Amity Institute Of Training & Development

INDIA'S HEALTHCARE SECTOR: EMBRACING THE FUTURE WITH HOPE AND COURAGE

Conversation between Dr. Gurpreet Sandhu, President – Council for Healthcare & Pharma and Brig R.K. Sharma Director, Amity Institute of Training and Development (AITD)

Dr Gurpreet Sandhu is the President of the Council for Healthcare and Pharma, a Not for Profit, Global Think Tank and Advocacy Forum. The Council advocates the development of sustainable integrated Health Systems & Affordable Healthcare for All.

Dr Sandhu has over three decades of experience in the Chemical, Pharmaceutical and Healthcare sectors. In addition to his role at the Council he is the Founder of Reva Pharma and serves on the company’s Board of Directors. Dr Sandhu is also the Chairman of CareIndia that operates in Healthcare Delivery Services and Chain of Pharmacies. He has earlier worked in senior positions with leading corporations including the TATAs, Global Traders and Daichi-Sankyo. He is a prominent speaker at various industry fora in India and overseas.

Widely recognized as a remarkable business leader, Dr Sandhu is credited with having created numerous ventures and partnerships in the healthcare and pharma space.

As an expert, his views and advice are often sought on wide-ranging and important matters concerning the pharma and healthcare industries. He is involved in strategic capacities with Governments as an advisor and serves on the Scientific Board of the India Pharmacopoeia Commission.

Dr Sandhu is passionate about the conservation of the environment and believes in economic growth with a benign eco-footprint.

A global citizen, Dr Sandhu has travelled to over 100 countries. He has invaluable experience, a deep insight and market knowledge of USA, China, Japan & Emerging Economies. He holds a Doctorate in Economics and an MBA with a specialisation in Marketing & International Business from the universities of Cardiff, UK and the Punjab Agricultural University, India.

Brig RK Sharma: Leaders to show and share their views on important events and themes relevant today. How these will impact the future.

Today's topic of discussion is India’s Healthcare Sector Embracing the Future with Hope and Courage. Today we have invited Dr. Gurpreet Sandhu, President of Council for Healthcare and Pharma in India. Dr. Sandhu is the President of Council for Healthcare and Pharma which is a not-for-profit global think tank and advocating forum. He has over three decades of experience in chemical, pharmaceutical and healthcare sectors. He is also the founder of Reva Pharma and serves on the company’s Board of Directors. He is also Chairman of Care India that operates in Healthcare Delivery Services and has a Chain of Pharmacies. Dr Sandhu is a remarkable business leader and has created numerous ventures in pharma and healthcare industries.

He is also acting as an adviser on the Scientific Board of Indian Pharmacopoeia Commission. We also have with us today Dr. Nitin Batra who is the head of our Amity Institute of Training and Development which regularly conducts learning that development interventions for our corporate clients. Dr. Nitin Batra was earlier the Global Head of the brand innovation at Johnson and Johnson. He has held marketing strategy roles at Pfizer and led strategy projects as a consultant in Mckinsey. May I know request Dr. Sandhu to give us an overview of today's subject and thereafter we will take questions from the audience, and I will request the audience to post their questions on chat and we will place them to Dr. Sandhu for his answers.

Dr. Gurpreet Sandhu: - Thank you very much Brig Sharma. Firstly, I would like to thank Amity Global Amity Institute for education and Dr. Nitin Batra for having me joining this august session, which has been scheduled. The world of healthcare is the most important industry, which we all must investigate because it drives the gross domestic product definition, number one. It drives the longevity of life. Third the quality of living. As we progress from a developing nation to a developed world, which is the way we progress into the nomenclature of the global scenario, healthcare drives everything. And as I was sharing, a couple of minutes back, with Dr. Batra that education and healthcare must work in sync and in tandem going forward if the GDP and the image building exercise of a nation and communities must happen.

Something very interesting to share with you, India is known today as the pharmacy of the world, but we have cultivated a big branding for India to produce low-cost quality, accessible products, which in terms of the terminology of the industry is the generic products. These are products which are gone off patent and, in some cases, there are challenges which the Indian industry and phenomenal work in fighting the patent litigations and positioning generics, so the accessibility across the regulated and the emerging world is happening now. Very important for you to understand, I will just first layout certain figures which will build the base of what subject we are going into and in depth and then we get into the cross questioning and share with your certain dynamics of this industry and then take your queries to address them one by one.

