How Indian Healthcare can set the Right Conditions for Research
Futurism, once considered a forte of science fiction writers, has become mainstream today. Universities offer advanced courses and a growing number of companies are building teams for the future. But what about the healthcare sector? Don’t we need more researchers to prepare us for the future? An HE report.
India has an advanced technological base. In 2014, Indian space scientists successfully placed a satellite in orbit on Mars. The budget for this extra-ordinary feat was just $72mn, less than the budget of the Hollywood movie Gravity. Even the image of women scientists celebrating the success in the Bangalore mission control room went viral. In fact, a Canadian scientist Catherine Mavriplis tweeted, “When was the last time you saw women scientists celebrate a space mission?”
While there is a lot of emphasis on R&D in space and technology, equal commitment to invest in critical sectors such as healthcare seems lacking. At 0.83% of gross domestic product (GDP), India is among the countries with the lowest investment in scientific research. Despite economic growth, Indian researchers face a lot of problems, including poor infrastructure, red tape, and disconnectedness from global trends.
A large proportion of medical device requirement in the country is met by imported products, with the US being the lead supplier. Twenty-three of the world’s largest medical technology firms have established sales and marketing offices in India. The domestic medical equipment sector is small and fragmented. With an estimated 700 manufacturers, most domestic players are focused on consumables. The higher end market remains to be dominated by global companies.
FINANCING OF RESEARCH
In fact, a parliamentary panel has asked the Centre to increase budgetary allocation for critical healthcare research after it found “huge” mismatch between demand and allocation of funds for Department of Health Research (DHR) policies.
The panel recommended increased investments in health research to provide affordable and quality healthcare. They noted that in the USA, the budget of National Institute of Health, which functions like that of Indian Council of Medical Research (ICMR) under DHR, is 32 billion dollars per year.
CHANGING THE CULTURE
Dr Clive Fernandes, Group Clinical Director of Wockhardt Hospital, points out, “There is a huge cost involved with no guarantee of ROI for healthcare research. Literally put, for research you require deep pockets. More money has to be poured as research is like aiming in the dark. There is no guarantee of success and, more often than not, the desired outcomes are never attained. This leads to a lack of interest in the funding of such projects.
“It is difficult to have start-ups in this field due to the same reason. No one would want to put their money where the chances of failure are greater than that of success. Research normally takes time and by time, I mean a long time. In this age of quick returns, there are very few entrepreneurs and companies who are willing to wait endlessly for the desired results.”
“One of the things that are easier said than done is accepting that, during the journey, there will be many more failures than success. Are we willing to accept failure? We have very few individuals and companies who have the mindset required for research and it shows, as the question itself reveals a lack of research culture,” he adds.
To put this in perspective, the world’s 12 biggest drug companies are making a return of just 3.2 percent on their research and development spending this year— down from 10.1 percent in 2010, according to Deloitte’s annual survey of pharma R&D investment. At the same time, the average cost of launching a drug has soared to a record $2bn from $1.5bn in 2016 and $1.2bn in 2010, when the professional services firm launched its pharma survey.
MORE TO BE DONE TO PUT IDEAS INTO PRACTICE
Interestingly, K Sujatha Rao, former Secretary of health and family welfare, points out in her book, Do We Care? India’s Health System, that “In systems of good governance, policy making is participatory and inclusive. Research institutions are fostered to produce the required evidence and key stakeholders taken into confidence. This was seen when crafting HIV/ AIDs policies, were key population groups most vulnerable were considered during policy making. But this was a rare example.
“By and large, policy makers have displayed a lack of conviction for such inclusion of target groups and have neglected to foster and nurture research institutions. Costly mistakes have been made such as disbanding malaria workers with multipurpose workers, reducing vigil and community-monitoring, neglecting primary care, opening up health markets without putting in place appropriate regulations, prioritizing immunization over comprehensive child health, or tackling the causal determinants of infectious diseases and so on.”
“We don’t have enough evidence to frame a policy on. Further, there is no money in research. A clinician earns ten times more than a researcher and our system of education is also for passing exams and cramming,” Rao told HE.
SHARED VISION IS KEY TO CHANGING SYSTEM
Abhijit Nadkarni, Co-director of Addictions Research Group of Sangath, seconds her views. He notes that the major challenges for mental health research in India are the shortage of funding, the focus of research in clinical settings (as against public health perspective), almost non-existent training programmes in graduate and undergraduate courses, shortage of leaders who can advocate for sustained and strategic investment in mental health research.
Nadkarni stresses that government invests in control and management of communicable diseases, maternal and child health, control of nutritional disorders and some major non-communicable diseases like cancer, cardiovascular diseases, and diabetes.
According to a 2016 study about correlation between public investment, intellectual property rights, drug pricing policies and innovation in global life-sciences, India ranked among the lowest (in the bottom five). This is due to weak intellectual property protection, lack of data protection for biologics, low investment in R&D and price regulations.
So, in order to have a world-class research ecosystem, what should the government do? “We should strengthen research training, invest in public health research and increase research funding,” he explains. “Further, we must give universities autonomy to raise research funding through other sources. Promotions of academics should be based on research outputs and not the duration of tenure. We must promote links with universities abroad and groom research leaders who have a larger vision and not just their personal research outputs. Lastly, India must also develop a national research agenda with clear time-bound milestones linked to national health priorities, funding, and outputs,” he concludes.