Marshalling Healthcare Post-lockdown

The spike in COVID-19 cases despite repeated clampdowns calls for a robust mix of public and private healthcare systems

As on the first week of April, 3.9 billion people (more than half of the world's population) across the globe were under some form of lockdown. A lockdown is a only a preventive strategy, and now it is time to research, analyse, and understand how to triage the country’s resources to battle the pandemic. The medical journal Nature, one of the first peer-reviewed analyses of the impact of health policies and lockdowns, suggests that the toll of infections and deaths would have been worse without lockdowns, social distancing, and other interventions. The countries studied were China, South Korea, Italy, Iran, France, and the United States. 

While economic and political compulsions are forcing most countries to ease/lift lockdowns, the reality is that the virus is far from being obliterated and the infection rate is stubbornly refusing to flatten out. Save for a handful of countries like Australia, New Zealand, Greece, Germany and Singapore, most have been struggling to cope with increasing infections. India falls in the latter group, with metropolises such as Delhi and Mumbai confronted with overwhelmed healthcare systems and other cities inching towards a similar crisis. Even though India’s lockdown was one of the most stringent and longest, the medical industry is still struggling to cope with the cases.

IS THE HEALTHCARE SYSTEM UP TO SPEED? 

The most affected countries − the U.S., Russia, the U.K., Brazil, and India − have a mixed healthcare system, ranging from being entirely a public healthcare system to one where the private sector dominates. The system that seems to have worked the best, as per the think tank, Council for Foreign Relations article titled 'Comparing Six Health-Care Systems in a Pandemic', is the one with a combination of public and private healthcare. The U.K., with its public-funded NHS, was overburdened and had to seek private collaborations. On the other hand, the U.S., with its primarily private healthcare system that depends on insurance policies, also fared badly with shortages, expensive treatments, and no room for expansion of services. 

Even before the pandemic hit the globe, the importance of a strong healthcare system was analysed in an article 'Which Country Has the World’s Best Health Care?' by Ezekiel Emanuel, a health-policy adviser to former U.S. president Barack Obama and one of the authors of the 2010 Affordable Care Act. He assessed 11 healthcare systems across four continents. The report ranked the U.S. just above China, which was the worst performer. The four countries that emerged as the most successful were Germany, the Netherlands, Norway, and Taiwan. While there is still a question on whether China handled the Wuhan fever well or not, it is no coincidence that the higher-ranking countries in his report are among those who performed well in the pandemic. However, some S.E. Asian countries also had the upper hand since they had protocols and institutes in place, courtesy the SARS epidemic. 

THE INDIAN SCENE

The private healthcare system in India has mushroomed over the years, while the public system stagnated, and in some cases suffered from neglect, starved of funds.

As reported in The Indian Express, nearly 70% of the healthcare services in India are provided by private hospitals/clinics/individual medical practioners. If the private healthcare crumbles due to economic constraints or other factors, India’s entire healthcare system could be jeopardised.  The public healthcare is not geared to take the impact of its billion plus population.

But there is a catch; private hospitals cater to a niche segment. Obviously, their price tags put them beyond the reach of the common man.

Healthcare is a State subject and does not fall under the purview of the central government. Each State has a different approach and emphasis on healthcare. As per the Constitution, every State is responsible for "raising the level of nutrition and the standard of living of its people and the improvement of public health as among its primary duties”. Kerala, which has invested well in the sector, handled the outbreak in an exemplary manner. On the other hand, Maharashtra, one of the richest States, failed to do so and is today paying the price.

As per the Global Health Security Index of 2019, which measures pandemic preparedness, India ranked 57, with the U.S. at 1, the U.K. at 2, Brazil at 22, and Italy at 31.  Data from the Organization for Economic Co-operation and Development (OECD) 2017 shows that India has 0.53 beds for 1,000 people compared with 0.87 in Bangladesh, 2.73 in Turkey, 4.34 in China and 8.05 in Russia. If India wishes to achieve a 1:1,000 ratio (the WHO-mandated doctor-to-patient ratio), it will need an additional 2.07 million doctors by 2030.

While the lockdown did slow down the spread of the virus in India, the coping strategy to wipe out the pandemic has perhaps not been robust enough. Testing rates of different States vary. BBC reports that while Karnataka averaged 93 contacts, Delhi tested as little as nine. The average testing rate is also lower than that of many countries, and the latest guidelines state that only symptomatic patients will be tested. The public sector hospitals are overwhelmed, even after roping in private hospitals for treatment. With a spike in cases, there have been reports of data not being updated quickly enough, allowing many deaths to go unreported

Some medications, like 'Cipremi', the local alternative to Gilead's antiviral drug Remdesivir, costs Rs. 3,350 for 30 tablets. This is not a high price when compared to the relative short time it has taken to make this medication available for mass use.  

India has not given adequate emphasis to the threat of pandemics. To cite an example, the regulation dealing with such a situation is the British-era Epidemic Diseases Act of 1897. It remains to be updated to meet modern challenges.  

The funding on health care research and start-ups has remained dismal.  Inc42’s research showed that Indian healthtech startups saw funding of a meagre $2.3 billion between January 2014 and March 2020, spread across 459 deals.  

ASSESSMENT

  • The lockdown’s effectiveness is not being downplayed. It was the only strategy when the pandemic blindsided the world.  However, six months down the line, it cannot be the only weapon in the arsenal.  The government has had enough time to prepare for the worst-case scenario, which appears to be staring us in the face with over a lakh cases being added every four days.

  • Lockdown was to gain time to prepare for the battle; ensuring technological facilities, preparing workers from the bottom up, having enough testing kits, and increasing collaboration with the private sector. Even the last rites have to be meticulously planned to ensure dignity and safety with empathy for relatives who cannot even bid goodbye.

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