How covid-19 pandemic exposed India’s chronic underinvestment in healthcare

New Delhi: Terming covid-19 pandemic as a “wake-up call” for India’s health system, a Confederation of Indian Industry (CII) report has said that India's public health-care system is chronically underfunded, leaving big gaps in the primary healthcare delivery.

The report titled-- strengthening public health delivery-- released on Monday said that all public health activities required for covid-19 epidemic control – including testing, early detection of cases and various preventive measures – are being carried out by Primary Health Centre (PHC)-level staff, despite often being overburdened due to inadequate staffing in many states.

As the primary health centres are already overwhelmed due to the public health crisis and face severe shortage of resources, the report highlighted that inadequate health services due lack of basic supplies and equipment, shortage of skilled work force medical and para-medical staff who are overburdened with long hour duties has further worsened the situation. The medical and para medical staff includes doctors, nurses, mid-wives, auxiliary nursing midwives, ASHAs and Anganwadi workers.

“The Covid-19 pandemic has exposed gaps in our system and showcased our under investment in our overall public health infrastructure. We need to develop a cohesive strategy to address the issues we are facing,” said Dr Randeep Guleria, Director All India Institute of Medical Sciences (AIIMS), New Delhi and Chairman CII Public Health Council.

He was speaking at a virtual event of CII in partnership with Ministry of Health and Family Welfare and the Ministry of Ayush--“India Healthcare Week” with the theme “Redefining Healthcare Ecosystem”. “The quality of our rural infrastructure is poor, and our priority need to be focused on the improvement of rural healthcare infrastructure through government facilities and nursing homes, along with improved manpower, while developing our district level capabilities,” Guleria said.

The Indian Public Health system is a tiered structure, where at the bottom of the pyramid are sub-centres, catering to a population of 3,000-5,000 each, roughly five villages. PHCs are the first base, acting as referral units typically for six sub-centres. PHCs function as the core, and flow into community health centres (CHCs), followed by sub-district and district 11 hospitals. At the apex are medical colleges and advanced research institutes such as the All India Institute of Medical Sciences.

“Challenges for upgrading primary healthcare include insufficient resources for equipment, medicine and vaccine supplies, deficient workforce, unmanageable caseload, clean toilets, and overall health facility,” the report said.

While guidelines and standard operating protocols (SOPs) are in place, the report said, challenges strengthen testing protocols across states with limited manpower persists, which can only be revamped with effective collaborations in Public-Private partnership models. Resilience of the frontline staff has to be built over the years for strengthening response strategies not just for this pandemic but also for future health crisis. The report highlighted that the proportion of the Union health budget allocated for the National Health Mission, for supporting primary and secondary health care, was reduced to 49% in 2020-’21 from 56% in 2018-’19, while the share for health insurance schemes, focussed on higher level hospitalisation care, has more than doubled to 9 % from 4 % in the same period. The declining trend for support to PHC must be revisited urgently and upscale to at least 70% of all health budgets, the report said.

Even in comparison to countries classified as the “poorest” in the world, India’s share of public expenditure on health as percentage of the GDP is far too lower than countries. In the National Health Profile 2019 - a detailed account of socio-economic status, disease burden, health finance, health infrastructure and human resources in the sector - the government admitted that in 2016, its public spending on health was just 1.17% of the GDP. States drive health spending in India; centre's contribution has stagnated.

“There is a need to augment our healthcare infrastructure and try to reach 2 beds per 1000 people by 2025. The private healthcare sector needs to play a more pivotal role about training specialists, doctors and high-quality nurses to ensure we achieve a robust and cohesive healthcare infrastructure,” said Dr Vinod Paul, Member, NITI Aayog.