Bridging the Gap: How We Can Strengthen Medical Research for a Healthier India - Dr Raju Vaishya

The challenges facing India's healthcare system can be broadly categorised into those impacting medical practice and those hindering medical research.

A) Medical Practice

1. Access and Infrastructure Disparities: A stark rural-urban divide persists. Over 60% of India's population lives in villages, yet these areas possess only 37% of the country's hospital beds. This forces rural patients to travel long distances, sometimes up to 100 kilometres, for treatment.

This disparity contributes to higher maternal mortality (80 per 100,000 live births in 2023) and infant mortality rates (25.8 per 1000 live births in 2024) in rural areas. Public spending on healthcare, though increasing (1.84% of GDP in 2022-23, aiming for 2.5% by 2025), remains disproportionately allocated to urban centres.

2. The Dual Burden of Disease: India grapples with both persistent communicable diseases (malaria, tuberculosis) and a rapidly rising epidemic of non-communicable diseases (NCDs). NCDs, including cardiovascular diseases, cancers, and diabetes, now account for 60% of all deaths, making them the leading cause of mortality.

Alarmingly, 1 in 4 Indians risks dying from an NCD before age 70. The economic cost is immense, projected at $4.58 trillion between 2012 and 2030.

3. Financial Accessibility: Out-of-pocket expenditure (OOPE) remains a significant barrier. In 2019-20, OOPE accounted for 47.1% of the Total Health Expenditure, pushing approximately 60 million Indians into poverty annually.

Despite a declining trend (39.4% in 2021-22), the absolute financial burden is still catastrophic for many, especially the nearly 90% of the rural population without health insurance.

4. Workforce Strain: While India's doctor-population ratio (1:834 as of June 2022, assuming 80% availability) numerically surpasses the WHO recommendation of 1:1000, severe maldistribution means doctors are concentrated in urban areas, leaving rural regions critically underserved.

This leads to immense pressure, stress, and burnout among healthcare professionals, with over half of postgraduate medical students and resident doctors reporting symptoms of depression and anxiety.

B) Medical Research

1. Inadequate Funding and Outdated Infrastructure: India's R&D expenditure hovers around 0.6-0.64% of GDP, significantly lower than global leaders. Only about 20% of this goes to key research bodies. Delays in stipend disbursement and rigid procurement processes further cripple research efforts, leading to unused funds and hindering cutting-edge work.

2. Brain Drain: India experiences a significant exodus of skilled researchers, doctors, and engineers seeking better facilities, funding, and career prospects abroad. Annually, 60,000 to 75,000 doctors and engineers leave the country.

This loss of human capital impacts research capacity and innovation, costing India an estimated $35-50 billion annually in foregone economic growth.

3. Ethical and Regulatory Frameworks: Clinical trials face lengthy and tedious approval processes, inconsistent timelines, and frequent regulatory changes, deterring global sponsors. Concerns about genuine informed consent, especially among low-literacy populations, and historical controversies have eroded public trust.

4. Limited Innovation and Global Competitiveness: India's contribution to global clinical research remains modest (1.4% of global clinical research in 2011-12, despite 17.5% of the world population). Research often lacks technological innovation compared to Western counterparts, and there's a disproportionate focus on infectious diseases despite the rising NCD burden.

Recommendations

Addressing these challenges requires a comprehensive, multi-pronged strategy. Here are clear recommendations for policymakers to steer India towards a healthier and research-driven future:

1. Enhance Access and Affordability through Strategic Investment and Digital Transformation

• Strengthen Ayushman Bharat: Continue to expand the reach and depth of the Pradhan Mantri Jan Arogya Yojana (PM-JAY) to cover more vulnerable families, ensuring cashless access to secondary and tertiary care.

Prioritise the establishment and full operationalisation of Ayushman Arogya Mandirs (AAMs) to bring comprehensive primary healthcare closer to rural and urban communities.

