India Covid crisis shows public health neglect, problems, underinvestment

A family waits in an ambulance with a patient who tests positive for COVID-19 to be admitted to hospital in Kolkata, India on May 10, 2021.

Debarchan Chatterjee | NurPhoto | Getty Images

World attention is now turning to India, the epicenter of the global pandemic, as the country battles a deadly second wave of Covid-19.

The unfolding human tragedy has exposed the deeply ingrained problems of the Indian health system after decades of neglect and underinvestment.

The crisis has brought India’s public health system to its knees. Scenes of hospitals running out of beds and people desperate for life-saving oxygen or critical medical care for their loved ones have made international headlines.

Low health care allocations

Since its independence in 1947, health has not been seen as an economically productive expense in the country for a long time – as opposed to investing in industry, agriculture and service sectors, K Srinath Reddy, president of the Public Health Foundation of India, told CNBC.

“For several decades, India’s health systems have not received the respect and resources they deserve. Public health funding has stagnated at around 1% of GDP and out-of-pocket health spending has been over 60% even in recent years” he said in an email. “The central government, as well as most of the state governments, had low budget allocations for health.”

India’s health spending is comparatively much lower than in many other countries.

The US spent almost 17% of its gross domestic product on public health care in 2018, while France and Germany spent more than 11% of GDP this year, according to the World Bank.

In a comparison of India with the other BRICS countries – Brazil, Russia, India, China and South Africa – India spent the least on health care in 2018. Brazil spent 9.5% of its GDP on health care that year, South Africa spent 8.1%, Russia 5.3% and China spent 5.35%.

India is now the second worst infected country in the world, just behind the United States.

The South Asian nation has reported more than 300,000 new infections per day in the past few weeks. According to the Ministry of Health, cumulative Covid infections reached almost 24.7 million on Sunday with more than 270,284 deaths.

However, health experts warn that the numbers are likely to be grossly underreported and the true extent of Covid infections and the number of people may never be officially known.

In a recent report by Fitch Solutions, the research firm said that despite several health reforms, India remains ill-positioned to tackle the rapid spread of the pandemic.

“With 8.5 hospital beds per 10,000 inhabitants and 8 doctors per 10,000, the country’s health sector is not prepared for such a crisis. Furthermore, the significant inefficiency, dysfunction and acute shortages of health systems in the public sector do not exist to meet the growing needs of the population “added the report.

The numbers are grim for a country like India with 1.4 billion people, which makes up 18% of the world’s population.

Lack of political will

India’s second wave started around February and accelerated through March and April. The virus spread quickly due to complacency with wearing masks at religious festivals and political rallies that drew large crowds in different parts of the country.

While the pandemic has highlighted the structural weaknesses of India’s public health system, those issues have always been there, Chandrakant Lahariya said. a Expert in medical public policy and health systems based in New Delhi.

I believe that after the long and excruciating pandemic, the political will is now stronger.

Chandrakant Lahariya

Expert in medical public order and health systems

He said this was mainly due to a lack of political will from successive political parties and the government, which had the power not to make public health a priority.

“Public health has never been a political priority or an election agenda,” he said. “Through the hands-off approach, the government has been sending a kind of message that health is an individual responsibility. People are unaware that elected governments and political leaders should be accountable and accountable to ensuring health services.”

This is where the problem arises, noted Lahariya.

“It has allowed the private health sector to grow by leaps and bounds while the public sector remains underfunded and underperforming,” he said in an email. “Now we are in this situation.”

Few Indians have health insurance

India’s private hospitals are largely commercialized and for-profit, and focus on treating disease. What makes matters worse is that the majority of Indians do not have health insurance and pay for health care out of their own pocket.

According to the Fitch report, more than 80% of the Indian population still has no significant health insurance coverage and around 68% have limited or no access to essential medicines.

While a pandemic can overwhelm almost any health system, including the best-equipped, the current situation in India was not inevitable, noted Vageesh Jain, a trained public health doctor in the UK

“The fundamental problem remains that the commercially operated private hospital system does not aim to provide long-term care to people to prevent and control disease,” said Jain, who is currently working with Public Health England on health protection in response to Covid-19.

Given the complex and multi-agency solutions, it is difficult to address such issues in any context, he added.

“But it is especially difficult in India, where there may be other quick public policy wins that are more deserving of immediate attention,” he argued.

A wake-up call for India?

India’s Prime Minister Narendra Modi has been widely criticized for failing to act earlier to suppress the virus resurgence.

In a rare reprimand, the British medical journal The Lancet recently beat up the Modi government for squandering early successes in controlling Covid and “presiding over a self-inflicted national disaster”.

“I believe that the political will is now stronger after the long and excruciating pandemic,” said Reddy of the Public Health Foundation of India. He added that the latest central budget and the Finance Commission’s recommendations are positive indicators.

The devastating situation caused by the ongoing wave is likely to be forgotten. But it must not be forgotten.

When the budget was announced in February, Indian Finance Minister Nirmala Sitharaman proposed that spending on health and wellbeing in India should more than double to $ 30.1 billion (rupees 2.2 trillion).

This includes strengthening national institutions and creating new institutions to identify and cure new diseases. There is also a new federal system in place to develop the country’s capacity for primary, secondary and tertiary care.

However, whether the crippling crisis will be a wake-up call for India to take its public health seriously remains to be seen, experts say.

“With this ongoing pandemic, the memories of the public and policymakers will last stronger and longer. Even after the pandemic has ended, it is a constant reminder that if We don’t invest, the economy will continue to slide on the banana peels of public health failure in public health and in strong health systems, “Reddy said.

Lahariya added that India has seen many public health disasters and emergencies. But most have resulted in very little, if any, changes in health systems.

“The time has come for India to have solid accountability of citizens to elected leaders. Questions should be asked of the people who elect them. Then only we can expect change,” he said.

“The devastating situation caused by the ongoing wave is likely to be forgotten. But it should not be forgotten.”

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