The pharmaceutical industry today and the world is round about 1.4 trillion dollars which is fairly very large, growing at just single digit today but by 2023 it should be 1.6 trillion. Now, which takes a growth round about 16% on a yearly basis and the driver for this kind of a number base what we are talking of, are the emerging markets. And when we talk about the emerging markets, yes as you are all aware that countries like China, India countries like Vietnam, Indonesia, they are the drivers. And then the next countries, which are playing a very critical role, countries like Turkey, get into the CIS region and Russia. So, the evolution of life, the urbanization, the increasing middle class, and the higher income groups are driving the need of healthcare. And I think, more so I expect that growth to be even larger with this COVID scenario, which we are all facing today, has not only awakened the private sector but also the governments across the world and more so the conversations which we have within our families today and across relations, friends everywhere we all talk about health today. That means that the awakening is happening.

If I look across pharmacies within our own business and outside the industry, sale of vitamins has gone out. People understand what is required in our body. This will bring in change of evolution, of diagnostics because if the diagnostics is right and affordability will lead to hospital visits, build up the primary and preventive healthcare, and then dispensing of the medicine. India today is still a very minuscule market, don't take me the wrong way. We are still at several rounds about 38 billion dollars as a market which is very small out of the 1.4 trillion when we talk about on a global basis. But out of the 38 billion, we as a nation are exporting round about 17.3 billion outside and going forward, we should be looking at several 19 million as an export. But our domestic market is very small, because our per unit price realization in India is very low as compared to when we investigate the larger developed economies, when we look at Japan, when we look at Germany, we look at France, we look at the United States of America. Very, very critical for you guys to understand that if you look at the largest markets in the world, the largest arena as United States of America, which is roughly round about to be 750 billion by 2023. So, that means it is the market which is driving the world forward.

You look at Europe, which is round about 320 billion, look at Japan, a nation, which is round about 120 billion. So, the growth which exponent, which we expect going forward, the numbers might be looking small for India. But we, as a nation, the urbanization getting build up, the healthcare dispensing taking place, the growth potential for India is very, very large and this will not only result in Government spending which will come forward but give a huge impetus for job creation and healthcare. Number two, the most important will be building the longevity of life in our nation and improving the quality of life as the infusion of education and healthcare lives taking place. The most important thing, which is missing today, why we as a nation have been recognized as the pharmacy of the world, giving the world affordable medicines. But we as a nation have not invented a single product.

Trust me good work started in a company, which is no longer existing Ranbaxy. When Dr Angie Reddy, the old promoter was down there and I still remember talking to Dr. Parwinder Singh since I have been associated with the company in the past, these two gentlemen worked hard to change and bring in the basic research into the industry. But unfortunately, the cost which we incur for R & D, the output, the banking industry does not understand. So, I expect that R & D has to be infused forward and I am very happy Niti Ayog has finally recognized that. And the guidelines which are getting stipulated to make sure that this gets pushed on for a positive track for our nation. Number two very important is the relationship between Academia and R & D has to be cultivated, which is a very common phenomenon when we look at the regulated world. When I say regulated world, it means if you look at United States of America. NIH, which is the driving force of the government, the National health policy structuring everything. They are spending around about 73 billion dollars each year on basic research.

The Government funds this money to Institutes, to small start ups, to basic research organizations. They then are coming up with new technologies, new intellectual property products, where the hold gets on with the government, because they have funded it and then they are sold out to the private industry who will capitalize them to build them up, this is one way. EEU, they are spending around about 32 billion a year and Japan is doing roundabout 27 billion. Now, this gives you a very awakening number that the potential for India is very large.

Yes, we are spending, I would say very small number, only spending around 5700 crores from the government side, which Is nowhere what world will require. But going forward, I am very positive that the big pharma industry, when I said the big pharma means the innovative companies are looking to India with the new policy structuring and could be that we as a nation become the part way for basic research, and then the research structures have to be created around NCR regions or Bangalore region or the Hyderabad area because we need to bring in a talent pool of people who are either committed to this work, or the Institutes which are there, next to these areas, can probably play a very pivotal role in cultivating this dynamics of getting the right people to work upon.

