingerprints and footprints found at a crime scene, providing crucial clues about the patient’s health.
- Of course, this process is easier said than done. Producing such real-time results with precision requires the support of rigorous data analysis.
- The genetic data from several tumour and blood samples needs to be assimilated by artificial intelligence systems based on machine learning algorithms, combined with big data analytics platforms.
- These technology tools enable researchers not only to process large amounts of information faster, but also to detect patterns that previously would have gone unnoticed by the human eye or mind alone.
Way forward
As we navigate the ever-evolving landscape of oncology, it is clear that the future holds immense promise. By combining the power of data at our disposal, with innovative technologies like NGS, we may well be inching closer to unravelling the complexities of this disease.
