-PRERNA MISHRA (CORRESPONDENT)
In a Ted Talk delivered in 2015 in the wake of the Ebola outbreak, Bill Gates compared preparing for the next epidemic to preparing for war. If we examine that analogy, they do seem to have similar requirements ─ well-trained personnel, resources that could be expeditiously mobilized in times of emergency, a vigilant monitoring framework, well-developed R&D capabilities and physical and technological infrastructure to make all of this possible.
If we compare the quality of health services provided and the strength of the public health ecosystem of countries like the USA, France, Spain and Italy with that of India, the latter comes off worse. All these countries ranked much higher than India in the Healthcare Access and Quality (HAQ) Index as well as the Global Health Security (GHS) Index, 2019. India ranked 145 and 57 respectively, making it evident that its public health system rests on a shaky foundation. Yet, it is these better-performing nations that are among the worst hit by the coronavirus catastrophe. This certainly drives home the potential for deterioration of the coronavirus situation here.
As per a NITI Aayog report (November 2019), India spends merely 1.13 percent of GDP on health. While the WHO recommends a doctor-population ratio of 1:1000, India has 1456 people depending on one doctor. India has only half the number of doctors, one-third the number of nurses and one-fourth the number of paramedic and support staff that it actually needs. According to The Economic Times, “There is just one primary healthcare center (generally manned by one doctor) for more than 51,000 people in the country”. On top of this shortage is the problem of quackery. In 2016, it was found that 31.4% of so-called allopathic doctors had only completed Class 12.
A UNDP report says that India has 7 hospital beds per 10,000 people which is far below the world average of 28 hospital beds. In fact, as per the National Health Profile of India 2019, there are 21,403 rural hospitals with 2,65,275 beds and 4,375 urban hospitals (government.) with 4,48,711 beds. Given that almost 70 percent of India’s population lives in rural areas, these figures are woefully inadequate. Adding to the already burdensome issue is the problem of poor quality of services provided in government establishments.
The private sector, which is mostly concentrated in the urban areas and includes both legal and illegal practitioners, caters to almost 70 per cent of all healthcare demands. Rising healthcare prices and out of pocket health expenditure at 62 per cent coupled with widespread poverty and inequality pushes 6 crores of Indians below the poverty line every year. A report by the Comptroller and Auditor General of India (CAG) brought to light the fact that India faces a shortage of 27.21 per cent in case of clinical equipment and 56.33 per cent as far as non-clinical equipment (including oxygen supply) is concerned. It was also discovered that in the absence of an annual maintenance contract, critical medical equipment remained unused for more than five years.
Given that India has an acute shortage of trained medical personnel, only around 20,000 ventilators and less than 1,00,000 ICU beds, whose availability is concentrated in cities, slowing down transmission via a three week lockdown was the most plausible option India had. However, the lack of proper planning and the wide scope of the lockdown has created problems in transporting supplies, clinical and non-clinical, exacerbating shortages in some areas.
There have been multiple complaints about poor conditions in isolation wards. In fact, there have been a number of cases of people attempting to flee from the unsanitary conditions in quarantine wards of public sector facilities. The medical personnel fighting the crisis on the frontlines are facing shortages of Personal Protective Equipment (PPE), sanitizers and even eviction from their homes. Despite WHO’s warning regarding possible disruption in supply chains, India waited until mid-March to prohibit the export of domestically manufactured PPEs and respiratory apparatus.
The United Kingdom had to ask 65,000 retired nurses to come back to work due to a shortage of manpower. If India is not careful, it could end up on the same slippery slope. There have already been reports of doctors contracting the very disease they are working so hard to treat.
Less than 50,000 tests have been conducted so far in a country with a population of 1.3 billion. Compared to 3,16,664 tests in South Korea and 1,67,000 in Germany, it is drastically inadequate. There are only 16,000 collection centres across the country and the state-run labs are operating at only 36% capacity as testing kits remain in short supply. India is now looking to deploy Rapid Test Kits.
From the above discussion, it is clear that while India has managed to keep up with the COVID-19 outbreak, it has largely been due to stopgap measures rather than the strength of its public health system. What is important is to understand what we should have been doing all along as epidemics like these can’t really be predicted. It is only long-term planning and a solid foundation that can carry us through them.
The first thing that comes to mind is that India must increase the carrying capacity of its health infrastructure without compromising on quality. Public hospitals must have excess capacity and emergency reserves of equipment that can be stored for a longer period.
If there is one thing that COVID-19 has taught us, it is that supply chains do not remain unaffected by large scale medical emergencies. Investment in research and development assumes great importance in the light of this. Locally sourced equipment will be less expensive, more abundantly available and will boost the economy as well.
An epidemic response framework on the lines of disaster response guidelines must be developed and a central coordinating authority should be empowered to oversee its execution in times of need. The importance of disseminating correct information to the general public cannot be overstated. Media can play a huge role here.
While insurance-based schemes like Ayushman Bharat are helpful, they work on the premise of people purchasing healthcare from private vendors. Strengthening the public sector health services at the primary, secondary and tertiary level is likely to have more productive returns in the long term.
India should capitalise its digital capabilities and look into using AI, GIS etc. in monitoring and analysing the health data. An annual or bi-annual survey would provide valuable feedback on policy impact. Patterns of how diseases spread can be studied to model likely future transmission pathways.
But none of this will happen if India does not increase its productive planned expenditure on health. Therefore, a more incisive health policy coupled with a larger outlay is the need of the hour. As Franklin D. Roosevelt has said,
“The success or failure of any government in the final analysis must be measured by the well-being of its citizens. Nothing can be more important to a state than its public health; the state’s paramount concern should be the health of its people.”
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