Poor Health Care Infrastructure, Lack of Doctors has Made COVID-19 Pandemic so Worse in India

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Globally COVID-19 has reached the community spread phase. Be it developed or underdeveloped, rich or poor, no one is spared from the wrath of this fatal pandemic. Broadly speaking, the majority of the countries are facing these challenges such as difficulty in stopping it’s spread and shortages in various health care supplies.

India has confirmed a mark of 276,146 COVID-19 cases as of today. Of these, 7,750 people have died and 134,670 people have recovered from the virus. But the healthcare system in India is declining each day. And with a huge population of 1.3 billion, it won’t be able to cope with the Pandemic if the system is not revamped accordingly. With a public health care system that is in a mess, many people are looking with suspicion at the country’s efforts to battle the COVID-19 pandemic. This is creating complications for government and health authorities to combat with. With 8 physicians per 10,000 citizens and 8.5 hospital beds per 10,000 citizens, we can say India’s Health care sector is not equipped for this pandemic.

According to the government, public health facilities available for COVID-19 case management are categorized into three main categories – Dedicated COVID Hospital (DCH), Dedicated COVID Care Center (DCCC), and the Dedicated COVID Health Center (DCHC) respectively. Now talking about each category, DCH offers comprehensive care primarily for those patients who have been clinically assigned as severe cases. The second category is the DCHC, it offers care for all cases that have been clinically assigned as moderate. The third category is the DCCC, it offers care only for those patients that have been clinically assigned as mild or very mild cases or COVID-19 suspect cases. The third category that is DCHC offers care for all patients that have been clinically assigned as moderate.



Lack of beds
In India, there is a huge shortage in the availability of beds in COVID-19 assigned hospitals. According to Raghuram Rajan commission states wise, Bihar has 0.12 beds per thousand people. It is the state with the fewest beds per person. And Odisha which is the poorest state of India has 0.38 beds per thousand people. In the Northeastern states of India, Manipur and Assam have 0.48 and 0.32 beds per 1000 people, respectively, which is way below the national average of 1.13 beds per thousand people. Whereas other states of Northeast India and South India have a better capacity to serve its patients. Their statistics are near to or above the national average.

Lack of health insurance and essential medicines
In India, more than 80 percent of the entire population still does not have any fundamental health insurance coverage. Also, approximately 68 percent of the Indians have limited or no access to essential medicines. Moreover, over the last twenty years, the availability of free medicines in all public healthcare facilities has reduced from 31.2 percent to 8.9 percent for inpatient care. And for outpatient care, it has declined from 17.8 percent to 5.9 percent, as declared by a rating agency with respect to the Public Health Foundation of India study.

Lately, health insurance is being emphasized during this pandemic. It is important as the insurance regulators in India had made it clear that any hospitalization case due to COVID-19 would need to be covered under health insurance that covered admission to any given hospital. This clearly meant that individuals who tested COVID-19 positive and were undergoing treatment at a hospital would be eligible to get claims under their health policy.

Lack of doctors and Nurses
India is quite short of the prescribed strength of doctors and nurses. This is purely a reflection of a wider healthcare gap. In the current scenario, India has one doctor for every 1,445 citizens —below the WHO’s prescribed norm of one doctor for a batch of 1,000 people. And it has only 1.7 nurses per 1,000 people which is almost 43% less than the prescribed minimum of three as per WHO norms. This includes ANM nurses, GNM nurses, and women health visitors. Currently, India has 3.07 million registered nursing personnel which is not sufficient to meet the rising demand in the country.

An absolutely hampering constraint in the Indian healthcare sector is that of doctors. A doctor usually takes approximately 6 to 12 years to acquire the necessary qualifications including MBBS and PG degrees. So, the total number of doctors in a country cannot be increased quickly in a short span of time to meet the current public demands. Overall 1.2 million allopathic doctors were registered in India as of Sep 2019. And assuming 80% of availability, about 961,000 may be available for service at this time. This gives a doctor-population ratio of 1:1,404 against the WHO prescribed ratio of 1:1,000. In the country shortage of doctors varies in different states. This shortage is mainly due to uneven rural-urban distribution patterns. Anything to do with Public health hospitals is a state subject. So the primary responsibility to work upon the availability of doctors in public health facilities lies solely on state governments.

Lack of PPE supplies
In India, each day doctors and healthcare workers are risking their lives at the forefront of the fight against COVID-19 pandemic. This is due to the shortage of supply of various PPE’s (Personal protective equipment) like masks, gloves, goggles, and face shields. Government delay in policymaking and very slow procurement of resources has resulted in this imminent shortage of equipment for health care workers thereby risking their lives. PPE’s are mandatory for all health workers while they are screening, testing, or treating people for the COVID-19 virus. Many doctors, as well as manufacturers, have flagged the issue of dwindling PPE supplies in this pandemic.

Lack of ventilators
A ventilator is a mechanical breathing medical equipment that can blow oxygen and air into the lungs. Ventilators are critical for the care of people with a lung infection. Lack of ventilators in hospitals is one of the major complications suffered by patients with severe COVID-19 infection. The number of ventilators today available in the country is about 57,000 devices. But most of those available ventilators cannot be used by COVID-19 patients. As per a report, the country might need anywhere between 110,000 – 220,000 ventilators by June 15 in the worst scenario.
But healthcare experts say we may have to struggle more if COVID-19 cases surge in the coming days ahead because nearly 3 percent of COVID-19 patients would require ventilators. Experts across the industry including doctors, engineers, and even entrepreneurs are trying to solve the ventilator issue.

The scarcity of these resources has weakened the Indian health care infrastructure, even more, leading to a rapid increase in COVID-19 cases throughout the country. At a time when even highly developed nations are struggling to deal with this pandemic, it is no exception that India has to deal with the same. Due to an exceptionally large and dense population, India’s debilitated health care infrastructure is in many ways disadvantaged to deal with this pandemic. So stringent actions need to be taken by policymakers to address these underlying issues.

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