Access, Quality & Sustainability - The Trinity That Matters

Access, Quality & Sustainability - The Trinity That Matters

Manoj Jagathmohan, Director & Head, QIAGEN India, 0

He has over 25 years of leadership experience in healthcare diagnostics and working towards bringing accessible and sustainable technologies to the market that have changed the paradigm. During these pandemic times his organization has been in the forefront of providing innovative COVID -19 lab solutions which has vastly supported testing across the country.

The last few weeks during the second wave has been intense for almost each of us, we have faced way too many challenges and stumbled upon situations where we strived to support each other as best as possible. It is important we continue to move forward strongly with the same grit and determination. We need to stand by each other fueled by the spirit of “one for all, all for one”. The result of this spirit must be that we leave no one behind.

The COVID-19 pandemic has a significant im-pact on the global economy. In 2020, the global Gross Domestic Product (GDP) decreased by 3.4 per-cent, while the forecast for this year was 2.9 percent GDP growth. The COVID-19 pandemic has hit people with underlying health conditions hardest—for example, diabetes, hypertension, chronic obstructive pulmonary disorder, and obesity, which are common across most of the world’s economies, have been associated with higher risk from COVID-19. In India, nearly 5.8 million people (WHO report, 2015) die from NCDs (heart and lung diseases, stroke, cancer and diabetes) every year or in other words 1 in 4 Indians has a risk of dying from an NCD before they reach the age of 70. n a report “India: Health of the Nation’s States” by Ministry of Health and Family Welfare (MOHFW), Government of India (GOI), it is found that there is increase in the contribution of NCDs from 30% of the total disease burden.

In total, 20.5 million years of life may have been lost to the coronavirus pandemic among the studied 81 countries, due to 1,279,866 deaths from the dis-ease. The average years of life lost per death is 16 years. Of the total years of life lost, 44.9% appears to have occurred in individuals between 55 and 75 years of age, 30.2% in individuals younger than 55, and 25% in those older than 75 as of January 6, 2021.

According to the International Labour Organization, currently over one billion workers worldwide are at high risk of a pay cut or losing their job. The industry sectors across India witnessed a significant decline in growth rate compared to previous years due to the impact of the coronavirus (COVID-19). Manufacturing sector taking a hit of -39.3% between April to June 2020. On the other hand the service industry across India saw the steepest decline of around -47 % during the same time, Trade, hotels, transport, storage, and communication took the major brunt.

There’s a well-understood correlation that as the economy of a country improves, so the health of its citizens improves. What may be less obvious is that the opposite is also true – improving the health of a nation’s citizens can directly result in economic growth, because there will be more people able to conduct effective activities in the workforce. Better health fueled global growth over the past century by enlarging the labor force and increasing productivity. In fact, economic historians estimate that improved health accounted for about one-third of the overall GDP-per-capita growth of developed economies in the past century. What probably was good enough then is not good enough now. We have to bring a system which is always ready proactive and not reactive.

Diagnostic tests are the backbone of efforts to track, treat, and control any infectious disease. The trinity that matters to ensure these efforts are successful are Access, Quality & Sustainability, they coalesce to make the patient care management more effective and efficient in the whole health care paradigm. These are essential to be pandemic ready as they are important and integral part of the whole healthcare spectrum to be proactive and manage patient care.

Access to a solution is critical in addressing a problem, more so in Healthcare. We had witnessed the phenomenal raise of RT PCR test providing labs in the last 16 months to address the COVID-19 testing need, thus increasing access. The number of Total Operational (initiated independent testing) Laboratories reporting to ICMR stands at 2563 labs as on 23 May 2021, 49.2% of which are Government Laboratories and 50.8% are private laboratories. This has enabled 32,86,07,937 total samples tested up to May 22 & 21,23,782 samples tested on May 22, 2021 alone. Enhanced Access made it possible to have testing sites in the extreme points of four cardinal directions in India. The landscape of testing has already changed significantly. We’ve moved from this mentality of sending samples off to a central lab, to now seeing diagnostics begin to appear in people’s homes so they can self-test.
This is really going to change how quickly we can respond to future infectious diseases. Home collections, mobile units and drive-through testing deployed by diagnostic labs has further expanded the coverage and access to the testing. For tests like cervical cancer screening sample collection has been one of the bottle necks leading to reduced access to testing.

