The paradox that is India is most apparent in its health and pharma sector, which provides life-saving medicines and services to the world but denies the same quality of care to its population of 1.3 billion.
The window-dressing is impressive. India’s strong pharmaceutical sector and 21 major vaccine-manufacturing companies have made it the world’s biggest supplier of quality medicines and vaccines. The high quality of products made India the top supplier to the United Nations last year, with sales touching $804 million in pharmaceuticals and medical services.
Health accounted for 80 per cent of the goods and services worth $1.06 billion procured by the UN in 2016, which made India the second largest provider to agencies such as UNICEF, UNDP and WFP.
All the exported drugs meet stringent unified international standards of quality, safety and efficacy. Those that are sold in India do not.
Substandard and contaminated drugs killed five women in Hyderabad’s Niloufer Hospital in February, concluded an inquiry committee report released this week.
“Clinically there is a strong case for suspicion on the questionable quality of drugs and sterile nature of intravenous fluids especially dextrose containing solutions, which might be the cause for all the maternal deaths that occurred at Niloufer Hospital from January 28 to February 4, 2017,” the report stated.
The committee ruled out hospital infection as a cause of death after culture reports showed all operation theatres were sterile.
India’s drug regulation laws are strong, but implementation often isn’t. Over the past year, the Centre has made an effort to improve quality by approving a `1,750- crore scheme to strengthen drug regulatory structures and by notifying the Medical Devices Rules of 2017, which provide for risk-based classification, licensing and regulation of medical devices.
India has banned 344 irrational drug combinations, including popular brands such as Corex, while expanding the National List of Essential Medicines to 376, to be made available free at government hospitals and health centres.
But these efforts fall flat when there is poor quality control – in manufacturing, packaging, storage and distribution – of bulk drugs, about 30 per cent of which are manufactured by small-scale-sector companies.
People using fake medical degrees to practice medicine make news every few months, with West Bengal making news most recently for having an estimated 500 unqualified persons working illegally in the public and private sectors. These doctors, said the CBI officials investigating the case, work using fake degrees and registration numbers of doctors who have retired, left the country or died.
More than half (57.3 per cent) of India’s allopathic doctors don’t have a medical qualification and 31 per cent are educated only up to the secondary school level, said the World Health Organisation’s Health Workforce in India report for 2016. Among nurses and midwives, 67.1 per cent had studied only up to secondary school level.
Though urban doctors have more education and medical qualifications than rural doctors, the number of those working without a medical qualification is shocking. Only 58.4 per cent allopathic doctors in urban centres have a medical qualification, and only 18.8 per cent of rural doctors. In every health-worker category except ‘ancillary health professionals’, women are more educated and better qualified, found the WHO report. Among allopathic doctors, 67.2 per cent of women have a medical qualification compared to 37.7 per cent of men. Among nurses and midwives, 11.3 per cent of women have one compared to just 2.9 per cent of men.
Thirteen women died and many more were hospitalised because negligence resulted in their getting infected during sterilisation surgeries at a makeshift camp in Chattisgarh in November 2014. The surgeon who did the laparoscopic tubectomies was qualified but used the same gloves, syringes and sutures to operate on 83 women in an unsterilised, abandoned building.
Keen to set a record, he abandoned infection-control protocols and spent less than 3 minutes on each patient.
The Chattisgarh tragedy made news because of the high number of deaths, but such deaths are not at all uncommon in India. The Clinical Establishment Act that prescribes infrastructure and services standards and provides for the registration and regulation of all clinical establishments has been adopted by all UTs and only 10 states since 2010. Unless states get serious about providing quality care, people will continue to die of avoidable causes.
As it is, most of us are struggling to stay healthy. If resistant bacteria and devious viruses don’t get you, heart disease, diabetes and cancers might. We can’t escape infection and disease, but we can minimise their impact and improve outcomes by following quality standards in healthcare at home as stringently as we do when we are dealing with the rest of the world.