Now, you will be very surprised, which is a looming story today that we have COVID scenario and when we look at the dynamics of the number, India is spending on a per capita basis, only 27 dollars on health per annum as compared to roundabout 3300 in Australia, 3800 in Japan and in China, looking at the population mass, still they are far-far ahead, they are spending 350 dollars per person in China. So, this number why I am giving you, gives an outlay. Yes, the need is there, we must do, the industry must build either in public private partnerships or on a private level or building the infrastructure going forward. The next important part the spending by the government on the healthcare is 1% of GDP. When we are talking of, that is probably we expect that, but this whole hit what we are going through probably the government is looking at a two and a half percent investment, going forward for the GDP towards building of the health care infrastructure. But if you look at a nation like United States of America, they are spending round about 14.3% and if you investigate small nation like Austria, they are doing roundabout 8% of the GDP. And if you look at Australia, it is doing round about 13% of the GDP which gives you that these nations have realized that healthcare is the most critical component to ensure that people, if they hold good health, they have longevity of life, the standards will be better, the output will better. The end of the day, the output derives what best can be brought in.

As I expressed, Indian industry has done well. We today are a self-sufficient nation in terms of the basic medicines what are getting to be available across with the pharmacy structures in India, but the risks are looming on us because as the industry grew forward, we did not invest in the large-scale base chemical manufacturing. And the technical terminology is active pharmaceutical ingredient, which is called API, which is the seed to make the medicine. Either it is a capsule tablet or an injectable product. The base product India manufactures round about 32 % of it, the rest we are today living on China. This is a subject of big concern.

Since we are going through a big turmoil between the two nations, a lot was discussed by our Hon’ble Prime Minister and the requisite Sector Ministries, but unfortunately building a critical mass like this to fill the gap will take long period of time. And I think my personal perception is rather than we are getting into a structure, the collaborative approach between the two nations, will ensure that the industry moves forward. And the cost of medicines is sustained because in the last practically three to four months, the base pricing coming out of China has increased from 10 to 14% which impacts a common man for his basic medicine requirements.

The most important thing, which we all today are aware is that India is not what we see, which is living in the cities. What is living for the future as a nation as a tier II and tier III cities in our part of the world and there the healthcare is totally missing. Let's look at a state like Uttar Pradesh. Uttar Pradesh has invested billions of dollars in building the primary and preventive healthcare but it's sad to say that if you go down, the minute we cross Greater Noida to get into a village structure, there is a structure lying there. There is a primary and preventive healthcare. The government has been very good in constructing but either a doctor is not there, either a gynaecologist is missing, or the diagnostic infrastructure is poor or the medicine quality which is being dispensed from there or the pharmacy within the structure, doesn't confirm in majority cases to the GMP compliance. What I mean by GMP, just to add to my friends, is a good management practices which result in the regulatory compliances to ensure that since the product has been consumed by human beings, there are structures which are complying to ensure that the product quality and the efficacy.

The second most important thing when we investigate the healthcare is the number of beds which we require as compared to the population. As per the world health standards, you require one doctor per thousand and trust me you will be very surprised if I give you the working thought, we do not even probably will have, with a kind of output which is coming out, we have one doctor for 30,000 people in India. Even if we investigate the data, when you see the number, we have 542 number of medical colleges producing good doctors every year. We have 30,000 medical graduates which get out of institutes every year. But if you compare with the current population and the working part which I have calculated to fill in the gap of what is required as per WHO standards, it will take us another 45 years.

I am again repeating it will take us 45 years to reach to fill the gap what is required. This is a very worrisome number. No doubt the government has been especially across states, they have been talking that every district should have a medical college. But the cost of creating a medical college as per the Indian standard requires a big amount of money to do that. Whereas if you investigate medical colleges which have been established outside and even in the United States or in the Caribbean or in Latino market, the cost of establishing a medical college it's probably one tenth what is being done. And now the Government of India has realized that they must change the policy structure and we are hopeful that if that is done, then the private sector should take a lead of injecting capital in creating medical colleges of world hospitals structure around it, to build the needs, going forward.

If I do a comparison just for you, as I said as per WHO recommendation, you need one doctor per thousand people, Germany leads the world with an average of 4.3 doctors per thousand, which is very high. They are way ahead than a neighbour nation like us and having a larger population than us, as per the demographics which are available today. So, to sum up, what I would like to say is that the industry has great potential. It has three phases which are very critical to be investigated. One is the medical device and diagnostics. This is itself an industry which is round about 750 billion dollars as a market today as an industry. Again, the United States lead the way followed by China. Third is Japan and forth is Germany.

If I give you the figure of China, China as a market is round about 98 billion dollars today and India is one billion and against out of the one billion, India is only exporting 400 million. It's a very sad example which I am going to give you, but this is a reality. The basic surgical scissor which is a very common medical device used across India be it small city or a large city. Our quality of surgical scissor is poor than that manufactured in Pakistan. I picked this example just to shake and I have been voicing this example across my sessions, be it the private sector or the government sector. So yes, we need to awake ourselves. When I did investigation along with agencies and Ministry of Commerce and Ministry of Pharma, I was surprised that what was told to me was that the cost of steel is high, and the right quality of steel is not manufactured.

