Photo courtesy of the Lancet Citizens’ Commission.
On February 16th, 2022, the Lakshmi Mittal and Family South Asia Institute at Harvard University, the Asian Bureau of Finance and Economic Research (ABFER), and Harvard’s Center for International Development (CID) co-sponsored the second of a three-part series, Post Pandemic: Driving Inclusive Growth in Asia. The Mittal Institute’s Faculty Director and Jorge Paulo Lemann Professor at Harvard Business School, Dr. Tarun Khanna, moderated the event titled Healthcare in Asia: Post Pandemic. The event brought together a diverse panel of experts focused on Asia: Dr. Manoj Mohanan, Associate Professor of Public Policy at Duke University in the US; Dr. Nachiket Mor, Visiting Scientist at the Banyan Academy of Leadership in Mental Health in India; and Dr. Sonia Bhalotra, Professor in the Department of Economics at the University of Warwick in the UK.
Dr. Khanna opened with the notion that the COVID pandemic has shone a brighter light on pre-existing fissures, many of which have been more extreme in developing countries and have likely been exacerbated by the pandemic. He asked whether there is a way to reset the trajectories of these economies toward more inclusive growth. He also talked about a commission of which he is a part of, called the Lancet Citizens’ Commission, whose goal it is to reimagine India’s healthcare. He drew attention to the role of the citizen in rethinking the system and moving toward a people’s vision of universal health coverage in India.
Dr. Mohanan started the panel discussion by focusing on the “stunningly low” quality of healthcare in India. Even where there has been an increase in care, there hasn’t been in an improvement in outcomes due to continued low quality of healthcare delivery. “You can deliver more, but if it’s the same quality of care, that doesn’t change outcomes.” He gave an example of oral rehydration solutions, which is a well-established practice and intervention for patients presenting with diarrhea. He says that 70% of doctors report they will give oral rehydration, while only 17% actual do. He suggests there is something broken in the system, including accountability and the need for incentives. “People know, but they don’t adhere to the guidelines; that’s the challenge.” He suggests thinking of strategies for improved adherence to guidelines and evidence. He says there needs to be a change in the culture of how providers adopt these guidelines into their own practice and said that the pandemic has made this even clearer: “We’ve learned how important this is over the last couple of years.”
The discussion then shifted to a focus on women’s health. Dr. Bhalotra made the case for investing in women and early life health investments and also posed some challenges in achieving universal health coverage. She focused on four key areas of neglect: maternal depression, domestic violence, maternal mortality, and selective abortion of girls. “Addressing these issues benefits the happiness, health and productivity of women, with spillovers to the next generation of men and women.” She says there is a need for surveillance to create evidence and monitor progress and adds that the absence of data is a major hindrance to research and policy. Evidence from a Randomized Control Trial (RCT) in rural Pakistan shows the potential for community health workers to have a major positive impact in many areas for women’s health, including maternal depression. She also says that increasing the share of women in policymaking leads to a sharp decline in maternal mortality, as women have the political will to act on known solutions. She concluded by calling for increased focus on expanding a workforce of community health workers with better training, salaries, and numbers. “This would also transform jobs for women and provide skilled jobs close to home.”
And, finally, Dr. Mor discussed how governments are approaching on-the-ground issues raised by the other panelists. He says India’s central and state governments are under the control of public-sector thinking with no real discussion of markets. He said that budget after budget continues to direct investment toward what is already at capacity, for example rural roads. He said there is a need to “recognize that there is a serious market within healthcare.” He also called for a shift in thinking or what he calls “the mental model.” “If you keep hitting at the policy levels without addressing the core beliefs that inform those policies, then we’re not going to get anywhere.” He sees the need to look at the whole system, and that evidence of what works in RCTs should be integrated back into the system rather than focused on a particular intervention on its own. He ended with an opportunity for change: “The good thing about India is that we are spending enough money in aggregate to deliver good healthcare, we’re just spending it badly.”