Indian Health Care Infrastructure and COVID-19

Sujoy Ghosh

India’s devastating second wave of coronavirus outbreak overwhelmed our health-care system. People who are waiting outside hospitals — where there are no longer any beds or even oxygen, in need of assistance either for themselves or their relatives, posted requests on social sites such as Twitter, Facebook, WhatsApp and Instagram. The agonising images of funeral pyres set up in public parks, burning an endless line of bodies, is only a glimpse into the tragedy unfolding across the country.

COVID-19 pandemic has highlighted the structural weakness in Indian Health Care System, ranging from inadequate hospital facilities and insufficient numbers of doctors and health care workers. 

According to CDDEP report published on (20 April 2020) and National Health Profile 2019, The total hospitals in India are 69,264, i.e., (public hospitals—25,778 and private hospitals—43,486); ii) the total hospital beds—1,899,227 (Public sector-7, 13,986; and Private sector—1,185,241); (iii) the total number of ICU beds—94,964 (Public sector—35,700 and Private sector 59,264); (iv) total ventilators—47,481 (public sector—17,850; private sector—29,631).

Above data clearly shows that most of the healthcare facilities in India lie in the private sector. There are only 5 government hospital beds and 9 private hospital beds are available per 10,000 Indians. In case of the availability of ICU beds, only 3 government hospital beds and 4 private hospital beds are available per 1,00,000 Indians.

According to WHO’s COVID-19 report (World Health Organization. Coronavirus Disease 2019 COVID-19 Situation Report-46), around 15 percent of total tested positive cases need hospital care and 5 percent of the total cases need ventilator support. Now to understand this with the perspective of our existing health care system, let’s consider that in a particular day the number of COVID-19 positive cases are 1,00,000. So as per WHO’s benchmark, 15,000 COVID-19 patients need hospital beds and among those 15,000 there would be 5,000 cases that need ventilator support. In a country where, there are 14 hospital beds are available per 10,000 person, and just 4 ventilator support per 1,00,000 population, it would not be very difficult to understand the pain of getting a hospital bed and ventilator support for a COVID patient.

Moreover, our country also lacks on health professionals. According to the WHO data on the density of medical doctors (per 10,000 population), most developing sub regions, namely South Asia, Africa, and Southeast Asian countries, have fewer than 10 doctors per 10,000 populations. Presently, India only has 8.57 doctors per 10,000 populations. It shows that India’s doctor–patient ratio is less than the prescribed limit of 1:1000 by the WHO.

The surge of COVID-19 has further eroded the existing health care infrastructure and creates a huge imbalance between demand and availability of hospital beds, ICU beds, ventilators, Doctors and trained medical personals throughout the country. During this pandemic healthcare infrastructure is highly unavailable for people suffering from other diseases.

Now if we take a look on the health care infrastructure across states we see that health care infrastructure and facilities are very much uneven among states. Some states have good healthcare infrastructure, whereas some fell short in meeting the healthcare needs. Among 35 States/UTs we analysed, there are 20 States/UTs where availability of health facilities are above the average national level and rest 15 states are at below national average (See the Data Table below). The most notable states that have health care facilities below the national average are Uttar Pradesh, Haryana, Rajasthan, West Bengal, Gujarat, Chhattisgarh, Madhya Pradesh and Bihar. Overall distribution of health care facilities across states are highly skewed. In states like Karnataka, Goa, Sikkim and Kerala there are twice more hospital bed available per 10,000 population are twice more than national average. On the other hand, in states like Assam, Odisha and Bihar where available hospital beds are only 7 (half of the national average) or less.

Source: State-wise estimates of current hospital beds, intensive care unit (ICU) beds and ventilators by Central Bureau of Health Intelligence and The Centre for Disease Dynamics, Economics and Policy (CDDEP) and Princeton University (As of April 2020). COVID-19 Data from Ministry of Health and Welfare Govt of India as of May 25th 2021.

If the State/UT-wise data of health care facilities and COVID-19 scenario (See the Data Table above) are compared, it shows that top states* with highest recovery ratio, are Delhi (96.6%), Uttar Pradesh (94.3%), Haryana (93.8%) Bihar (93.8%), Jharkhand (93.2%) and Maharashtra (92.5%) (*we are excluding UTs as total number of COVID-19 cases are very less as compare to the other states). Along with Karnataka, most of the states (Sikkim, Mizoram, Meghalaya, Nagaland and Tripura) from north east part of our country are at the bottom in the list with lower rate of recovery ratio.

Since healthcare infrastructure such as hospital beds, ventilator supports and availability of doctors and paramedical professionals is a prerequisite for providing quality healthcare facilities, it is believed that states scoring high on healthcare facilities are likely to score high on recovery ratio in their fight against the Covid-19 pandemic as well. However, available data shows that states like Uttar Pradesh, Haryana, Jharkhand and Bihar where availability of healthcare facilities are below the average level but recovery ratio are much higher than Karnataka where availability of healthcare facilities are much higher than our national average.

Another major concern of our healthcare system is that most of the healthcare facilities lie in the private sector (more than 60%). In most of the big states with higher number of health infrastructure facilities, private sector is the dominance healthcare system. For example, in states like Maharashtra, Andhra Pradesh, Karnataka, Uttar Pradesh, Bihar, Gujarat, Kerala and Madhya Pradesh where private sector have the major role. On the other hand, in north east states where facilities of health infrastructures are very less as most of it are under public healthcare system. So, in India healthcare system is much depended on private sector. During this pandemic it has been found that the private sector hospitals are charging exorbitantly to treat COVID-19 patients. Though, Indian healthcare system is highly dependent on private healthcare system, excessive expenditure rates in private health care facilities proved the importance of the public health system in our country wherein the population’s substantial size is rural and poor.

Overall, the outbreak of COVID-19 has emerged as an eye-opener and reality check of the Indian healthcare system. The adequate availability of public healthcare infrastructures, particularly in hospitals, primary and community health centres, beds, ICUs, ventilators, etc., still has not been congruent to the size of the country’s population. In a country like India where the public healthcare system including that of the state and central government is close to just 1.3% of GDP, needs to expand the public healthcare system and enhance the expenditures much as possible.

*Sujoy Ghosh is a Trend Watcher ( Economy and Politics and holds a masters degree in Economics

Kindly note that the point of views expressed in the article are entirely the author’s personal views. IPD takes no responsibility for the same.

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