So, I am just talking a very stupid thing, a basic thing down here but the aggregate solution is, that the basic awakening must come in if we need to build a healthcare. Because the most important thing is diagnostics. If the diagnostic infrastructure is there, which is supported by the medical devices, the patient knows what's the problem with him. He moves to the primary and preventive healthcare because if he will have to go to the tertiary hospital, big hospital, the cost is very high, you take a lot of time be it primary and preventive healthcare, take your need and if there's a problem, he moves down to the larger hospital and then only the medicine gets dispensed.

So, this cycle chain must be emphasized. Our government has to say that, yes, the need of the hour is building the healthcare system. If the healthcare system is built up and the government propagates that yes, we will invest 2.5% of the GDP into this arena going forward from 1.27 what has been the figures which have been seen for the last year and they push and support the private sector to come forward. I think the dynamics will change and it will be very fruitful that it will ensure the vision path of Niti Aayog and what our Honourable Prime Minister has been embarking upon, that we could be a 5 trillion-dollar economy where healthcare will be a very major contributor. So, that is one part of the system which is critical for us to investigate.

The other part is which I will just take two more minutes before we get into the mainframe because the time remaining is hitting on the other side. Basic R&D, then the new generation medicines, biosimilars, peptides, biosimilars and regenerative medicine are the future. Gene therapy, you can reduce the cost, and this is something which probably we are trying to work upon with institutes to see if gene therapy labs could be structured in Institutes because they will get a lot of work from the big research companies outside. You don't need critical scale in terms of land even if Institutes like Amity which is round the corner, which is part of the NCR region, can structure a gene therapy lab. You just need, I would say, a roundabout half an acre of land which can be put on in a building structure and the work starts happening.

Drug control of Government of India, which is the main controlling body is very committed along with the Ministry of Health to ensure that the new generation vision which is growing in a large way should be built in. If you go to Japan, you will be very surprised that if you go to a Regenerative medicine lab, you can get your kneecap done in one day and you can be walking. Vision outlet, you don't need large scale structures. I can name you a company like ASAHI KASEI which is a very big conglomerate in Japan. They partnered with us with my other pharmaceutical company and their medical device infrastructure. And they also have made an artificial kidney and it's available.

So, there is a lot which is happening in the world, and we are the diabetic capital of the world. We are today, the mental capital, mental health capital of the world. Every suicidal death, we are the largest in number value. In terms of population, we are the largest in number value. People are not willing to accept this taboo but trust me we have every issue. But if this issue can be brought out with the need, with the society understanding the need, the families understanding the need of healthcare, I think it paves a new generation of a business, it paves a new generation of understanding our body structure, it paves a new vision for the government to build infrastructure along with the private sector, which will lead our nation to the next level and fulfil the dream of us as a leading player in the top three going forward. I have laid the foundation and then probably we can get into the question and answers which you have outlined. Besides that, if there are any questions coming from the audience, I will take them on and then we could discuss it forward.

Brig RK Sharma: Thank you very much. You have given us a very comprehensive outline of the healthcare sector. I am sure you have covered everything which we needed to lay the foundation. My first question to you is:

Q) Healthcare industry is largely driven by services, which will be around 137 billion dollars by 2023. Pharma which is about 55 billion dollars, devices about 11 billion dollars and diagnostics 3-4 billion and primary healthcare in India is about 13 billion dollars. So, what are the trends you see over the next 5-10 years in the structure of healthcare in India?

Dr. Gurpreet Sandhu: What I look upon and what as a nation we need to do about it, the role of digital health is the future, you will see e-pharmacy structure and you have seen in the last, I would say last fortnight, larger houses grabbing each other, structure has started working upon, new structures are being folded. You have players like Amazon, you have the Big Boys from the US and even Reliance acquiring a structure to create something for this nation. Telemedicine is the future. Medical tourism, now this is very surprising. People don't cover it now, but I see that India will play a very important role in this medical tourism base. Today we should be round about 4 billion dollars as a market. When I say medical tourism means that people from poor countries I would say, neighbouring countries, you look at Bangladesh, you look at Afghanistan, you look at Sri Lanka, you look at Indonesia, the people in the East African markets, they are all flocking into India, getting their medical services and Delhi, Chennai, Bangalore are hubs today.

