Health | Coronavirus exposes India’s weak healthcare foundation

Coronavirus (Representative image)

Dipa Sinha

On January 30, the second meeting of the emergency committee convened by the WHO Director General under the International Health Regulations (IHR) (2005) declared the outbreak of the novel coronavirus (2019-nCov) as meeting the criteria for a Public Health Emergency of International Concern (PHEIC). It recommended that all countries “be prepared for containment, including active surveillance, early detection, isolation and case management, contact tracing and prevention of onward spread of 2019-nCoV infection, and to share full data with WHO”.

According to the latest data from the WHO, as of 17 February, there were 71,429 confirmed cases of COVID-19 globally, and 1,775 deaths. While most of this is reported from China, there have been 794 confirmed cases from other countries, including three deaths. In India so far there have been three positive cases, all in Kerala, while a large number of people have been kept under community and hospital surveillance across the states. Kerala is releasing regular updates about quarantines, tests and hospitalisations and the Ministry of Health and Family Welfare (MoHFW) of the Government of India has stated that the “situation is under control in India”.

The response of the health system and the government in Kerala has been appreciated for its role in ensuring there is no panic and for its effective surveillance. The MoHFW is also regularly monitoring the situation across India and has advised states to strengthen disease surveillance and enhance awareness on personal hygiene and disease prevention.

The minister himself has also been briefing the media and has appreciated the team that successfully evacuated 645 Indians from Wuhan, the epicentre of the outbreak, in China. A large number of passengers (over 300,000) travelling to India by flights and ships have been screened and samples have been sent for testing. All of this indicates that there has been an urgent response to the disease, given the constraints of the health system.

An important role the state as well as union governments would have to continue playing is to share information on the spread of the disease, and ensure that there is awareness on prevention measures, while curtailing the spread of false rumours and scaremongering. Strict action must be taken against false campaigns such as a recent Whatsapp message (screenshot below) that was circulating warning people from buying goods, including Holi colours from China as that is a conspiracy to spread the disease among Hindus. At the same time there are also some issues for concern which pertain not specifically to COVID-19, but to the health system in general, which are cause for worry about our capacity to respond should the disease spread in India.

The symptoms of being infected by the virus are mostly mild and similar to those that are caused by many other viruses, including common cold, and in the extreme causing pneumonia. Given the poor state of disease surveillance in India, it is possible that many of the cases are misdiagnosed or are just missed, as argued by Oommen C Kurien of the Observer Research Foundation (ORF).

Issues such as large number of vacancies and a crumbling primary healthcare system afflict the health system in many parts of India .Any efforts at containing and dealing with this outbreak will have to be on the foundations of this very weak edifice. The Rural Health Statistics of the MoHFW, for instance, shows that 24.9 percent of doctors’ positions in sub-centres and primary health centres (PHCs) remain vacant.

There are also huge vacancies in the posts of health assistants, male health workers, lab technicians and pharmacists. The shortfall and vacancies of specialists at the community health centres (CHCs) are even higher, with 73.7 percent of the positions lying vacant. There are also massive gaps in availability of functional buildings, drinking water, toilet facilities, etc. in health centres. The community health workers, such as the ASHAs and the ANMs, are already overburdened by the number of tasks assigned to them under poor working conditions.

Further, the preventive measures that need to be taken for the COVID-19 are the same as those that would be required to curb the spread of most other viruses — largely to do with hygiene. The ability to ensure this not only depends on awareness but also availability of infrastructure, especially access to clean drinking water and sanitation facilities which are still lacking in many parts of India.

On the whole, while the situation of COVID-19 in India does not at present raise a cause for alarm, this is another reminder that the public health system in India needs be strengthened urgently so that we are prepared to face any such circumstances.

Dipa Sinha is faculty at Ambedkar University Delhi. Views are personal.