Covid-19: Private sector has a key role in the battle

The State cannot fight the pandemic alone. It needs help on testing, treatment, PPEs, and a lot more

Countries across the development spectrum are grappling with an unprecedented situation in which a seemingly innocuous viral illness, the coronavirus disease (Covid-19), has spiralled into a global pandemic in less than 90 days. It has infected more than 1.7 million people in more than 200 countries, claimed over 100,000 lives, and brought most of the world to a standstill.

In India, the authorities have responded decisively with a strong whole-of-government approach. However, given the enormity of the challenge, we also need a wholeof-society response.

According to the World Health Organization, a critical lesson from the 2014-16 West African Ebola crisis is that both the public and private sectors need to work in tandem in responding to large-scale epidemics. In the Covid-19 response, the private sector in the country — for-profit and not-for-profit segments — has to play an even more important role, as it is the dominant provider of health services. The National Sample Survey Office’s 71st round data shows that private hospitals, clinics and nursing homes provide over 70% of health care. Data on the nearly 10 million treatments received under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) corroborate this finding.

At present, most of the Covid-19 testing and treatment are being done in public facilities. As the epidemic progresses, both these services will need to be expanded several-fold, and the private sector will need to step in as a major partner and stakeholder.

First, the creation of a large and accessible testing infrastructure is a key weapon to battle the virus. Countries such as South Korea, Singapore, Germany and Japan have been successful in controlling its spread and reducing mortality through early detection and quick containment.

This has been possible only through widespread testing. India has opened testing up to private labs and payment for testing is covered under the ABPM-JAY as well. We need to substantially expand our testing capacity, something not possible without the active participation of the private sector.

Second, as the government deepens its containment efforts, the numbers of quarantine units, isolation wards and intensive care unit (ICU) beds in dedicated Covid-19 hospitals have to be rapidly increased. It will also need to ensure increased and continued supply of essential medical products, from testing kits, masks and other personal protective equipment (PPE) items to oxygen and ventilators. According to a recent Indian Council of Medical Research (ICMR) study, around 5% of those infected will need intensive care and half of those in ICUs will need mechanical ventilation. The study was based on available global epidemiological parameters from the initial phase of the outbreak and comparison with other countries with similar transmission dynamics. These projections translate into large numbers that considerably exceed the capacity of the government’s health care system.

During the current crisis, the activities of the private health sector should be the core part of national health efforts. Private hospitals with adequate infrastructure will need to be converted into dedicated Covid-19 hospitals. This process will, of course, have to be steered by the government through a clear policy framework of designated hospitals, reporting and referral systems, and an appropriate payment system. The experience of purchasing health care services through the ABPM-JAY can be the template.

Some private hospitals can help in managing the treatment of non-Covid-19 patients. With many government facilities being converted into dedicated Covid-19 hospitals, a large number of non-Covid-19 patients will need facilities and providers to take care of their health care needs.

The ABPM-JAY has started a process to bring on board more hospitals to respond to such needs. It is assisting state governments in temporarily empanelling additional health facilities to provide emergency care and treatment for other serious illnesses to all citizens, particularly the poor and vulnerable.

Third, as more private providers join this fight, a major concern that is bound to arise is keeping health care workers from getting infected. Ensuring the protection of doctors, nurses, paramedics, lab technicians and other health care facility staff from infection is of paramount importance. Companies manufacturing essential medical products such as ventilators, masks, face shields, clinical gloves, hand-sanitisers, and sterilisation equipment will need to crank up their production lines. Direct support from banks may be needed for this.

Fourth, the private sector will need to vigorously support the large ecosystem that drives the health system, as the lockdown and ongoing epidemic restrict movement and normal economic activities. The production of essential drugs and medical products, logistics to maintain smooth supply, transportation of health workers, and delivery of food and other essential items must continue and also accelerate. Support for community activities such as night shelters and community kitchens must be strengthened.

Finally, an adequate stage-wise response to the pandemic and its economic, social and political aftermath will require filling many knowledge gaps. Government, private and not-for-profit research institutions need to collaborate to understand the nature of transmission of the virus, the factors that helps to slow down its spread, the most at-risk communities, or the optimal quarantine period.

The fight against Covid-19 involves the continuous management of an evolving public health crisis that threatens to create economic and social disruptions. This is an appeal to all private and charitable health care institutions to join this effort for our people and humanity. It is the time to embrace reality and play our individual and collective roles in the fight.