It's time to face facts: India is facing an unprecedented public health crisis. According to figures released by the National Vector Borne Disease Programme, recorded cases of dengue have risen by 157% between 2012 and 2016, Japanese encephalitis by 124% and chikungunya, which causes debilitating joint pain, by a staggering 300%. Cases of malaria, which the government has vowed to eliminate by 2030 have gone up by 2% over the same period. Needless to say, it is the poorest and most remote parts of the country that make up for the majority of these cases: mountainous and tribal regions, where only 20% of the population live, account for 80% of malaria cases. And with public health spending set at a dismal 1.4% of GDP—a level that has barely fluctuated over the past decade—it doesn't look like the problem will solve itself.
If India is to defeat the scourge of vector-borne diseases it is going to need radical, out-of-the-box thinking. The sheer size of the challenge demands it: according to the Healthcare Federation of India, the country is in need of two million doctors and four million nurses, since 70% of the nation's healthcare services are concentrated in the largest 20 cities. To date, the most radical, and controversial, measure adopted to make up the shortfall has been the training of unlicensed "doctors", otherwise known as quacks. These practitioners, who by any international legal definition are medical fraudsters who have no business treating sick patients, abound in India today. It is estimated that a staggering 2.5 million people are diagnosing, treating and even carrying out surgery, despite having no formal medical training.
Without the help of the private sector to nudge things along, India's public health crises will only multiply in the years to come.
In the state of Madhya Pradesh, fully 77% of all primary healthcare is provided by these informal practitioners, with that figure ranging between 50 and 80% in other states. Some of them may have worked for a while as a doctor's assistant, or studied some homeopathy, but none have anything like the several years of university-level training required to call oneself a doctor. And, as expected, in direct contradiction of the Hippocratic Oath taken by real doctors, these quacks do plenty of harm.
Studies have highlighted the role played by such unlicensed practitioners in the spread of hepatitis C through the reuse of unsterilised instruments and syringes. Or worse, due to a tendency to overprescribe antibiotics, they are contributing to the growth of antibiotic resistant bacteria, as well as exacerbating ailments like diarrhoea and pneumonia—two of India's biggest killers among children—by prescribing potentially harmful treatments.
Groups like the Liver Foundation, a healthcare NGO, have been working to provide the rudimentary medical training that most of these practitioners are lacking. Since 2007, some 2000 quacks have been trained in "harm reduction" methods. The foundation taught them how to correctly diagnose fevers and infections, while also educating them on the perils of prescribing unnecessary drugs.
The programme has met such an enthusiastic reception from both the practitioners and their patients alike that the government of West Bengal has plans to team up with the Foundation to train all 170,000 fake doctors in 33 centres around the state. The support of the government can be explained by the fact that, although still far from adequate, the results have shown significant improvement in the quality of care they provide.
However, laudable as such innovative thinking is on behalf of the government in its efforts to make up for its own deficiencies, relying solely on training quacks is a faulty strategy. A less controversial and infinitely better solution would be to get the private sector on board—and I'm not referring to for-profit hospitals.
Indian companies who take their social responsibility seriously should look to the examples of Rusal, Sanofi and Firestone to find innovative ways of bringing healthcare to villages in need.
For a recent example of how well private public partnerships can work together in the area of disease outbreaks one can just look at the Ebola outbreak in West Africa three years ago. During the height of the epidemic in late 2014, Rusal, an aluminium mining company and the biggest investor in Guinea, built a $10 million diagnostics centre in the city of Kindia. Besides obtaining the highest survival rate in the country, the facility served as a test bed for a new vaccine that has been lauded as a possible preventative against future outbreaks. In neighbouring Liberia, where the tyre manufacturer Firestone has a rubber plant whose workers were threatened by Ebola, the company built a treatment centre and opened its schools, hospitals and clinics to the surrounding community, providing a cordon sanitaire against the encroachment of the disease.
Similarly, last year in Zika-stricken Brazil, the French pharma company Sanofi working in collaboration with Walter Reed Army Institute of Research in the US developed a vaccine was then disseminated among the population. The above provide clear examples of how the pulling power of large companies can be drawn on in the battle against epidemic diseases. There is no reason why the same can't be done in India, where behemoths like Tata, Reliance Industries and Indian Oil could easily invest in India's health system.
One government-led programme that companies like these could hitch their carriage to would be the smart villages initiative. Even something as simple as harnessing White-Fi—the unused spectrum owned by TV stations to provide wi-fi signal—could help rural communities partly offset the shortage of doctors by making telemedicine and teleconsultations with doctors from nearby cities possible.
To be fair, while the government did introduce telemedicine in 1996, the programme has so far largely failed due to slow internet speeds and infrastructure. Without the help of the private sector to nudge things along, India's public health crises will only multiply in the years to come. Indian companies who take their social responsibility seriously should look to the examples of Rusal, Sanofi and Firestone to find innovative ways of bringing healthcare to villages in need.