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Health care in India in the prevailing COVID-19 pandemic scenario.

Article  in  Eubios journal of Asian and international bioethics: EJAIB · April 2020

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Eubios Journal of Asian and International Bioethics,30 (3) (April 2020) :91-93.

Dhastagir Sultan Sheriff, Health care in India in the prevailing COVID-19 pandemic scenario.
Abstract
Healthcare in India is undergoing a change that will meet the demands of the citizens from the
village to the metropolitan city level. The National Health policy announced in 2017 is focused
on "wellness" of patients and guarantees healthcare with suitable insurance to cover from
primary to tertiary care. Ayushman Bharat Mission is a policy that promotes healthcare with a
Center-State co-operation. Program Indra Dhanush aims to cover immunization of children in
rural and urban areas including those who were not covered in the previous program like Pulse
Polio.
In general healthcare is to provide and promote quality care, focus on emerging diseases and
invest in promoting and preventive healthcare. The policy is patient centric and quality driven. It
addresses health security and make in India free for drugs and devices. Yet the Health care
policy and its implementation face many hurdles in the form of funds, primary care, doctor:
patient ratio, and communication.
With the focus being shifted more on non-communicable diseases from infectious diseases, the
centers for testing for various infectious diseases and viral diseases have taken a back seat. This
is very relevant today when the world is reeling under the pandemic threat of Corona virus
Disease(COVID-19).
India reported its first case of COVID-19 on 30th Jan,2020. The Indian Council of Medical
Research and Ministry of Health and Family welfare have reported nearly 606 cases and 10
deaths in the country. The rate of infection for COVID-19 is 1.7. The whole nation is locked
down for a period of 21 days.
The COVID-19 poses a great challenge to India with a population of around 130 crores to treat
COVID-19 positive cases as it needs more ventilators and other facilities.
The present pandemic may help reduce the gap to implement its National Health Policy.

Key Words: Health care, India, COVID-19

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Introduction:
Republic of India, a South Asian country is the seventh largest nation by area, the second most
populous country and the most populous democracy of the globe. One of the fundamental rights
of Indian constitution is ‘Right to life’ which translates to “Right to Health”. India is a Federal
country with 29 states and 8 union territories.1 Indian Healthcare is taken care of by the States by
organizing and delivering health care and the Central Government takes the responsibility of
international health treaties, Medical Education, prevention of food adulteration, quality control
in Drug manufacturing, National Disease control and family planning. Indian health care under
the public sector is to provide free to people who are below the poverty line. Indian Public
Health sector caters 18 percent of total patient care and 44 percent of total in patient care.
The total expenditure for health care is around 4.2 percent of the GDP and out of pocket
expenses to be around 69 percent. If it is calculated the cost of health care is around 1700 Indian
rupees /capita/year.2
National Health Policy
The National Health policy of the Government was formulated on the recommendations of
Bhore Committee 3 which has taken the shape of National Health Policy.
The National Health policy announced on 2017 is to promote to “wellness” of patients and with
suitable insurance cover total health care. To encourage Center –State cooperation Ayushman
Bharat Mission is formed. Rashtriya Swasthya Bhima Yojana (RSBY) is Central Government
policy to provide health insurance coverage for poor families. RSBY is reported to have
benefitted 57 percent of target population.
Health Care Delivery
The health care delivery system is a network of primary health sub centers which is first point of
contact between the village community and the health care workers. Each sub center caters to
3000 to 5000 population. Six sub-centers cluster together to form the primary health care(PHC),
the first contact point between the community and the doctor. It has a doctor, few health care
workers with 3 to 5 beds. PHCs cater to the health needs of 20,000 to 30,000 people.
The next level of health care system is the community health care center (CHC). It has specialists
in Medicine, Surgery, Gynecology and Pediatrics. It has 30 bed strengths with paramedical and
health care workers, a Lab, X-ray unit and a pharmacy. It takes care of the health of 80,000 to
1,20,000 population.

