The timely response in the form of the strictest lockdown imposed by the Indian government helped in slowing down the spread of Corona infection. OXFORD COVID-19 Government Response Tracker” designed to systematically record government response worldwide gave India a score of 100. The other countries to score 100 are Israel, South Africa, Mauritius, New Zeland, etc.
As the lockdown is being eased the number of cases has started swelling. This was expected. The consolation to India is that its recovery rate is above 50% Covid19 pandemic has shaken the world. The healthcare system of countries considered best in the world like Spain, Italy, the USA, etc. Where the government spends heavily on 8-10% of GDP on healthcare are now overstretched. How can India be not affected severely where government expenditure in healthcare is meager 1.2% of GDP and the government is struggling to increase it to 2.5% in the next two to three years. Not surprisingly Indian healthcare system is overwhelmed by Covid19 patients.
This pandemic has inspired us to sit down and reevaluate ourselves and make a paradigm shift in our priorities. Equity in health is defined as the absence of systematic disparities in health or major determinants of health between groups of different levels of underlying social advantage/disadvantage that is wealth, power, and prestige. Investment in health is always a business of profit.
The vast Indian healthcare system comprises of public and private sector both. State governments mainly responsible for people`s healthcare share 64.4% of expenditure. The principal objective of the central government is to implement national programs like Janani Suraksha Yojana, Pulse Polio, Pradhanmantri Sawasthya Suraksha Yojana, etc. The share of expenditure of the central government is 35.6%.
At the time of independence, the private sector provided 5-10% of total patient care which has escalated to 80% today. After 2005 private players began to join the health sector in a big way. The private sector provides better healthcare as there is a shorter wait time, good doctor-patient ratios, and upscale amenities. It also provides huge employment and generates revenue in billions. No wonder it encompasses 58% of hospitals, 29%beds in hospitals, and 81% doctors. All this made India the most sought after medical tourist destination. At present India is offering world-class treatment at a cheaper rate in comparison with developed countries.
But the other side of the coin is not so bright. India the land of Dhanwantari(Health God) and where Atharveda was written 2000-1500 BC whose hymes discuss the well being of human beings in detail never gave as much attention to health as it deserves neither in pre-independence era nor in post-independent time. The poor state of affairs of the public healthcare sector is evident from the fact that private sector is the primary source of healthcare for 70% of urban and 63% of rural households and the household expenditure made out of pocket in India is 62% compared to 16% in the USA and 11% in the UK. The much-hyped doctor-patient ratio in India is less than 1:1000 when only allopathic doctors are counted. If all doctors including Ayurved, homeopathy, unani are included the ratio is 1:860. India will take another 7-8 years to achieve the WHO standard of 1:1000 with allopath doctors. But the bigger problem is the public health sector is not adequately utilizing the existing doctors. Only in Maharashtra a developed state 60%posts in public health department and 41% posts in medical education are lying vacant. In Bihar shortage of doctors is 57%.
Many states are appointing doctors on contract basis. The paucity of beds is a big hurdle in providing quality health to people. The national average is 1,3 beds per thousand but there are many states like Bihar, Odisha, North East states where this number is much below the national average.
National Health Policy covers a wide area of public health. But implementation is poor. Moreover, in public health sector corruption, inefficiency, lack of adequate staff and equipment, a dearth of money, and lack of sense of responsibility are rampant.
Public-private partnership model may work but not in all areas especially rural as it may not be as profit-making as in urban areas. The need for secondary and tertiary care is growing rapidly and there is money in it. So private sectors are more willing to invest in it. But the epicenter of any healthcare is the primary health center. Prevention, early detection, and treatment saves a lot of life and money. India needs to strengthen its primary centers by putting more money, periodic training, supplying adequate diagnostic kits, equipment and drugs, and above all cutting unnecessary interference by bureaucrats who often treat health workers and doctors snobbily. To attract young doctors to rural areas the government needs to provide good perks, housing, facilities for children education, social securities, and proper respect for doctors.
Arrogance in bureaucracy is another impending factor. A collector is the boss of every department in the district, health, education. engineering etc. As a result, he heads without a hundred percent commitment. An approach to make public and private sector work in tandem is probably needed for an hour. That model is already working in Ayushman Bharat and should be expanded. One more such program working for BPL economic group is PM National Dialysis Programme. All stakeholders should be consulted in the course of policymaking. Apart from Covid19 India has a huge burden of communicable and noncommunicable diseases. Neglect of such patients will result in more complications in them and ultimately extra load will be added to already overstretched facilities.
In today’s time, India is a pharma hub. It is the largest supplier of generic drugs to the whole world. More than 80% of the antiretroviral drugs are supplied by India to different parts of the globe. In spite of that its over-dependence on China for bulk drugs(APIs), equipment, and diagnostic kits makes it very vulnerable in the period of crisis like this. One of the major causes of low testing in initial days could be the unavailability of or substandard diagnostic kits. The shortage of PPE, masks, devices almost created a chaos. These days many companies have diversified themselves and started manufacturing devices like a ventilator. They need encouragement, incentives, and a proper market.
India must also reinitiate manufacturing bulk drugs(APIs). Before globalization, India has many manufacturers of APIs & its intermediaries. Torrent, IDPL, Hindustan Antibiotics, Spik, Alembic are some of the companies which were producing bulk drugs in large quantity.
Post globalization China entered into the Indian market and started selling these drugs at a price less than that it sold in China. As Chinese bulk drugs cost 40% less than that of India there was a decline of demand for Indian products. Gradually China captured the Indian market. These units are still in existence but many are shut as there is no demand. The import bill of bulk drugs of India is of rupees 17000cr. India must urgently revive these units and give adequate incentives to manufacturers to make their products globally competitive. India may also lure foreign bulk drug manufacturers.
We are living in an era of technology. The primary health centers must be upgraded technologically with integrating systems. It will empower the patients and reduce healthcare costs. It will help physicians enhance their knowledge and make people aware of health.
It may raise eyebrows to many but it is true. In India, only 53% of the population wash hands with soap and water after defecation. Spitting, micturating by the side of the road, coughing, and sneezing without covering the face in public are common phenomena. Littering is a habit of Indians. We are yet to see the impact of Swachh Bharat Abhiyan. Hygiene should be made an integral part of the school curriculum. The cleanliness drive should be taken on a priority basis and apart from public awareness, the offenders must be legally punished.
The very large and uncontrolled population growth of India is a menace. It will surpass China by 2024 and swell to 1.5 billion by 2030. The unchecked population growth poses additional challenges in the effort to eradicate poverty, achieve equality and provide jobs.No developing country has become a developed country in the last sixty years. India has a very high population density which is a big hurdle in social distancing and isolation in the Covid19 pandemic. In spite of many hurdles like starvation, a cultural revolution that killed 1.5 million people China continued its family planning program. The government must take urgent steps to check the population. It may offer better job opportunities, better wages, cash assistance, etc. to those who agree to the program. If tough measures are required government should not be hesitant to take them.
DR. NIKHILESHWAR PRASAD VERMA