What Must Be Done Before A Third Wave?

Context: The pandemic has exposed India’s threadbare public health system. The article discusses critical gaps in the Indian healthcare system and the prospects of actions needed.

Critical gaps in India’s healthcare system

• Rural areas lack adequate public health infrastructure: To address the rising rural spread of the virus.
  • Rise in rural caseload: Over half of all new covid cases (53% in the last week of May) reported from rural areas.
  • Bihar and Uttar Pradesh, which have inadequate public healthcare, the share of rural cases in May was a high 79% and 67%.
  • Inherent infrastructure gap: National Health Profile 2019 point out that India has 600 hospital beds in public hospitals per million persons, which is far less than WHO recommended standard of 5000 beds per million population.
• Staggering shortage of healthcare workers: In India, there is a government doctor for every 10,189 people, while WHO recommends a ratio of 1 doctor for every 1,000 persons.
  • A report by the US-based Centre for Disease Dynamics, Economics & Policy (CDDEP) estimates a deficit of 600,000 doctors and 2 million nurses in India.
• Wide disparities between states: Public hospital beds per million population range from 171 in Bihar to 1,231 in Andhra Pradesh.
  • One Primary Health Centre (PHC) in Kerala caters to an average population of 13,746 persons, whereas in Jharkhand, it is 97,296 persons.
  • Disparities in quality of infrastructure in PHCs: In Andhra Pradesh, Telangana and Rajasthan, all PHCs have at least 4 beds, whereas, in Odisha, only 8% of PHCs have recommended 4 beds.
  • On average, a health worker in a PHC caters to 1,821 persons in Kerala, compared to 7,410 in Uttar Pradesh.
• Abysmal state spending on healthcare: Ministry of health and family welfare got just around 0.3% of GDP for much of the last decade;
  • Even including states’ health budgets, this goes up only to 4% of GDP, shows WHO data for 2018; lags behind China (5%), UK (10%) and US (17%).
  • 2021-22 Economic Survey ranked India at 179 out of 189 countries in the priority given to health in public spending.
  • Compounded by the low share of capital expenditure: In 2018-19, this was 11.2% for states and 10.3% for the Centre, according to data from the Comptroller and Auditor General (CAG).
  • About 85% of all capital expenditure on health is incurred by state governments.
  • For e.g. In 2020-21, Jharkhand spent Rs 4,312 crore on public health; of this, only Rs 271 crore, or 6%, was on capex.

Way forward

• Leverage private sector: In upgrading medical infrastructure, as well as in training doctors and paramedical personnel.
  • According to National Sample Survey on healthcare expenditure conducted in 2019, 55.3% of hospitalisations take place in private facilities.
• Upgrade infrastructure: Emphasise creating durable and robust infrastructure that can be used even after the pandemic wanes. Address the healthcare expenditure gap.
• Mobilise medical staff on a war footing: Further policies like deploying final year MBBS students and nurses on covid-19 duties, prioritising forthcoming government recruitments for medical personnel completing 100 days of covid-19 duties etc., are needed.
  • Call for expansion: Karnataka government has announced that it will mobilise nearly 100,000 medical and nursing students for covid-19 duty immediately.