India: Covid crisis shows public health neglect, problems and underinvestment
A family waits in an ambulance with a patient who has tested positive for COVID-19, for admission to a hospital in Kolkata, India on May 10, 2021.
Debarchan Chatterjee | NurPhoto | Getty Images
The world’s attention is now on India, the epicenter of the global pandemic as the country battles a deadly second wave of Covid-19.
The unfolding human tragedy has laid bare the deeply rooted problems plaguing India’s public 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 vital oxygen or essential medical supplies for loved ones grabbed international headlines.
For a long time since gaining independence in 1947, health was not seen as an economically productive expenditure in the country – unlike investments in industry, agriculture and services, said K Srinath Reddy, president of Public Health. Foundation of India, at CNBC.
“For several decades, health systems in India have not received the respect and resources they deserve. Public funding for health has stagnated around 1% of GDP and direct health spending has exceeded even 60%. in recent years, “he said. in an email. “The central government as well as most state governments had low allocations for health in their budgets.”
India’s healthcare expenditure is comparatively much lower than that of many other countries.
The United States spent nearly 17% of its gross domestic product on public health care in 2018, while France and Germany spent over 11% of their GDP that year, according to World Bank data.
Comparison of India with the rest of the BRICS countries – Brazil, Russia, India, China and South Africa – IThe ndia spent the least on health care in 2018. Brazil spent 9.5% of its GDP on health care that year, South Africa 8.1%, Russia 5.3% and China 5.35%.
India is now the second most infected country in the world, behind the United States alone.
The South Asian nation has reported more than 300,000 new infections daily in recent weeks. Cumulatively, Covid infections have reached nearly 24.7 million with more than 270,284 deaths on Sunday, according to data from the Ministry of Health.
However, health experts warn the numbers are likely vastly underreported and the true extent of Covid infections and the human toll may never be officially known.
In one recent report from Fitch Solutions, the research firm said that despite several healthcare reforms, India remains ill-placed to tackle the rapid spread of the pandemic.
“With 8.5 hospital beds per 10,000 inhabitants and 8 doctors per 10,000 inhabitants, the country’s health sector is not equipped for such a crisis. Moreover, the acute inefficiency, dysfunction and scarcity of health care systems in the public sector do not. meet the growing needs of the population, ”adds the report.
The numbers are grim for a country like India with a population of 1.4 billion, or 18% of the world’s population.
India’s second wave started around February and accelerated in March and April. The virus has spread quickly due to complacency in wearing masks at religious festivals and political rallies that have drawn large crowds to various parts of the country.
While the pandemic has exposed the structural weaknesses of India’s public health system, these problems have always existed, said Chandrakant Lahariya, a expert in medical public policies and health systems, based in New Delhi.
He said this was mainly due to the lack of political will from successive political parties and the ruling government not to make public health a priority.
“Public health has never been a political priority and an electoral agenda,” he said. “Through the hands-off approach, the government has sent a sort of message that health is an individual responsibility. People fail to perceive that elected governments and political leaders should be responsible and held accountable to ensure health services.”
This is where the problem arises, Lahariya noted.
“This has allowed the private health sector to grow in leaps and bounds, while the public sector has remained underfunded and underperforming,” he said in an email. “Now we are in this situation.”
India’s private hospitals are largely commercialized and profit-driven, focused on treating the disease. What makes the situation worse is that the majority of Indians do not have health insurance and pay for health care out of their own pockets.
According to the Fitch report, over 80% of India’s population still lacks meaningful health insurance coverage and around 68% has limited or no access to essential medicines.
While a pandemic can overwhelm almost any health system, including the most well-resourced, the current situation in India was not inevitable, noted UK-based public health doctor-in-training Vageesh Jain. .
“The fundamental problem remains that the private, commercial hospital system does not seek to provide long-term continuous care to people with the goal of preventing and controlling disease,” said Jain, who is currently working with Public Health England on health protection. response to Covid-19.
It is difficult to tackle such problems in any context given the complex and multi-agency solutions required, he added.
“But it is particularly delicate in India where there may be other quick victories in public policies, deemed more worthy of immediate attention,” he argued.
Indian Prime Minister Narendra Modi has been widely criticized for failing to act sooner to suppress the resurgence of the virus.
In a rare reprimand, the British medical journal The Lancet recently criticized the Modi government for waste the first successes to control Covid and “to preside over a self-inflicted national catastrophe”.
“I believe the political will is stronger now, after the prolonged and agonizing experience of the pandemic,” said Reddy of the Public Health Foundation of India. He added that the recent central budget and the recommendations of the finance committee are positive indicators.
When the budget was announced in February, Indian Finance Minister Nirmala Sitharaman proposed more than doubling health care in India and welfare spending at $ 30.1 billion (2.2 trillion rupees).
This includes strengthening national institutions and creating new ones to detect and cure new diseases. There is also a new federal program to develop the country’s capacity in primary, secondary and tertiary care.
Still, it remains to be seen whether the crippling crisis will be a wake-up call for India to take its public health seriously, experts say.
“With this protracted pandemic, there will be a stronger and more lasting imprint in the memory of the public and policy makers. There must be a constant reminder, even after the pandemic is over, that the economy will continue to slide on the banana peels of public health failure if we do not invest in public health and in systems. strong health, ”Reddy said.
Lahariya added that there had been many public health disasters and health emergencies in India before. But most resulted in very minor changes, if at all.
“It is time that strong civic responsibility was imposed in India on elected leaders. The people who elect them should ask them questions. Only then can we expect change,” he said.
“The devastating situation created by the current wave is likely to be forgotten. But must not be allowed to be forgotten.”