Some critical weaknesses in
the country’s health system can come in the way of a credible strategy to
Much concern about the novel
coronavirus in India is understandably about the number of cases and
It is important to remember
that the vast majority (80%) of COVID-19 cases will be mild.
The estimated mortality rate
varies considerably between 3% to 0.25% of cases, and is much higher among
Notably, wealthier countries
with stronger and better financed health systems such as Italy and China
have struggled with containing COVID-19.
As such, it is prudent to
understand how well India’s health system can respond to COVID-19,
especially since it is unclear how long this disease will persist. We
believe that there are some critical weaknesses in India’s health system
that can prevent a credible response to COVID-19.
Addressing the scarcity of
hospital and intensive care unit (ICU) beds in India is critical for
providing clinical support to severe COVID-19 cases.
Without flattening India’s
COVID-19 epidemic curve, our current hospital capacity is so low that it
will be quickly overwhelmed if infections surge.
It is critically important
that India puts in place a strategy to ramp up hospital and ICU capacity,
as well as provision for essential equipment such as ventilators and
personal protective equipment for health workers. In both China and Italy,
hospitals were rapidly constructed to accommodate infected patients.
Tapping the resources in the
private sector is particularly important. India’s health system is highly
privatised and most of the country’s health-care capacity in terms of
human resources, hospital beds, laboratories, and diagnostic centres is in
the private sector.
Recognising this, several
State governments have initiated action, such as enlisting private
laboratories for testing and using the private hospital bed capacity to
treat positive patients.
More of this is needed, as
well as, engaging private hospitals in planning and coordinating the
workers are crucial
Health-care workers are a
critical resource for the COVID-19 response. They go into communities to
carry out preventive care, trace potentially exposed people, and treat the
whether they are formally trained (e.g. medical officers, nurses,
auxiliary nurse and midwives, pharmacists), or lay workers (accredited
social health activists) or informal workers (rural (not registered)
medical practitioners, or RMPs, drug shops) will likely be the first
contact health workers for COVID-19 patients.
Health workers also take on a
disproportionate share of infections. Health worker safety is particularly
important for India because it already faces a shortage of doctors and
India like other countries
faces important health system challenges in mounting a credible response
to COVID-19. Many of these issues are not new.
Addressing these health
system issues will require much effort, financing, and, in some cases, not
even entirely possible to remedy in the near future.
How India deals with these
health system issues in the days to come will make all the difference.