Going beyond the slogan

The Prime Minister’s enthusiastic call ‘vocal for local’ or his localisation vision, if you will, has expectedly received media attention and appreciation from many admirers, including in industry. Emphasising self-reliance or an Atmanirbhar India, the government has asked that products not just be made in India, but local brands and supply chains be promoted. While articulating a vision is easy enough, walking the talk needs focus, discipline and entrepreneurial risk-taking, and a progressive policy framework conducive to innovation and scale. It is perhaps about time that local industry and governments together went about the business of translating slogans into action. After all, India is the biggest and the fastest-growing market in the world for the vast majority of product categories. The public healthcare sector, for instance, on which the vast majority of the poor depend, generates significant demand for medical supplies.

Ironically, the onslaught of Covid-19 has also brought in its wake business opportunities of considerable magnitude and turned the spotlight on the enormous but woefully under-utilised potential in the country to manufacture quality hospital equipment, medical devices and disposables. We can rid ourselves of the excessive dependence on imported goods that has served as the easy, lazy response in both public and private healthcare in India thus far.

Consider this: India imports the bulk of hospital furniture, such as hospital beds, OT tables, despite having a number of local manufacturers, simply because they fall well short of quality standards. Basic medical equipment like ECG machines, bedside monitors, syringes and infusion pumps are mostly imported. There is a large number of fine instruments for ophthalmology and ENT, surgical instruments used regularly, and medical devices commonly used that can be manufactured in India to high quality standards with little investment in Research and Development.

Yet, unfortunately, we do not even manufacture a quality, world-class IV Fluid delivery set. This is a shame because these are products used in large quantities. Though a few Indian manufacturers have improved some of their products, the quality does not match up to the best in the world. Our own specifications fall short: they have to be manufactured like precision products; tooling and design, and raw materials, have to be best of class; and the manufacturing process automated with laser-assisted quality checks. There are genuine reasons why our pricing is not right, quality below best-of-class standards, and the extant procurement policy seriously compromised. These deeply entrenched causes need to be addressed.

If we want to go beyond being vocal and truly implement local, it will require courage to face up to the political economy dimensions of being a prisoner to imports of even rather basic healthcare supplies -- the vested interests and corrupt lobbies -- that currently circumscribe the healthcare sector.

A more important reason, to break out of the health supplies-import syndrome, must be the realisation brought home in morbid fashion by the pandemic -- that there is an urgent need to at least double the existing public healthcare delivery infrastructure. What is more, this will need to be done over the short-term, say no later than the next five years, if we are to be equipped to face other zoonotic pandemics that might confront us in the future.

Existing public health infrastructure, including government hospitals and teaching hospitals, can be upgraded and doubled for a fraction of the costs relative to the unconscionably high costs that private hospitals might require. This, in itself, should give the private players a run for their money, and perhaps serve as a catalyst to inspire them to lean more towards Hippocrates and a little less towards Mammon.

Yes, considerable changes in public healthcare will need to be wrought, not least to make them more accountable, enhance the quality and the adequacy of service delivery, and upgrade quality assurance standards in both products and services under the public healthcare system. This is not an option but an imperative -- the poor, the disadvantaged and the vulnerable have no recourse but the public health system. Government hospitals and teaching hospitals must be compelled to compete with the private healthcare players, but only after they are provided an even playing field, and of course rigorously audited for performance.

To achieve this, the government must specify quality standards for every product used in a hospital to meet the standards prescribed by the Food and Drug Administration or the European CE mark, as the case might be. This is important because when the Prime Minister says go ‘vocal for local’, it is implicit that products be made competitive vis-a-vis global brands, to enable local brands to have a global presence.

Several factors determine the length of time it takes for a medical device, particularly a new device, to reach its end-user. One is the time it takes manufacturers to navigate regulatory requirements and establish the safety of a device and its effectiveness before it gets to the market. In terms of these requirements, government needs to demonstrate a strong will to enable completion of regulatory compliance in no more than 12 months. If this is achieved, it would be practicable to mandate adherence by all manufacturers to the new standards prescribed, if they are to be allowed to commence or continue manufacturing, as is the case with the manufacturers of medicines.

The Central Drugs Standard Control Organisation will need to pioneer the regulatory reform process, if the new standards to be set by the government should become the benchmark for manufacturing; and if the approval process is to be simplified. This is a necessary step if we want to emerge as a high-quality hub for the manufacture of quality hospital equipment, medical devices and disposables.

This would be action that can transform ‘vocal for local’ from the nicely rhyming but nonetheless the mere slogan that it is to becoming a reality on the ground that will hold meaning for manufacturers and users alike, and help transform public health services for the greater good.

(The writer is Director, Public Affairs Centre, Bengaluru)