Trust me, if you go down to Max in Saket, you will see a lot of foreigners walking around and these people are part of the medical tourism people. But the medical tourism industry has not been structured. It doesn't have regulations as of now. But yes, the public and private sector are working on for medical tourism and this is one sector which could probably, in the next five years, can cross 11 billion marks. So, there is a huge potential which is lying here, and which is one.

Then I have expressed down is, the start-up capital if India has to move to the next to the kind of younger generation we have, the education community we have, and to create any economy in the start-up vision is big and there are a lot of start ups, which have reached the level and if you look into an education by you today is billion-dollar entity in itself. E learning, which was never thought that this kind of thing will serve this nation. Similarly, E-pharmacy, which is an industry in the world, people would like to do that convenience and as the digitalization of money happens which government took over. Yes, over a span of time ‘Phygital’ money will lead to Ecommerce and the models, which will go forward.

The another, which is important thing is that we, as a nation, as I said, lifestyle diseases are the big taboo for us, we have diabetes, we are the diabetic capital of the world, the cardio issues are looming for us, mental disorders are a big issue going forward and the most important thing, which have been missed it is being talked about by the government while some of the states have taken a very positive initiative, is the women healthcare. If I say that if the lady’s health is taken care in the right way, right from the base of the basic nutrition, the whole family structure improves.

Since masses of our tier II and tier III cities, the women’s literacy levels are low and if you investigate, I come from a rural background, so I understand this aspect much better, a mother, before she becomes a mother, she is committed to her father’s health. She is married, she takes care of her husband's health and as she bears children, she takes the children, she puts herself in the last. If the mother is taken care, I am sure that the family will build itself on a very strong footage.

Osteoporosis which leads to arthritis is one of the biggest issues for the women because during the period she lactates, the calcium content is practically missing. I am just giving you a very simple example which is there. Then the issues of cancer, which was a rich man’s disease, when you investigate the west, it was unaffordable even outside. We are today the numbers what we have 400,000 new patients came out in the state of Uttar Pradesh suffering from cancer. If I investigate the state of Punjab, the cotton growing districts of Gurdaspur, Sangrur, Faridkot, Firozpur, and Bhatinda, which is a cotton belt of, I will say a Northwest and same goes for Gujrat as well, the numbers are very large on Cancer. So, cancer working modules to see how the affordability can be brought in. These are the challenges. And then mental health, will become a very big challenge as the urbanization, people want to achieve everything overnight, people must have the patience and work upon it to see how things will work upon it.

Brig RK Sharma: Today’s The Times of India where the CEO of Niti Aayog Mr. Amitabh Kant has written a piece about the healthcare which he hopes with the next driver of growth and the first thing that he strongly recommends is strong primary healthcare system. Now, as we know accessibility to healthcare is a major issue in India, only 37% of the population even less has access to in-patient facilities within 5 Km of their home. Only 2% of doctors practice in rural areas. As you already brought out, there is 1:30,000 against the ratio of 1:1000 of the WHO recommended. So how do we fix this. How do we progress and how do we take healthcare to the rural areas and the primary healthcare?

Dr. Sandhu: This is the most challenging aspect which you have touched. Our government in the past has invested sizably on the model in the last thirty years.

If you investigate the numbers, primary healthcare infrastructure was created but PSE as a model is not a remunerative model in terms of planning because when we go into the arena of the tier III cities and the rural community, in truer sense, a good doctor because the numbers are limited again as per what the ratio we have in our nation. We have around about, for 30,000 people we have one single doctor, and the doctor wants to only work in the rural arena because he earns more money there. So, the first step which the government must do is that the doctors which are employed in the government sector, they should be given a very high remunerative salary. So that they feel motivated, they feel respected in the society that yes, they need to work and contribute into our community in the rural area.

The bigger hospitals, you will be very surprised if you investigate the Apollo or the Max or even the Institutes like Medanta, they are not making the kind of money, kind of money capital which they have invested. And this is not my thought, this is the general discussion if you sit on any of the forum - FICCI or CII or the international arena seminars which are looked upon, this is a big issue.

Next is for the government to make sure that these each district, we should create low-cost Medical Colleges and support the universities to ensure that certain proportion of the candidates are doctors, and these doctors are then worked upon to see how their field of specialization could be done, created. Then the big problem what we are seeing today is that the doctors which are graduating from the premier Institutes of India, because they are not getting a proper renumeration in our own nation, they tend to leave India and go for greener pastures in the western world.