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The next level is the District Level Hospitals who work around the clock to provide the
emergency services to obstetric care and blood bank.
There are about 6.3 lacs beds in the nation with 2 lac beds in the rural areas. The private sector
provides extra care to the affordable patients whose services are regulated by National
accreditation body.
There are about 29,000 PHCs with controlled by 25 000 doctors which still need 3500 more
doctors. About 11 lacs doctors are registered with Indian Medical Council to man the health care
delivery. Yet the nation has not reached the WHO guidelines of 1 doctor per 1000 people. It is
roughly around 0.7 per 1000 people. To support and add to the shortage of physicians India
launched AYUSH program (Ayurveda, Unani, Siddha and Homeopathy) in Nov,2014. There are
about 7.5 lacs of such Practitioners. 2
There are 529 Medical Colleges in India, 269 government medical colleges admitting 35,000
medical undergraduates and the private medical colleges with another 350,00 admissions. Yet
India needs more doctors. India has population of nearly 130 crores with 29 states with 22
different languages in 13 different dialects. There are 6.5 lacs villages and 4000 cities with a
geographical area of 3.287 km2. Some of the megacities are thickly populated with Mumbai
having the largest number of people ( 22 millions), Delhi (18.5 millions) Banglore ( 10.1
millions),Chennai ( 4.6 millions) and Kolkatta ( 4.5 millions) respectively.1
The Health Care delivery in India is therefore, very complex though highly organized.
There are still children in the rural areas 1.6 times more likely die before the completion of 1
year and 1.9 times before the age of five years. Neonatal mortality rate is high and with
additional incentive, funding, facilities India is looking forward to improve its health care
delivery in the Public Sector.2
Corona Virus Disease –COVID-19
In such a scenario providing health care in a pandemic has to be relied more on preventive
measures. The Corona virus pandemic demands a very competent handling of the health care of
the citizens.
COVID-19 has taken all nations by surprise because of its wild fire spread. Corona virus is one
of retro viruses with RNA genome. Corona virus 19 is the seventh virus that has a structure with
spikes, the spikes helping the virus to bind to the host cells. It is zoonotic virus which has
mutated to a form that has resulted in the transmission of the virus through human contact.

3
WUHAN is the epicenter of COVID-19 and it threatens the whole world with nations under-
prepared to face the attack. Highly organized advanced Nations like Italy, USA, NATO countries
including UK find it difficult to tackle the pandemic because of lack of preventive measures.
Medical Equipment, Ventilators, Face Masks, Sanitizers shortage have created a grim situation
for ordinary people to get the needed health care. The doctors, nursing, paramedical and
accessory health staff have taken the huge responsibility to provide the best medical care to the
needy risking their own lives, all over the world. 4
Without proper drugs or vaccines to treat, safety measures like personal hygiene in the form of
proper hand wash, social distancing and other WHO recommended methods of community care
have become mandatory to fight the pandemic. It has led all the nations to lock down the cities
and towns demanding the citizens to stay at home.
India has declared total lock out for 21 days including the cancellation of all modes of travel, air,
train and buses. Previously about 75 Districts through out India have been locked out.
Ministry of Health and Family Welfare and Indian Council of Medical Research regulate the
dissemination of true information, health care, and other related activities with the help of State
Governments.5
Ministry Health and Family Welfare has reported that 606 cases have reported to COVID-19
cases with 553 patients with the disease, 43 cured patients and 10 dead cases.
The ICMR centers help in the diagnosis of COVID-19 along with 6 private sector labs. The test
kits for COVID-19 –RT-PCR kit is manufactured in India by Mylab, Pune. Each test kit can test
100 cases. One can test 1000 cases per day. The company is reported to produce 1 lac kits per
week. 5
Mahindra groups of Company have converted their holiday resorts into rehabilitation centers,
and have directed their production units to manufacture respiratory ventilators. Reliance
Industries have opened up 100 bedded Hospital totally devoted to treat COVID-19 patients in
Mumbai.
Yet the challenge is enormous. Stay home, keep distance, avoid crowded places, maintain
personal hygiene like personal hygiene and follow the instructions given by the Government to
follow are the dictum to be followed by the citizens. Social distancing is the most important
criterion that has to be followed by every nation taking the example how one case like No31

4
 COVID-19 case of South Korea unknowingly by her church visits and dinner in a hotel was
responsible for considerable spread of the infection in the country.
Bill Gates of Microsoft in one of the Ted Talks had warned that the world is not prepared to
tackle a viral pandemic, particularly Corona virus. He had warned that every nation must prepare
on a war footing preventive measures, health care facilities including diagnostic facilities and
therapy. He said the world has to put together world’s Best Scientific Minds to prepare a method
of cure or a vaccine in place. Like wars every nation like military exercise must do medical
exercise to face such a pandemic including germ games like war games.
Rather it is important that every nation has to priority for pandemic viral diseases as it is mooted
that
“We need to make sure that every country in the World has the capacity to identify new diseases
and treat them.”
References:
1. Know India: https://knowindia.gov.in/my-india-my-pride/interesting-facts-about-india.php
2. Anuradha S, Sheriff DS - Health Care Delivery in India - SWOT Analyses. Int Arch Public
Health Community Med 2019; 3:024. doi.org/10.23937/2643-4512/1710024
3.Ravi Duggal, Bhore Committee and its relevance today. Indian Journal of Pediatrics
1991;58:395-406.
4. Centers for Control and Prevention of Diseases, USA-About Coronavirus Disease 2019
(COVID-19)
5. Ministry of Health and Family Welfare, India
6. Bill Gates. predicted Corona Virus Pandemic. TED Talk. Mercury News,2015

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