About India's Health care System in dealing with crisis

• The world’s largest democracy is particularly vulnerable to infectious diseases—but history shows it can be surprisingly resilient.
• As India braces for the rapid spread of the coronavirus, its health care system offers limited comfort. The country spends just over 1 percent of its GDP on public health, while some of its smaller neighbors such as Nepal (6.29 percent) spend a much higher proportion.
• Advanced economies are even further ahead: The United States, for example, spends about 17 percent of its GDP on health care; Germany and the United Kingdom spend 11.14 percent and 9.76 percent, respectively.
• Other indicators are not heartening either. India has just 0.5 hospital beds for every 1,000 people living there; the World Health Organization (WHO) recommends at least five. India averages 0.8 doctors for every 1,000 citizens; even Italy, which has been badly hit by the coronavirus outbreak, has five times as many doctors per capita.

There is ample reason to fear that if the coronavirus disperses rapidly through a country as densely populated as India—it may already have done so—it could overwhelm the country’s medical infrastructure. Such misgivings are hardly new: Given the hapless quality of public health infrastructure in India, they are in fact understandable. Yet the Indian state somehow seems to be remarkably resilient when confronted with crises. Three compelling examples from the past few decades suggest that the country has an ability to mitigate dire health challenges even though it has displayed a lax attitude toward addressing routine public health needs.
When the HIV crisis hit the world in the late 1980s, many experts predicted the virus would severely impact India. Yet the National AIDS Control Organization managed to prevent a national epidemic, with infection rates showing a substantial drop in the late 1990s after an initial spike. At least two policy initiatives stemmed the spread of HIV. The government provided free antiretroviral drugs to the afflicted population. It also made significant outreach efforts to the two most vulnerable population groups—gay men and sex workers—despite having laws at the time that made gay sex illegal. India’s relative success in reducing new infections showed that it was able to adopt a crisis plan despite its laws or subpar health care system. Then, in 1994, there was an outbreak of the pneumonic plague in the city of Surat in Gujarat. After a somewhat confused response, the government nevertheless managed to control the plague before it assumed epidemic proportions. Surat’s officials improved trash collection and street cleaning, and put in place strict standards of hygiene in restaurants—practices that have today made it a public health leader in the country. There is little doubt that routine access to health care for the vast majority of India’s citizenry, especially for the poor, remains abysmal.
More recently, when confronted with the deadly Nipah virus, for which there is no known cure, Indian health authorities acted promptly to limit its dispersion. Following the initial outbreak, local health authorities sent a virus sample for testing to the National Institute of Virology in Pune. They also waived the costs of the tests and promptly imported anti-viral drugs from Australia. Meanwhile, the National Centre for Disease Control coordinated efforts with local, state, and national health authorities, eventually containing what could have been a far deadlier outbreak.
Despite these relatively successful outcomes, there is little doubt that routine access to health care for the vast majority of India’s citizenry, especially for the poor, remains abysmal. A mere 44 percent of the county’s population has some form of health insurance. This is a situation that the government of Prime Minister Narendra Modi hopes to address as it embarks upon ambitious plans to create a national program to give citizens free health care. But the reality is that India’s health care system has long been unequal. While the poor suffer, the country’s rich can afford elite hospitals that are often world-class. Not surprisingly, India has become a hub of global medical tourism.
Current Scenario

• India currently has over 140 confirmed cases of COVID-19. The government has been quick to adopt a multipronged strategy, including issuance of clear guidelines to ministries for coordinated action, imposition of travel restrictions, suspension of visas, large-scale screening and contact tracing as well as regular dissemination of information to the public.
• Mounting a swift response involving all stakeholders in a country of India’s scale and diversity is undoubtedly commendable. With these measures in place we can be confident that India will be able to successfully limit the spread of the disease.
• Meanwhile in Italy, the number of coronavirus cases and deaths continue to surge. Doctors and nurses are under increasing pressure and are calling out for help while medical supplies run out rapidly.
• In the US, dozens of health-care workers have fallen ill with covid-19, and more are quarantined after exposure to the virus, an expected but worrisome development as the U.S. health system braces for a surge in infections.
• The need of the hour is to build a resilient public health system that can prevent diseases, promote good health and respond quickly to minimise loss of life when faced with an outbreak of this magnitude