If I tell you that the American Association of Physicians or the Indian Association of Physicians which is there, about 125,000 Indian doctors are working in United States. For every seventh American, he gets treated by an Indian doctor because he earns more money there. Imagine if you bring that community down, the number will change. So, a lot must be done by the society in respecting. The other thing which as a Council, have requested the Government is that the people who are retiring from the government at the age of 60 as doctors, they should be re-employed and brought back into the community. We can train, let's say good pharmacist and they could probably educate the need of medicines, they can do the basic.

A Head Nurse could be given a further qualification and a push that she could manage a primary and preventive health care system structure or lease out this primary and preventive healthcare which are created by the government as base infrastructure on long lease. And I am very sure that the private sector will be willing to invest into that module and offer the services, which could change the landscape going forward. So, there are various things which could be initiated to do that, and it could make, going back forward. And then the good thing part is that our own wealth of our Ayurveda and yoga must be cultivated further deeper into the system. Our basic medicines of Ayurveda can play a critical role looking into the basic issues of health. If you investigate China, this is a very good learning, which we can imbibe upon. The traditional Chinese medicine are still supporting their own healthcare system by 33% as compared to the allopathy structure. We as a nation have not pushed the Ayurveda, which is our own science, and there's a lot of tangible wealth to support when we talk about of Ayurveda. So that is missing, which can be done.

And then the role of ‘think tank leaders’ which are there. If we can promote the social media message by getting certain Bollywood stars or getting key leaders in the society emphasizing what health is, why health is golden, it is the complete essence of life, I think it will make a remarkable change to the society and these are the kind of programs which will get the village level think tank changing and moving this vision to the tier II and tier III cities. If the tier II and tier III cities are built forward, it will make a lot of, I think, the corporate social responsibility advantages which the government or the corporate ministry have given if they are pushed for one year or two years to only build the healthcare, I think it will change at larger way in pushing the vision of what we need in the key mass communities of our country.

Brig RK Sharma: Moving towards the insurance sector, towards the health insurance side. As you know Ayushmann Bharat is a national health protection scheme, which will cover about 10 crores poor and vulnerable families, that's about 50 crore beneficiaries approximately. Each family will get a cover about 5 lacs rupees per family per year for a secondary and tertiary care. And hospitalization, they can go to the public sector hospital, or they can go to private sector hospitals. So, what impact of the scheme do you see happening in the next 5 to 10 years? Also, a little bit about the health insurance, which does not cover OPD. So, unless the insurance is in the hands of the people, industry will not grow. So, a little bit about Ayushmann Bharat and a little bit about the health insurance sector in India.

Dr. Gurpreet Sandhu: I would say, great vision thought policy structuring has been done by our Honourable Prime Minister Mr. Modi in positioning the Ayushmann Bharat on national scale. There has been a success in certain states but still the complete coordination between the hospitals, large hospitals and the primary healthcare infrastructure has not been collated in the right spirit to ensure that the critical mass of the population is being investigated. But number two, the complete disbursement model of people getting medical care, surgeries and the OPD structure is still being worked upon and I think as we push this structure forward, it will lay a great help and build a very robust structure for the needy community and the tier II and tier III and the rural population we have. If we can embark and build the rural population to the next level, I think, the scheme which has been initiated, will make tremendous value going forward.

Now coming down to the subject of the insurance sector. Insurance sector needs great thrust and the FBI structure, which is currently there, must be changed so that we could bring in larger players from the outside. Number two we also must change how the dispensing models must be built, because still certain of the healthcare policies are not being reimbursed at every hospital structure. There is a misuse which is happening today in a great way. And that has been resulted in some of the bigger voices which were there in the insurance sector.

Moving out, LIC which has played a very critical role in where we see the health care structure, the term insurance, the basic term insurance, the basic packages which are there, they are being built but the mental makeup of the people which are working upon in the health sector, the insurance agents, they are looked upon by the community. But trust me this is one of the biggest services, which must be given a positive pact that yes what they are adding is, what they are caring is. And I am very sure that the way, the negative problem what we are facing on Covid, it will add to the mental makeup that people will start, and people have realized and will realize going forward more that they must either go if they can afford with the private sector or they will register themselves and seek the support which comes under Ayushman Bharat. If you investigate the kind of practice which the local Delhi Government did of the Mohalla Clinics, they are to a certain extent are success. Vending machines for basic medicines have been established, infrastructure is there. I think if that model is successful in Delhi to some extent, we need to cut down the of the political arena but use the wealth which has been there to build in that into a low cost structure either under the umbrella of Ayushman Bharat or along with a special scheme with insurance sector, to serve a community and create the message that yes the need of the hour is there and we need to do it.

