COVID-19 and the Public Health Care System in India: An Introspection: The health care system in India is mostly dominated by the private health care organisations. Here, the latter mentioned organisations provide with high class health care facilities, along with good quality, latest technology and sophisticated health care systems. Also, they provide with well trained nurses and staffs, who are always a step ahead to help the patients and also keep the surroundings neat, cleaned and sanitized. Also, they provide the patients with television sets to keep them engaged and entertained. Alongside, the air condition facility is also a factor. Due to the above mentioned advantages, the patients are charged so high, that all their savings go down rapidly. What people look for are FAITH and BELIEF, which they fail to get in a public health care facility. A total first class hospital will be nomenclature as “Multi Speciality Hospital”, which can deal with all types of problems. In case of a public health care system, it is divided into three parts- Sub-centres and Primary Health Centres (PHCs). At the secondary level, we will find there are Community Health Centres (CHCs) and smaller sub-district hospitals. Finally, at the tertiary level, care is provided by the government, where we will find Medical Colleges and District/General Hospitals. These levels are not found in a Multi Speciality Hospital, which is a private health care facility. During the COVID-19 pandemic, it is immensely difficult for people to travelling distances and reach out the right health care centre, as it can lead to a huge leap in the number of cases in the country.
Now, let us take a glimpse of the three divisions of public health care systems in India:
- Sub Centres: All sub centres are located in the rural areas, which mostly comprise of at least two workers, of both genders, who serve a population of 5,000 people (or 3,000 people in a remote, dangerous location). This type of health care system is financed by the government. These sub centres also work to educate people about healthy habits. Now, it is extremely difficult for minimum two people to perform so much work. Therefore, act of negligence will occur, and thus, the patients are not served to their might.
- Primary Health Centres: In this type of a health care centre, patients with more complex diseases are referred from local sub centres. This type of health care centre is located in those places, which are considered to be more developed rural areas, consisting of 30,000 or more population (20,000 in remote areas) and are served by larger health clinic staffed doctors and paramedics. The major difference between Primary Health Centres and sub centres include that, the respective state governments fund the Primary Health Centres, ad not the central government. Alongside, the Primary Health Centres also function to improve health education with a larger emphasis on preventive measures. These educations are very much important in rural areas during COVID-19 pandemic to make the people (the residents) aware about how they should take care of themselves and what they should do.
- Community Health Centres: The Community Health Centres are the first referral units. They look after those patients who need obstetric care, new born/child care, and blood storage capacities at all hours, each day. The Community Health Centres are funded by the respective state governments, and accept those patients who are referred from Primary Health Centres. The Community Healthcare Centres serve around 120,000 people in urban areas, or 80,000 people in remote areas.
- District Hospitals: District Hospitals are the last option left for referrals by the sub centres, Primary Health Care Centres and the Community Health Centres. One must remember that it is mandatory for each district to set up a district hospital. But, India consists of 640 districts, where there are 605 district hospitals, as per 2010 record. Alongside, normally there are 75 to 500 beds in district hospitals. One disadvantage is that, these district hospitals often lack with the latest equipments required. Also, they don’t tend to have a good relation with the local blood banks. Due to the above mentioned disadvantages, people travel long distances in search of proper medical treatment.
- Medical Colleges and Research Institutes: The medical colleges and research institutions are the only public health care units which have the required facilities. These are controlled by the central government. AIIMS are functional in various states like Delhi, Bhubaneswar, Jodhpur, Patna, Raipur and Rishikesh. Also, these are located in cities only. A regional Cancer Care hospital and a research institute which are controlled jointly by the central government as well as the state government.
Due to the rise in the COVID-19 cases in the country, the government has decided and categorised the public health care facilities in to three- Dedicated COVID Hospital (DCH), Dedicated COVID Health Care Centre (DCHC) and Dedicated COVID Care Centre (DCCC). Dedicated COVID Hospitals (DCHs) are for those patients who have been diagnosed as severe. This is of the first category.
The Dedicated COVID Health Centre (DCHC) is of the second category, which has been diagnosed with moderate symptoms.
The Dedicated COVID Care Centre (DCCC) is of the third category which deals with patients who have been clinically assigned with mild or very mild cases. COVID suspect cases are also dealt here. The DCCCs are set up mostly in places like hostels, hotels, schools, stadiums, lodges, etc. by the respective state governments and union territories. People who have been assigned with suspected and confirmed cases are taken elsewhere.
As of May 10, 2020, there are 7,740 facilities in 483 districts that have been identified in all the states and union territories. There are 656,769 isolation beds, 305,567beds for patients diagnosed with confirmed cases, 651,204 beds for patients with suspected cases, 99,492 beds which are supported with oxygen manifolds and 34,076 ICU beds.
For the betterment of the public, the central government has asked all the states and union territories to furnish the details, like COVID dedicated facilities on their websites.
For the purpose of testing of COVID-19, there was procurement of a high throughput machine as per the recommendations of Empowered Group 2 at the National Centre for Disease Control (NCDC). COBAS 6800 machine was successfully installed at NCDC, and presently it is providing support to various states like Delhi NCR, Ladakh, Jammu and Kashmir, and various other states as per needs.
NCDC conducts 300-350 tests per day. But, after the installation of the COBAS 6800 machine, as high as 1,200 tests are conducted per day.
Challenges of Public Care Units During COVID-19: COVID-19 has hit all the parts of the country. Numerous problems are faced by the public like shortage of medical supplies, lack of conducting adequate number of tests each day and difficulty in flattening the curve of confirmed COVID-19 cases, though in different magnitude. To stop the havoc in the rise of conformed cases, the Prime Minister had implemented a 21 day complete lockdown, starting from 25th March.
In order to curb the challenge, the Prime Minister had decided to allocate Rs. 15,000 crore (USD 2 billion) to build the necessary infrastructure to curb or to flatten the curve of confirmed COVID-19 cases. Alongside, the state governments are trying to expand the facilities to bring the situation in their hands.
As of 2017, a data from World Health Organisation was proved that the Indians spend 62% of their income in health care expenditure, as compared to other countries like UK, USA and European Union of 16%, 11% and 22.29% respectively. During the COVID-19 pandemic, ICU is highly necessary.
Now, let us come to the problems that are faced by the public, due to the incapability of public health care system:
There is a huge shortage in the number of beds as compared to the population of the country.
One of the most least developed states of the country, Bihar has 0.12 beds per thousand people, which is the fewest per person. Also, Odisha, which is considered to be the poorest states in India, has 0.38 beds per thousand people, as stated by the former Reserve Bank of India Chief, Raghuram G. Rajan.
The north eastern part of India, Assam and Manipur has below the national average of 1.13 beds per thousand people. Other states of Northeast and Southern part of India have much better capacity to serve their patients, which is somewhere near or above the national average.
States like Bihar, Madhya Pradesh, Rajasthan and Uttar Pradesh where we can find one of every four persons are below the poverty line have less number of beds, than the national average and more than half of the population of the country live in these four states.
Another crisis that is being faced by the public is the shortage in the number of doctors in the public health care centres. The main reasons are that they are not paid as per their requirements, and the doctors are scared to get infected.
Alongside, another problem that is faced by the public is the shortage in the number of government approved laboratories, which are capable to perform COVID-19 tests in India. There are only 892 government approved laboratories. This is absolutely insufficient as compared to the huge population of the country. Though there are private laboratories, which are capable of performing the tests. But, the cost of conducting the test if the major factor, that has to be looked upon.