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As India鈥檚 COVID-19 crisis continues, the percentage of the population testing positive for the virus has听听in the past 30 days.
With more than听, hospitals and crematoria face collapse. Global media have been awash with heartbreaking images, statistics and stories showing the failure of the country鈥檚 health system in the face of surging infections and deaths.
The fracture lines in India鈥檚 health system have been developing for years. After decades of under-investment in healthcare and preventative health, India has one of the most privatised health systems in the world. As a consequence, healthcare costs are a听.
As my recent听听into rural mental health services shows, patients are caught between the under-resourced public sector and the profit-focused private health market. Some even many, have to 鈥渟ell a buffalo to pay for a brain scan鈥.
Lack of investment in health
Back in 1946, India鈥檚 visionary听听declared in its preamble that:
No individual should fail to secure adequate medical care because of inability to pay for it.
In 2021, countries like Vietnam, South Korea and China have successfully contained COVID-19 with few deaths, while in India hundreds of thousands are sick with the virus without adequate medical care.
Promised oxygen generation plants have听听and most days I receive messages from colleagues in India seeking hospital beds and oxygen cylinders for loved ones gasping with severe COVID-19 infections.
The cost of healthcare pushes many into destitution. The global average of out-of-pocket healthcare costs is 18.2%, but in India the number is听.
While India has bounced along with 8% or higher growth in GDP for the past three decades, in 2018 the Indian government invested just听. The average investment in health across South Asia is听听and New Zealand and Australia spend over 9.0% of their GDP on health.
In the past two decades,听听in India, from 43% in 1993-4 to 32%. In 2011, 70% of community health centres could not provide emergency obstetric care.
The consequences of India鈥檚 flawed health system are obvious. In the field of nutrition (the most basic building block of health) India is among the听听(38.7% for听).
A third of听听and India鈥檚 ranking in basic health indicators compared to regional neighbours has dropped. In a list of 195 countries, ranked by the听, India is behind neighbours Bhutan and Sri Lanka.
The smaller but more resilient nations of Nepal and Bangladesh have a lower per capita GDP, but in 2020 both achieved an infant mortality rate of under 26 per 1000 live births. In India,听.
Not trustworthy and not trusted
惭测听听into community health systems also underlines that in a country as mini传媒 and vast as India, one size cannot fit all.
A key component of the treatment gap for people with neurological and mental health problems is that the system has not engaged with the听. The health system is not trustworthy and not trusted.
Rising infant and maternal deaths
India鈥檚 COVID-19 surge has revealed a system in disarray. During the country鈥檚 harsh lockdown in March and April last year, healthcare was听.
While the private sector is much larger than the public sector, it handled听听during the first COVID-19 wave. Many private hospitals stayed closed for weeks.
Rationing of public services meant limits had to be introduced on the number of听. Diverting resources (personnel, resources, hospital beds, policymaker attention) to respond to COVID-19 meant vaccination rates have slowed and maternal mortality听听in the past 12 months.
As a consequence of disruptions to neonatal and child health services, India is expected to record an听听by 15% (154,000 deaths) for 2020. The Indian economy is predicted to听, which means more people in poverty and less cash to pay for health infrastructure and staff.
Health systems are complex but they are not rigid. They can be resilient and responsive to new challenges like COVID-19. There are some simple steps India could take to strengthen its failing health system.
It could invest in the public sector 鈥 staff, infrastructure, medicines and equipment. It could set up accountable governance structures and prioritise care for those experiencing inequities in access and outcomes. Maybe COVID-19鈥檚 exposure of its fragmented health system will push India to rebuild, from the ground up.
This article was originally published on听.听
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