Brig RK Sharma: Thank you very much. I will now come to very basic question and that is, it is suggested that the Government should invest in health, so that it reduces the future expenditure towards healthcare. So that is investing in preventive health, good health for the people in school days, young day. So, what do you suggest, how should the Government and the country go into it, how to invest in health rather than healthcare?

Dr. Gurpreet Sandhu: The first foremost thought is to structure an independent Ministry. Today the Pharma Sector has its own Ministry or an independent Department, Aayush has its own. The first mental makes up must be done at a national level. Number two is the Regulatory Compliance. We need to improve the standards of our manufacturing in India. You must have heard, must have read, or seen – oh the medicine, which is being sold outside in United Kingdom, you will feel proud that 90% of the medicines with their dispense in the government or private sector hospitals in United Kingdom are coming from India. Because we are affordable.

But on the other side, if you and I must buy a medicine, we will probably go and buy a product either coming out of Cipla or Dr. Reddy’s or Sun Pharma. But there is a lot of manufacturing which happens across various cities. The good management practices, which I said, are not being adhered. So, people talk about that in India we have dual manufacturing standards. One is superior manufacturing what we export out of India and the second is the ‘me too’ product which we call the generic manufacturing. So, we today have over 20,000 manufacturing plants in India. I personally feel that going forward probably, it will have 5000 because compliances in the healthcare must be incorporated by the Government because inspector, the drag regime structure must be a national decision making by the Government.

It cannot be done by the private sector. The most important thing is compliance – number one. Number two the loan the funding by the banks must be on low rate of interest to support the healthcare sector because money, the capital must be invested. It can be invested in hospitals, medical colleges collaboration with institutes, educational institutes to imbibe pharmacy colleges, pharmacists who are required, nursing ability, which is missing, the paramedics. So that sector must be built in. We are still facing a huge paucity of even nurses, forget paramedics. We have 53 institutes of paramedics in India, but if we evaluate them, only four of them are producing paramedics of the right calibre. We must invest in basic infrastructure because that was missing.

Number two, FDI, Foreign Direct Investment, which has changed in a greater away, must be made 100% in the healthcare. When I say healthcare, I am talking of a bigger voice in the world coming forward. Then basic R&D, Research and Development, until is not there, nothing will move.

Lastly Intellectual Property. Respect to intellectual property is very important. Companies or governments which have built systems, technologies, they are willing to share because the common area is benefit to the mankind. The world has got united now on Covid if you see. Everybody is talking of when, where the vaccine will be manufactured, blah, blah, blah, all this kind of thing. Now that mental makeup for intellectual property respect will drive. There are companies, there are many governments which are willing to support India, but we do not respect the intellectual property regime. The policy structuring must change. You will be very surprised if you investigate the blood plasma story, which is being talked about, the blood bank system is still not structured in our country. These are policies, which are there for the last forty years.

We have not changed them; we need to change them. Yes, our Government is doing great work in working upon one step by step, but the thrust must be brought in to make sure that such changes are brought in and that will then result in larger investment in this sector to take it forward. We as a nation have shown to the world that we are capable producer in terms of basic medicine, the generic. We are the largest producers of supplies of 70% of the vaccines in the world. But the mental makeup must be more.

Capacity building as an issue - if you talk with the US FDA, which is the global regulator for US and it commands great respect in every nation, if your product or your manufacturing infrastructure, or even a hospital for that matter or a medical device infrastructure plant is FDA approved, it gets an accessibility to over 200 countries. The only question which they want to discuss today is – Can the capacity building be built forward?

They would like to work with India, but for capacity building again, the taboo comes in, the cost of capital. The cost of capital still is 0.85-0.9%. I am talking of an average number across the estimates as well. It can reduce the capital base, but for the estimates which will drive this larger structure in nation that has to be done and larger thrust must be created in each state.

If you investigate Uttar Pradesh for that matter, being the 5th largest population country in the world. The local government has now come forward and is laying the foundation to create pharmaceutical parks, get into medical parks infrastructure. They want to have longevity connections on the basic research. If we talk upon this, each state will have to do something different, because the need is not central, it is the need of the state. So, all these things can be devolved, I think there will be a positive track. And if the positive track takes place, it impacts the entire system. India as a market change totally and bring the thrust to every side of the economy.

Brig. R.K. Sharma: Thank you Sir. We will now take a question about the future and about innovation. As you would know Sir, healthcare organizations face challenges to improve quality, reduce harm, improve excess costs. Innovation is becoming a major focus. What are the big drivers of health care innovation in India because that is one thing which is very important for healthcare in innovation?

