Covid-19 should lead to greater investment in health | Opinion – analysis
The coronavirus pandemic (Covid-19) has exposed the new nature of health threats and emergencies, linked to food systems, human-wildlife and anthropogenic conflict, and the dynamics of globalization. To counter this emergency, all governments, the scientific community and citizen groups have initiated an unmatched response.
On March 25, despite fewer reported cases compared to other countries, India initiated a 21-day national blockade, adopting social distancing and citizen isolation, state border closings, and a call to action for low-cost innovations to support to the government through this crisis.
While the healthcare system tries to scale up what seems like a long battle ahead, this is a wake-up call and an opportunity to invest in healthcare systems like never before. India’s investments in the health sector have been historically low, at no time exceeding 1.3% of its GDP. Compare this to 5% in China, 8.1% in South Korea, 10.9% in Japan. Despite instituting one of the first rural primary care architectures, the Indian public health system is struggling to understand the challenges that Covid-19 has brought with it.
In 2005, the National Rural Health Mission (NRHM), now known as the National Health Mission (NHM), attempted to strengthen primary, secondary, and tertiary health services. But this was not followed up with heavy investments in health infrastructure, the workforce, supply chains, and community models to deliver care. While the Prime Minister’s Ayushman Bharat Yojna (PMJAY) has led to risk accumulation and increased access to health for the poorest households, the issue of quality assurance needs more attention in the future.
The Covid-19 response provides an opportunity for meaningful health reform. India needs to make low-cost, customer-focused health and medical innovations. A four-pronged approach can help.
First, we need to invest in human resources for health, now and in the future. India must strive to meet the World Health Organization (2016) standards for the density of the health workforce: 44 health workers per 10,000 people. Recent estimates indicate that the current total density of human resources is 29 per 10,000, with wide variations between states. While India is increasing this number, it should also seek to improve quality through additional training. Through emergency response training, competencies such as testing, referral, quarantine, and use of medical equipment can be developed. The fight against Covid-19 cannot be won without the active participation of the private sector and other healthcare providers who can play an important role in identifying potential cases and ensuring early quarantines. We need to rethink the roles and responsibilities of frontline health workers, such as Accredited Social Health Activists, Nurse Assistant Midwives, and multipurpose workers, taking into account the skills they have.
Second, with citizens locked up and their mobility restricted, the role of community health centers and district hospitals will be key. The state and district administration will need the support of local community agencies, panchayats, local urban agencies, and citizens’ groups to ensure that cases are isolated early and that supply chains of essential drugs and equipment function optimally. A communication plan to spread the right messages will be important. District hospitals need appropriately trained medical personnel and equipment to ensure that cases are managed effectively on-site and mortality is minimized. The effective use of telemedicine can treat complicated cases, especially in inaccessible areas. We must be careful not to concentrate services only in some cities.
Third, the government must make every effort to encourage low-cost innovations in medical technology to meet the needs for essential equipment, both to respond to the pandemic now and to build capacity for the upcoming flu season. Identifying and facilitating regulatory frameworks for the development of new medical products can help enable rapid responses. Regulating the prices of essential drugs, the low-cost mass production of masks and protective equipment, will ease the burden. In the medium and long term, India needs to further strengthen its biomedical research capabilities, invest in cutting-edge “made-in-India” healthcare technologies and make it easier for new healthcare technology companies to operate with tax cuts. Scientific innovations are the key to solving social crises.
Finally, a working group is required to understand the impact of Covid-19 on the health system and households. The pandemic presents an opportunity to expand PMJAY coverage, including consideration of a universalized health insurance model. Social distancing can lead to new challenges for anxiety and overall mental health. The costs of this pandemic could also be borne by other health and nutrition programs, as services and care are likely to drift. We require state-level working groups that represent not only administrators and physicians, but involve civil society at large to address some of these long-term effects.
Covid-19 presents an opportunity to strengthen India’s health system, sustain investment in technology, and redirect budget priorities toward what is truly essential: our health. As our medical workforce fights this invisible enemy, India owes them a robust healthcare system that can facilitate all their efforts.
Madhavi Misra and Nandita Bhan have extensive work experience in the public health system.
The opinions expressed are personal.