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A policy eco-system needed for ‘out of the box’ health options

Loknath Das January 18, 2020 Health Comments Off on A policy eco-system needed for ‘out of the box’ health options
A policy eco-system needed for ‘out of the box’ health options

As shown globally, fresh approaches will lead to improved outcomes for the public

If there ever was a time for thinking innovatively about policy, that time is now. Finance Minister Nirmala Sitharaman will present this year’s Union Budget amidst a slowing economy, lower-than expected tax revenues, and a fiscally stretched government. Lower resources for the social sectors — health and education, mainly — suggest that our culture of innovation should be applied to policymaking.

Other countries have explored innovative policymaking. In the UK, there is a government policy innovation lab, housed in the UK Cabinet Office. France has a one-year programme that puts private sector expertise together with senior public servants for a year, to help them ‘think out of the box’. It was piloted in 20 departments involving 300 senior civil servants in 2017. Demand for the programme is growing.

Ilona Kichbusch, co-chair of the UHC2030, a global initiative to enable universal health coverage the world over by 2030, makes some important observations. First, many of the everyday patterns of our lives — where we eat, how we travel, what we shop for — can endanger our health. That means health goes from being an individual matter to a larger societal one. That changes the focus of healthcare to managing disease and shifts many of the solutions to the most challenging health problems to other areas: education, agriculture, transport, industry, consumer affairs and sports, to name a few. Innovation is about applying a radical and new mindset to health policy.

Policy innovation has been defined as applying fresh insights, resources or approaches that can demonstrate improved outcomes for the public, compared to the conventional ways of doing things.

Here’s one example: a cancer initiative in London developed integrated cancer care pathways by identifying and recruiting clinical leaders as ‘champions’ for each pathway. These leaders convened “pathway boards” that were made up of primary-care physicians, secondary and tertiary-care cancer professionals, and patients.

We have made an auspicious beginning. Take Ayushman Bharat. The announcement of the Prime Minister’s Jan Arogya Yojana (PM-JAY) was a bold step on the road to transforming the state of healthcare in India. It was also backed by strong political will.

Since health is a state subject, policy coordination and coherence — given that many States have similar programmes in place already — are critical to success. To sustain the gains made, and the investment, in Ayushman Bharat, more innovative policy ideas are necessary.

Social impact bonds

Healthcare financing, for example, in India is a huge challenge. Social impact bonds (SIBs) have been used as innovative mechanisms to address unmet needs. An SIB is a contract with the government that pays for better social outcomes and passes on part of the savings achieved to investors.

The world’s first healthcare development impact bond — a type of SIB — was introduced in Rajasthan in 2017. The desired outcome was to improve the quality of care among private maternity care providers in Rajasthan. Success would mean that 10,000 maternal and newborn deaths will be avoided over a five-year period.

A policy designed to make India an innovation centre for original medicines would pay huge dividends. Researchers have discovered new cures for what were considered incurable diseases (like many forms of cancer) through biologics, medicines developed from living cells.

As the disease burden in India leans more heavily towards non-communicable diseases, access to these medicines will be critical to manage the disease and give patients a quality life. A policy ecosystem that drives innovative approaches and a strong science-based culture multiplies positive impact significantly.

These are the goals of innovative policymaking: to discover creative solutions, in the midst of social complexity and uncertain environments, that deliver the most desirable outcomes.


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