Dr. Gurpreet Sandhu: Innovation is a direct scenario to basic research promoting start-up companies, respecting what talent is there. And then the FDI. Money is available, capital is available outside. I will give you a very-very peculiar example of Japan. This community after the World War II, have created the base infrastructure. The average age of a female in Japan is 90 years and a male is 89. If you compare with our nation, today has touched 57 and 59 in India. We were twelve years back; we were in the late 40s.

Now when you look at the longevity of life, longevity of life is a derivative based on how the governments and the public are looking at it. The longer you live, the structures are there. You are more earning; the system moves on. More cultivation of economy drives it. We must bring in large scale as we have been talking in our previous subject. Private entrepreneurship must be encouraged in a very large way in the medical arena. We must build and the need of more people in the nursing infrastructure, in the paramedic infrastructure and doing that. And then the most important thing is respecting our Ayurveda Science which makes it much more affordable as compared to Allopathy. Because that can really push the system very hard because affordability in our community in terms of earning versus what is required in the healthcare, which must be pushed in.

Then large-scale structuring of education of healthcare is required which is being done but not being done in a very serious intent which can be done. Then lastly to rebuild the primary and preventive healthcare which is the cheapest way because infrastructure is there. But to do that, the private and public, long lease infrastructure is required where the government says okay fine, either you invest, and you are there for the next fifty years to cultivate the bandwidth. Then only this model can be remunerated. If the model is that yes you invest today and you earn tomorrow. In the healthcare, it is not same because the medical science is progressing daily.

A medical equipment if you install today, I will give you a very simple example of X-ray infrastructure machine, they are changing day by day. You can do, as I shared earlier, gene therapy, you will be able to evaluate where my problem is, gene mutation. These are big words but yes, the scientific bandwidth will realize. There is a research which says today why are Indians diabetic more than an African. The basic structure of education if I know that yes is known, people will start preventing that problem which will come in. It's a very common thing in India, a lady has problem more than a gentleman, the issue of osteoporosis because there is a calcium.

If you see the Ganges Plain, if you read more, if you get into the Central Asia region down to the Ganges Plain, there in the soil, the calcium intake just goes away. So that's why, the problem of Osteoporosis is big in India. It's big in Afghanistan, it’s big in Iran, Iraq, Afghanistan, Pakistan, and India. But it’s not there in Bangladesh. So, the analytical ability, the digital understanding, the role of artificial intelligence must be brought in and worked upon areas which will get the accessibility to the public in affordable cost. That is how we can educate people. A tremendous work must be done in by the States, by the Centre and with a collaborative approach with the private sector. That is the only way forward, because until we don't thrust it down, top to bottom and bottom to up, we will not be there.

Brig. R.K. Sharma: Thank you Sir. We have so many questions, there are so many questions from the audience, but we are running against time. When we have an expert, an experienced person like you, there is no end to the questions. But then again, we must keep in mind the time. I thank you on my behalf Sir for such a wonderful session with you. I will now request Dr. Nitin Batra to say a few words and thank before we bring this session to an end. Over to you Dr. Nitin Sir.

Dr. Nitin Batra: Thank you Brig Sharma and thank you so much of course, Dr. Sandhu for the insights that you shared. I kept an eye on the questions. So, thank you Sakshi and Bhushan for sharing your questions amongst others. You did answer the questions. So, Brig Sharma, I think the description by Dr. Sandhu was comprehensive enough for those questions and I think the way I understood you are a great student as well as an exponent of systems thinking, which we practice, which I practice as strategies for companies when you look at the whole thing as a system, both from awareness, driven by science and data, reaching to the last woman or man. You also talked about diagnostics, you talked about healthcare delivery. And in each of these 3 areas, you talked about what are the urgent as well as the long-term initiatives that the country needs to take.

Thank you also for sharing international insights which are always helpful to push as well as themes for innovation. So, I have learned a lot Dr. Sandhu with your talk. All I can say is we wish we had more time. So, at the risk of committing you, we would love to have you again sometime in the future whenever its convenient to you to dive deeper into some of the themes emerged out of this discussion. Thank you so much Dr. Sandhu for your time.

Dr. Gurpreet Sandhu: Thank you very much and let’s look forward to adding value to our nation and most important is building Uttar Pradesh where you are based because if U.P. as state grows to the level which we require, I think it will impact on the GDP of the nation and change the longevity what we require for a better healthcare and a better quality of living. Thank you very much Brig Sharma for all your kind support and let hope so we meet soon. Thank you very much once again.

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