One country one quality care in health care is the need of the hour

Innovative health care financing with quality care embedded will show demonstrable population outcomes.

By Pompy Sridhar

The need for catalytic funding in healthcare is apparent more than ever before. Health care can be made more accountable by correcting three defects: over- and under-utilization, inequity, and high out-of-pocket expenditures, which often discourage people from seeking healthcare sooner rather than later. The good news is that quality has finally become a focus of democratic politics in India. Taking account of the views of women is a priority, while state governments are under great pressure to reform their health system and make it more user-friendly.

In addition to integrating the private sector, health care systems must establish basic standards and guidelines to ensure quality of care at the very least. Innovative healthcare financing will ensure affordable care at the last mile but will need to have quality care embedded in the DNA to show demonstrable population level outcomes. The demand for quality is missing and it needs to be bought front and center in the healthcare narrative.

Access to capital is critical and the incentives need to be aligned for this to happen. Relevant rules and policies need to be examined in this context. Regulations need to be reviewed to ensure there is correct balance of pre-determined outcomes, and necessary level of due diligence and compliance is maintained when such models are scaled. It is time for One Country One Quality standard in healthcare.

Unlocking private sector capital to finance India’s healthcare needs

By shifting investments away from improving medical indicators such as maternal mortality, we risk undoing some of the significant progress we’ve made as a country in recent decades. For India’s healthcare priorities to be realized, catalysing funding and resources is more critical now than ever. Private sector has an indispensable role to play in this regard.

As the government works to bring the country back on its feet, the private sector can mobilize to plug the funding vacuum and complement the government’s efforts in ensuring holistic recovery as we build back. But it’s not simply channeling resources – private sector funding is crucial to incentivize experimentation and innovation that can not only create fiscal space for healthcare but also allow scalable, sustainable, and impactful models of healthcare delivery to flourish

Through innovative financing mechanisms, the private sector can solve for one of the most intractable challenges in grant-based healthcare models for sustainability. There is a risk in excessively relying on funding and implementation agencies. Therefore, a sustainability strategy must be woven into the program from the beginning, and into a larger global discourse on private-sector healthcare funding.

This can ensure that all stakeholders are geared towards a dual vision: focusing on achieving targeted outcomes while working to sustain the program long-term so that the impact is not disrupted once the funding cycle runs its course – for instance, via advocating with the government to adopt and scale the intervention model. It is here that innovative financing can play a significant role, as evidenced by the world’s first maternal health Development Impact Bond implemented in Rajasthan – Utkrisht.

The Utkrisht Impact Bond, aimed at enhancing maternal health outcomes in Rajasthan, India leveraged private and public capital to mobilize innovation and improve the quality of maternal care in over 400 hospitals in Rajasthan, by training and certifying them on clinical standards of safe, respectful, and quality care. The success and efficacy of the Utkrisht model relies heavily on the way it is structured – as a results-based program vis-à-vis a traditional grants-based approach that prioritizes outcomes rather than inputs and processes. The impact is significant and tangible: not only has the intervention succeeded in improving the quality of maternal care in the pre-determined number of facilities, but the payouts from outcome payers have also already been released to the funder six months ahead of schedule, with some capital channeled back to the implementation agencies.

The most significant factor that enables success for an outcomes-based model like Utkrisht is the independence to course-correct and alter the direction and strategy of the program. Since implementation agencies retain a laser-sharp focus on meeting pre-determined targets, and their progress is independently monitored in real-time, they have the incentive and flexibility to bring innovation in program design and service delivery in order to the adapt to the changing needs of the program. Not only does this amplify the impact that the intervention is able to foster, but it also strengthens accountability and transparency at every stage of implementation.

Others are following suit. As a pioneer of this model in India, Utkrisht not only can be used as a case study to learn from and be replicated to improve other development indicators but will also facilitate greater innovation in financing and program design. As the success of innovative financing models becomes evident, it will also attract government buy-in and partnerships, paving the way for scale and sustainability for healthcare interventions.

For instance, Maharashtra’s Pimpri-Chinchwad Municipal Corporation (PCMC) has signed an MoU with the United Nations Development Programme (UNDP) to co-create India’s first Social Impact Bond, aimed specifically at strengthening the public healthcare ecosystem in the area. In a first, the government body will act as the outcome funder – and not the upfront investor as traditionally expected – once the pre-defined targets of the SIB are met.

While COVID-19 has indeed presented many challenges and continues to overwhelm the healthcare system, it also presents a unique opportunity to rethink and restructure how we fund, design, and implement development programs in India. 

If we are able to embed long-term sustainability at the heart of the program – with innovative financing as a key catalyst and enabler – we can ensure that the impact we seek to create is deep, long-lasting, and continues undisrupted.

(The author is India Director, MSD for Mothers. The article is for informational purposes only. Please consult health experts and medical professionals before starting any therapy or medication. Views expressed are personal and do not reflect the official position or policy of the Financial Express Online.)

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