Those who are either old enough or have read the history of health services in India, will testify that in the mid-1980s, there were a number of government health-care facilities across the country, with newly constructed buildings, impeccable linoleum floorings, imported state-of-the-art medical equipment such as infant radiant warmers and at times ‘foreign made’ cars/jeeps (for the field visits of health staff).
These facilities had benefited from generous financial and commodity assistance as part of the overseas development assistance (ODA) from many well-intentioned international donors. However, in the year to follow, the number of patients attending these facilities continued to be low and the equipment remained packed and stacked in store rooms. Years later, the vehicles were repurposed for use in some national programmes such as polio elimination and blindness control. Most of such upgraded facilities had failed to meet the health needs of the poor people. A key reason was that while infrastructure was upgraded, there was perennial shortage of health staff, i.e., doctors, nurses and others, which was supposed to be recruited by the governments. Four decades later, in the COVID-19 pandemic response, the Indian government appears to repeat the same mistake.
Centre’s financial package
On July 8, 2021, the Union government announced the “ India COVID-19 Emergency Response and Health Systems Preparedness Package: Phase II ”, with the stated purpose to boost health infrastructure and prepare for a possible third wave of COVID-19 . Through this financial package, there is plan to increase COVID-19 beds, improve the oxygen availability and supply, create buffer stocks of essential medicines; purchase equipment and strengthen paediatric beds. However, the package barely has any attention on improving the availability of health human resources.
Even before the novel coronavirus pandemic, as reported in rural health statistics and the national health profile (both official government documents), there are vacancies for staff in government health facilities, which range from 30% to 80%, depending upon the sub-group of medical officers, specialist doctors to nurses, laboratory technicians, pharmacists and radiographers, amongst others. In addition, there are wide inter-State variations, with States that have poor health indicators with the highest vacancies.
Workforce shortage
The Government seems to have recognised the gaps in health infrastructure; however, the shortage in the health workforce is barely being discussed. An intensive care unit bed or ventilator is no use unless there are trained staff to run these equipment and qualified doctors and nurses to attend to patients. Sixteen months into the pandemic, though there has been occasional recognition of the shortage in the health workforce and a few commitments to fill the vacancies; very few are known to fructify, even partially, at both the Union and State levels. As an example, the Union Ministry of Health in May 2020, announced recruiting 300 epidemiologists; it is not known what the status is. Among the States which announced filling vacancies of health staff, attention has mostly been narrow — on select subgroups such doctors or nurses, and not holistic, and promises remain unfulfilled.
The COVID-19 package II (which focuses on health infrastructure strengthening) needs to be urgently supplemented by another plan and a similar financial package (with shared Union and State government funding) to fill the existing vacancies of health staff at all levels. Alongside, an objective approach to assess the mid-term health human resource needs could be the Indian Public Health Standards (IPHS), which prescribe the human resources and infrastructure needed to make various types of government health facilities functional. Once such a need is assessed, the Union and State governments would have to come up with another financial package for human resources to complement the COVID-19 health package II. That alone can make health facilities functional in a sustainable manner.
The broader picture
Second, the COVID-19 pandemic should not be seen in the narrow sense of an infrastructure shortage for the health sector. Even after being supplemented by another package for health human resource, the pandemic should be used as an opportunity to prepare India’s health system for the future. As an initial step in this direction, the new Union Minister of Health should consider getting a comprehensive review of actions taken on the key decisions and Government promises made (to strengthen health services) since the start of the pandemic in March 2020.
Alongside, the progress on key policy decisions, for the last few years, to strengthen India’s health system, including those in India’s national health policy of 2017, need to be objectively scrutinised. These two sets of policy decisions and announcements should be reviewed and progress monitored, through a meeting of the Central Council of Health and Family Welfare, of which the Health Ministers of the States are members. This should not wait for the pandemic to get over and should be done now. It is only if the past policy promises and commitments are followed through and implemented that India’s health system could be strengthened from what it is now.
India’s health system will not benefit from ad hoc and a patchwork of one or other small packages. It essentially needs some transformational changes. The COVID-19 package II appears insufficient and seems to be based upon a misguided assumption that infrastructure is equal to health services. Governments (both Union and State) seem to be on the path to repeat four decade-old mistakes. While international donors could be excused for being bereft of ground realities, what would the excuse for the Government be?
Dr. Chandrakant Lahariya, a physician-epidemiologist, is a public policy and health systems expert and co-author of Till We Win: India’s Fight Against The COVID-19 Pandemic