Diagnostic tests that are CE IVD approved for self-sampling are already available, such self-collected samples can be picked up further through home collection and delivered to lab for testing, thus in-creasing access to cervical cancer screening. Enhancing access to testing through these labs in sensitized women population will be a game changer to address the burden. The same channel of services must be leveraged best to increase the depth of access for non-communicable disease testing across the country.

The quality of the solution that is accessible is vital. For a diagnostic test which is accessible but of poor quality will do more damage than good, it can lead to other adverse outcomes, including unnecessary health-related suffering, persistent symptoms, loss of function, and a lack of trust and confidence in health systems. Waste of resources and catastrophic expenditures are economic side effects of poor-quality health system. Poor quality of laboratory testing and a heavy reliance on outdated diagnostic technologies can also contribute to misdiagnoses.

While as a country we could scale up covid testing several folds ensuring sustainability of testing and management of other diseases is key as well

There are 8.6 million deaths every year in low- and middle-income countries — the majority of the world, 134 countries — that could have been saved with good-quality health systems. These were deaths from treatable conditions because people didn't get good care. Of that 8.6 mil-lion, we found that 5 million were people who got care but just got poor quality care. The remaining 3.6 million were because of a lack of access, which has been the traditional focus in global health.

Measuring the quality of the health system as a whole and across the care continuum is essential, and more to be done in this area of clinical diagnostics. Quality of care will become an even larger driver of population health as utilization of health systems in-creases and as the burden of disease shifts to more complex conditions.

The quest for sustainability always transforms the competitive landscape, influencing companies to change the way they think about products, Solutions, technologies, processes, and business models. The key to progress, particularly in these challenging times is innovation. With finite resources available to deliver a high standard of patient care, quality improvement must look to maximise sustainable value, i.e. to deliver maximum health gain with minimum financial cost and harmful environmental impacts, while adding social value at every opportunity.

While as a country we could scale up covid testing several folds ensuring sustainability of testing and management of other diseases is key as well. The National Health Mission reported a 21% reduction in institutional deliveries; a 50% reduction in clinic attendance for acute cardiac events; and a surprising 32% decrease in inpatient care for pulmonary conditions in March 2020 compared with March 2019. Cancer care wasn’t far behind, as nearly 70% of patients could not access life-saving surgeries and treatment. Chemotherapy treatments and follow-ups were post-poned.

Even private clinics in major Indian cities reported a nearly 50% decrease in patient footfall for cancer care and diabetes from the numbers they saw earlier. This is of paramount importance to deliver continuity of services. Certain disease areas despite hit by the covid pandemic converted the crises into an opportunity by integrating TB case-finding activities and COVD-19 preventive measures. The National TB Elimination Programme could identify and notify 18.05 lakh people with TB including 31% from the private sector (till the middle of December 2020. The response to the COVID-19 pandemic has shown that innovation can be accelerated in the right circum-stances and that collaborative approaches, the sharing of knowledge, and transparent information are critical aspects.

In these VUCA times the Trinity that Matters in ensuring continuous patient management is Access, Quality and Sustainability. While Access creates the path to deliver patient care, quality is the protector and Sustainability ensures no destruction, here no disruption of services. Prioritizing health can be the formula for prosperity and rethinking health as an investment, not just a cost, could accelerate growth for decades to come. The pandemic has issued a clarion call to remodel our health systems and processes to ensure this trinity is always in action such that we not only ensure continuity of care but also have a combat ready healthcare framework.