The first pandemic led to the defeat of the mighty Spartans in 430 BC. Over twenty centuries, fatal plagues and influenzas have come and gone, some changing the course of history. Despite warning bells from SARS and H1N1 just a decade ago, nations scrambled for resources when the microscopic Coronavirus made its arrival at their borders.

India responded in panic too. The unpreparedness was far more compounded by decades of governments neglecting healthcare— poor infrastructure, understaffed and negligibly-funded— making this crisis far more lamentable. In less than a month, the country has gone from being the tenth to the fifth-worst nation to be affected by COVID-19 (behind USA, Brazil, Russia and UK). With a tally of over 260,000 cases nationwide currently, India’s health system is overwhelmed.

Will this pandemic be a lesson for our leaders to recalibrate healthcare? Public health experts weigh on the issue and advise on the way forward for India.

Nachiket Mor, Visiting Scientist, The Banyan Academy of Leadership in Mental Health

"The strengths of developing countries lie instead in their vast networks of community-based organizations, NGOs, and primary care providers.”

COVID-19 is an enormous crisis for the world and the people of India, but it is not clear that it will necessarily and automatically bring India closer to the goal of Universal Healthcare for the whole country. Independently of this crisis, 2,000 infants die needlessly in India every day; 1,200 lives are lost daily on account of Tuberculosis; over 500 million people remain at risk of developing Lymphatic Filariasis but India has not been propelled any closer to Universal Healthcare because of these equally large crises. This particular crisis has had a much wider impact on upper-income households and has therefore attracted more attention but it will pass in a little while, leaving underlying health systems unchanged unless, specific pathways to dealing with this disease are followed.

In dealing with this crisis the focus has correctly to be on the twin and urgent goals of minimizing mortality and of bringing the economy back on track as soon as possible. The broader challenge of building UHC is unlinked to this and has much more to do with whether the government can allocate the increase its allocations towards healthcare from the current levels of close to 1% of GDP to bring them closer to the 5% that is needed. If it is unable to do that, alternately, is it prepared to alter strategy to help organize the existing fragmented health system; so that it can deliver more value to its citizens. The problem is that at the moment there is no willingness to traverse either of the two feasible pathways which is why UHC remains a distant goal that is out of reach for most Indians.

In response to the current crisis, most developing countries have chosen to follow the path taken by the more developed nations and have focused on rapidly adding ventilator capacity to their centrally located large hospitals. The concern with this approach is that if the disease starts to grow in magnitude, as it appears to be doing, these facilities will be rapidly overwhelmed, as they have been even in some of the developed countries. The strengths of developing countries lie instead in their vast networks of community-based organizations (CBOs), NGOs, and primary care providers (PCPs). Working with these networks to carefully protect the elderly from getting infected, and to provide early oxygen therapy in local settings to those that need it, would need to form the core of an effective response to this current challenge. The added, even if unintended, benefit of such an approach is that it will serve to strengthen primary care capacities of developing countries and thus bring them that much closer to the goal of UHC.

Dr Dileep Mavlankar, Director, Indian Institute of Public Health (Gandhinagar)

"Nationalization of healthcare may be a bad idea."

Political, social and economic priority to health in Indian society has been neglected. We have not upgraded our infectious disease hospitals which were created by the Britishers in the 1920s. The lack of sustainable public-private partnership models has limited our capacity to act in times of crisis. As of today, no state or municipal corporation has a good viral diagnostic lab except for polio and HIV which were created due to national programs, funded largely by our governments.

Nationalization of healthcare may be a bad idea. Our nationalized banks, oil companies, insurance companies, etc. have not performed well. Hence nationalization of healthcare won’t be happening anytime soon. I believe in the public-private partnership model. Ayushman Bharat program is taking a very creditable step towards universal health coverage by covering 40% of the total population. We must widen this benefit to at least 80% of our population and also expand the coverage to include outpatient care. To rope in private players swiftly to provide quality care under such schemes, payments have to be in line with market-based rates. India has adequate resources to build a good UHC system in 5-10 years; all it needs is political will. The investment in healthcare can be a game-changer—not only health— but employment and women’s empowerment too.

Dr. Feroz Ikbal, Assistant Professor, TISS, Mumbai

“To look at a problem as a problem of healthcare alone is a narrow and reductionist approach.”

The COVID-19 is a black swan event that has taken the entire globe by storm. If you take countries in the West, many believed that they were beyond a ‘pandemic’. The health system of the USA has become the victim of the medical-industrial complex whereas the NHS of the UK is largely focused on curative care. Health system of every country is evolved by its historic context. One cannot just develop a perfect health system. India has never bothered to invest in public health or to bridge the huge differences in healthcare systems across the states. The response from the private sector has been far from satisfactory even in the catastrophic pandemic like this. where many private hospitals are not taking even the emergency cases unless the patient has a COVID-negative certificate. I am not in favor of nationalization of hospitals as the public and private sectors can exist separately. But the government needs to invest more in health services and PPP is not a panache as it can lead to privatization of public property. Similarly, our wrestle for UHC or making health a fundamental right makes no sense; the same way our experience with the right to education has made very little difference to the primary education unless we have the necessary structure, the processes, and manpower.

Will this Pandemic Recalibrate Healthcare in India?

Will the sudden shift in India’s attitude to prioritising healthcare be an evergreen effort? Public health experts weigh on its possibility.