• Boost Public Health Spending: Increase government health expenditure as a percentage of GDP, with a clear focus on equitable distribution that prioritises rural infrastructure, personnel, and essential medical supplies.

• Leverage Digital Health: Accelerate the implementation of the Ayushman Bharat Digital Mission (ABDM) to create a robust digital backbone for healthcare.

Promote telemedicine platforms like eSanjeevani to bridge geographical gaps, ensuring remote consultations and diagnoses are accessible and widely adopted, particularly in underserved areas. Develop and deploy low-cost, intelligent diagnostic devices for rural India, enabling frequent data capture and remote expert access.

• Ensure Data Privacy: As digital health expands, enact and rigorously enforce robust data protection policies, such as the Digital Personal Data Protection Act, 2023, to safeguard sensitive patient information and build public trust in digital health initiatives.

2. Strengthen the Research Ecosystem for Indigenous Innovation

• Increase and Streamline Research Funding: Significantly increase India's R&D expenditure as a percentage of GDP. Crucially, shift the funding strategy from generalised per capita allocations to per-researcher funding, ensuring timely disbursement of stipends and grants.

Implement the DHR-ICMR 2024-29 Action Plan with full commitment, focusing on indigenous and affordable health technologies and solutions for challenging health problems.

• Upgrade Research Infrastructure: Invest in modernising research institutions with state-of-the-art equipment and facilities to enable cutting-edge research and attract top talent.

• Incentivise Private Sector Research: Introduce tax incentives and other mechanisms to encourage greater private sector participation and investment in medical research, particularly in fundamental research at universities, not just commercial product development.

• Streamline Regulatory Processes: Continuously refine clinical trial regulations, aiming for transparent, consistent, and efficient approval processes. Strengthen Ethics Committees by ensuring they have the necessary expertise and consistently enforce ethical standards, thereby rebuilding trust and attracting global sponsors.

• Foster Global Collaboration and Data Interoperability: Actively pursue international partnerships in medical research, ensuring equitable collaboration and transparent data sharing. Promote health data interoperability through initiatives like federated learning to unlock the full potential of AI in research while protecting patient privacy.

3. Invest in Human Capital and Prioritise Preventive Care

• Address Workforce Shortages and Maldistribution: Expand training programs for local healthcare providers in rural areas. Implement the National Commission for Allied and Healthcare Professions Act, 2021, to create a well-trained cadre of allied healthcare professionals, facilitating task shifting and alleviating pressure on doctors.

• Retain Talent and Combat Brain Drain: Implement long-term strategies to retain skilled medical professionals by aligning salaries with global standards, creating advanced career opportunities within India, and strengthening educational institutions.

• Support Professional Well-being: Implement systemic interventions, including comprehensive mental health support systems and emotional intelligence training, to address the significant occupational stress and burnout faced by doctors.

• Shift to Preventive Healthcare: Reorient the healthcare system from a reactive, disease-centric model to a proactive, preventive one. This includes promoting affordable and smart devices for periodical health screening and intelligent alert systems for NCDs.

Foster multi-sectoral collaboration to address NCD risk factors through evidence-based interventions and policies. Continue to emphasise national programs like the Universal Immunisation Programme and initiatives tackling nutritional deficiencies.

Vision for a Healthier India

India's journey towards universal health coverage and global leadership in medical research is ambitious but achievable. By systematically addressing the identified challenges through strategic investments, streamlined regulations, and a renewed focus on human capital and preventive care, India can transform its health landscape.

Its vast and diverse population, coupled with its growing technological prowess, positions it uniquely to drive affordable innovation and contribute significantly to global health security.

The ongoing efforts are laying a crucial foundation, but sustained commitment and agile policy action are paramount to realising the vision of a "Viksit Bharat" – a developed India, where health is a fundamental right and a cornerstone of national progress.

Disclaimer: The views expressed in this article are of the author and not of Medical Dialogues. The Editorial/Content team of Medical Dialogues has not contributed to the writing/editing/packaging of this article.