With crumbling health infrastructure due to an overburden of diseases in the country, India’s preparedness for handling epidemics such as novel coronavirus (nCoV) becomes a major challenge. The virus that has created havoc in China with over 100 people killed and over 4000 affected. The World Health Organisation has said that due to human to human transmission, the virus can fast spread in other countries also.
Public health experts believe that India is ill equipped to handle such emergencies. “India is not prepared to tackle health epidemics, particularly given its urban congestion. In fact given the city structure and the way the settlements have grown epidemics once occurs will spread at a galloping rate. The slum clusters all around the cities and the unhygienic growth, poor waste disposal system will only aggravate the situation,” said said Arup Mitra, professor, Health Policy Research Unit (HPRU) at the Institute of Economic Growth.
Current health infrastructure in India paints a dismal picture of healthcare delivery system in the country. Health Infrastructure has been described as the basic support for the delivery of public health activities.
According to the National Health Profile 2018, there are 23,582 government hospitals having 710,761 beds in the country. 19,810 hospitals are in rural area with 279,588 beds and 3,772 hospitals are in urban area with 431,173 beds.
Over 70% of population of India lives in rural area and to cater their need there are 156,231 Sub Centres, 25,650 Primary Health Centres and 5,624 Community Health Centres in India as on 31st March 2017. According to the latest government data, as on March 2018, the country has total of 2903 blood banks which means less than 3 blood banks for every 10 lakh population.
The private sector in healthcare emerged as a strong force in India’s healthcare service delivery which accounts for over 74% of the country’s total healthcare expenditure.
According to Global Health Security (GHS) Index, 2019 released in October 2019, majority of countries are unprepared for outbreaks of major infectious diseases, with Asian countries facing significant risks. According to the report, Thailand and South Korea were among the best-performing countries in Asia, while India was at 57th rank with a score of 46.5.
While Asian countries may be facing the most risks, the research pointed out that no country was fully prepared for the next epidemic or pandemic – only 13 of nearly 200 countries score in the top tier. The average overall index score was a shade over 40 out of a possible score of 100, pointing to substantial weaknesses in preparedness.
Epidemics have been occurring with greater frequency. The 2014-16 Western Africa Ebola epidemic claimed more than 11,000 lives, and the outbreak of the disease, in the Democratic Republic of the Congo, killed another 2,100 in 2018-19, according to the World Health Organisation (WHO).
These emergencies and others, the report said, including the Zika epidemic in 2015-16, highlight the need to understand how countries can better prepare to face these threats. The Index, which serves as a barometer for global preparedness, is based on a central tenet: a threat anywhere is a threat everywhere.
The report pointed out that deadly infectious diseases can travel quickly, increased global mobility through air travel means that a disease outbreak in one country can spread across the world in a matter of hours. And, understanding a country’s readiness to manage an infectious disease emergency is in part a factor of global preparedness.
The report showed that even when emergency plans were in place, there was little evidence that countries have tested these capabilities to show they would be functional in a crisis. “At least 85% of countries showed no evidence of having completed a biological threat-focused simulation exercise with the WHO in the past year. Fewer than 5% of countries have a national requirement to test their emergency operations centres to respond to a health emergency on an annual basis,” the report said.
“Capacity to contain a virus outbreak depends on the ability to identify cases and contacts in the community on clinical criteria, while ensuring smart surveillance on inward travellers; isolate and identify the causative virus; treat severe cases while counselling mild cases,” said Professor K Srinath Reddy, President, Public Health Foundation of India.
“Also effective risk communication to the general public to prevent panic and provide advice on precautionary measures and (v) deployment of a safe and effective vaccine if developed and available. While our laboratory network has improved after the H1N1 scare, much needs to be done to improve the community facing primary health services and risk communication to the public. In general, hospital services can quickly gear up to treat severe cases in urban areas but rural healthcare needs a step up. Kerala’s success in responding swiftly and smartly to the Nipah outbreak should be a role model to other states, he said.
Reddy explained that the aerial spread of the newly detected coronavirus poses a threat of rapid dissemination but it can still be contained with an efficient response which combines effective public health, microbiological, clinical and communication responses. Central and state health agencies must act in tandem. The media too must helping in increasing awareness without triggering panic.