How India is using the Covid-19 catastrophe to start fixing its crumbling healthcare system

Badly unprepared for the havoc that could be wreaked by a major surge in Covid-19 cases, India has taken this deadly pandemic as an opportunity to begin mending its inadequate medical infrastructure and to build new capacity.

Early Thursday, Indian ambassador to China Vikram Misri had some good news to share with the nation of 1.3 billion people. He tweeted that a total of 650,000 testing kits, including antibody tests and RNA extraction kits, had been dispatched to India from China’s Guangzhou Airport.

India’s embassy in Beijing and consulate in Guangzhou played a big role in the delivery, external affairs ministry sources were quoted as saying – and India has broadened its search for more testing kits to include Germany, South Korea, France and Israel. In a country that still has a ragtag and woefully inadequate healthcare system to serve the world’s second-largest population, a big inflow of medical equipment is indeed heartening – and crucial.

Could the adversity of the Covid-19 outbreak provide the much-needed impetus for India to begin an overhaul of its ailing healthcare system, by boosting manpower and capacity?

Testing India’s weaknesses

So far, India’s Covid-19 testing levels have been far below what is needed. As of April 19, the country had conducted about 386,791 tests, or 291 tests per million people. Compared to hard-hit Italy’s 22,436 tests per million people, Russia’s 13,294, South Korea’s 10,982, or even the US’ fiercely criticised 11,666 tests per million, it is clear that India is nowhere near adequate when it comes to testing.

Even when we consider the significant difficulties of testing such a vast population, other largely populated nations Brazil, Mexico and Pakistan are a shade ahead of India at 296, 384 and 446 tests per million respectively. Indonesia, which leads South Asia in the number of confirmed cases, trails behind, with 154 tests per million.

Yet, modern India does not want to benchmark itself against Pakistan or Indonesia. It is the world’s fifth largest economy, is led by an extremely popular and proactive leader in PM Narendra Modi, and envisions a permanent seat for itself at the United Nations Security Council. For a resurgent nation with deep ambition, India’s health system has been an embarrassment despite its recent efforts.

Lacking manpower

A 2019 survey published in the British Medical Journal found that the size of India’s total health workforce was 3.8 million as of January 2015 – around 1.2 million less than the total number of health professionals registered with different councils and associations.

Health workforce density in rural India and in states in eastern India is lower than the World Health Organization’s minimum threshold of 22.8 per 10,000 members of the population. Shockingly, roughly 25 percent of working health professionals do not possess the qualifications mandated by professional councils, while 20 percent of qualified doctors are not active in the current workforce.

Then there’s the uneven distribution of manpower. Two out of three doctors, nurses and midwives are working in cities where only 29 percent of Indians live. In many villages, the density of medical professionals is less than that seen in many African countries.

Numbers submitted to Parliament in 2018 show that just 739,024 beds were available in the government hospitals and clinics – that’s roughly one government bed available for every 18,000 people.

The road to recovery

Positively, India has begun to use the pandemic to begin swiftly building capacity over the last two months, with Modi announcing an investment of 150 billion rupees ($2 billion) to strengthen the ailing healthcare sector.

The government has used the ongoing 40-day Covid-19 lockdown, which has resulted in less regular pressure on hospitals, to allocate nearly 110,000 isolation beds and 12,024 intensive care units in more than 600 hospitals for Covid-19 patients only. 

Indian Railways has also pledged to convert 20,000 coaches into medical facilities with 320,000 beds (16 beds in each coach). The national railway company has also begun mass-producing critical protective equipment, including 600,000 masks and 40,000 litres of sanitizer. Meanwhile, the Indian Army is creating another 16,000 isolation beds. The country is also buying more ventilators and individuals states are buying Personal Protection Equipment (PPE) in bulk.

As of April 15, the Integrated Government Online Training (IGOT) system has trained 336,682 new healthcare workers, including 282,433 physicians and 80,543 nurses. More than 160,000 others have enrolled to become healthcare workers. 

Booster dose for the future

Government-led efforts have received a big push in India over the last few years under Modi. In 2018, India said it planned to create the “world’s largest healthcare program,” known as the Ayushman Bharat scheme, with insurance coverage worth around $7,100 paid for by the government and given to 100 million ‘marginalised’ families (about 500 million people). Approximately 150,000 health and wellness centres are also being built under Ayushman Bharat.

Another Modi government scheme, the Pradhan Mantri Jan Aushadhi Yojna, is working to improve access and slash the cost of essential medicines by offering generic alternatives, as well as cardiac stents and knee implants for the poor and the new middle class. The government has also been encouraging private players to innovate and manufacture health products and equipment in India – and the pandemic may only hasten that positive process.

In the face of crisis, a decrepit and tattered system is waking up and putting on its running shoes. Indeed, provided Covid-19 remains relatively under control, this period of adversity could provide India with a staggering opportunity to overhaul its entire medical system. 

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