India's Second Wave is Systemic
How for-profit healthcare and political motives led to COVID-19 devastation
Hospital corridors full of patients, out-of-stock signs at vaccination centers, and funeral pyres burning all night long have become common sights as the second wave of COVID-19 that began in mid-march pushes India’s healthcare system to its limits. Hundreds of thousands of people are being infected daily as India struggles to stop the spread of the virus and treat all affected individuals simultaneously. India’s healthcare system was already corrupt and hanging by loose threads, especially when it came to the healthcare provided for the poor, and COVID-19 proved the last straw. India’s healthcare system requires urgent reform to recover from this pandemic and prevent future pandemics as well, and the entire world has much to learn from this situation.
To truly understand why India's healthcare system is the way it is, we must travel back to 1947, when India first gained independence from British control. A three-tier healthcare system was established at the time with “a primary care system at the village level, a secondary care system to cover smaller urban centers and tertiary care for specialized treatment”. An attempt at universal healthcare was supposed to bring a high quality of healthcare to the then much rural India.
However, the end of British rule also meant the beginning of urbanization and industrialization in India. The economically struggling country turned to capitalism and failed to prioritize the reinforcement of the universal healthcare system. The universal healthcare system is now barely a fraction of what it was meant to be.
With urbanization, healthcare talent and doctors migrated to cities, pooling healthcare resources in cities and depleting them in rural areas. 80% of Indian doctors live in rural areas, and for a country that has 65% of its population still residing rurally, this is clearly problematic. By these statistics, 65% of India’s population is cared for by just 20% of India’s doctors, leading to high patient-to-doctor ratios in rural areas. Rural villages are characterized by their high poverty levels, so the people the universal healthcare system should be helping are not able to get the necessary aid. One state, Bihar, has 1 doctor for every 40,000 people, a stark contrast to WHO’s healthcare recommendation of 1 doctor for every 1,000 people. It is easy to see how even a slight increase of patients at rural hospitals could break the already struggling healthcare system, so the pandemic’s second wave results are not as surprising as they seem to be.
During the pandemic, the scarce amount of rural healthcare and its low quality has pushed rural villagers to city hospitals in search of treatment, thereby overcrowding and overwhelming the city doctors and resources. This has also contributed to crowding in cities and hospitals, further spreading the virus. A lack of PPE for doctors has also pushed government doctors to leave their jobs in the pandemic, reinforcing the cycle of the hospitals becoming overwhelmed.
Problems like the lack of PPE can be attributed to the fact that the federal healthcare system in India is extremely underfunded, with only 1% of the government’s GDP being allocated to healthcare. The government hospitals have a subpar quality of care and those who cannot afford private healthcare, the poor, have no other option but to settle for a low-quality treatment, without proper equipment and well-trained doctors. Rural healthcare is even more underfunded than urban healthcare, pushing this quality gap even more. Even some rural government hospitals that have been provided with ventilators and other pandemic resources have been unable to deliver proper treatment to COVID patients because of underfunded staff training by the government and a lack of qualified doctors in rural areas.
The underfunding of the universal healthcare system is once again a direct result of the push for capitalism soon after India’s independence. The prioritization of a for-profit healthcare system over the existing universal healthcare system led to the direct breakdown of the latter. High-quality private, for-profit hospital care became common-place in India, pushing those who could afford it to it. Government officials helped reinforce this system and the quality gap between private and public hospitals to earn profits off the private hospitals they have individually invested in. Most upper class and middle-class families also opt for private healthcare treatment, leaving the underfunded public healthcare for the poor. Doctors, executives, and politicians all end up profiting off the for-profit healthcare system at the cost of the poor. As a result, malpractice in both private and government hospitals in India has lacked proper regulation so far. Unnecessary surgeries and overpriced treatments have been consistent problems, but new ones during this pandemic include the black market sale of vaccinations that are supposed to be administered to patients.
A for-profit healthcare system proves even more problematic when insurance is unavailable. This is true for 90% of India’s poor, leading to high out-of-pocket healthcare costs for those who can least afford them. In 2017 alone, 55 million people were pushed into poverty in India because of health expenses. Both private hospitals and medicines contribute to healthcare costs since medications are not covered by the universal healthcare system. India is the 6th biggest private spender on healthcare, with extremely high out-of-pocket costs for those in India. Technically, in relation to other developed countries, the cost of treatment in India is lower, but most Indians earn a small fraction of what people in developed countries earn, making the relative cost of healthcare outrageous.
Throughout this past month, many of us have also read about the oxygen shortage in India, accompanied by a lack of necessary medications for treatment. Once again this is not a chance event but a systemic healthcare issue in India. The oxygen supply in India has been consistently poor for a while. In 2017, Japanese encephalitis, a common mosquito disease in India, hospitalized numerous children in Uttar Pradesh. 30 hospitalized children ended up dying with a lack of oxygen tanks in the hospital being a highly likely cause of the occurrence (STAT). Both a low amount of oxygen in India and poor distribution of it to places like rural areas, with underfunded healthcare systems, resulted in the pandemic’s oxygen shortage in India.
Lastly, from a public health standpoint, India’s pro-nationalist government failed to adopt proper measures during the second wave, leading to the current devastation. During the first wave, immediate lockdowns were implemented, leading India to early recovery and a low COVID death rate. However, many people wrongly attributed India’s preliminary success against COVID to the presence of herd immunity in the population and declared a preliminary victory against the virus. Though India was probably not immune, even in the chance that there was some level of immunity in the population, the double mutated B.1.617 variant posed a fresh threat during the second wave. Nevertheless, social activities resumed fully before the second wave, with large sports matches, religious events, and political rallies occurring, often without mask requirements.
Just a few weeks before COVID cases began climbing in India, the federal health minister declared that India was “in the endgame” of the pandemic, and the government as a whole supported reopening. Even at the start of the second wave, Prime Minister Modi severely discouraged lockdowns and even encouraged people to attend in-person voting for his political party. Sounds shockingly similar to what happened under the Trump administration, huh. America managed to get out of the situation, India didn’t. Throughout the second wave of the pandemic, Modi’s decisions remain driven by politics rather than public need, as the government recently turned down China’s offer to provide oxygen to the country because of the existing political turmoil between India and China.
Vaccination rollout, on top of all the other public health measures, also needs urgent improvement. As of April 30th, only 150 million out of the 1.8 billion people in India have been vaccinated. A key part of tackling this second wave is getting as many people as possible vaccinated which India hasn’t been doing. The Indian government chose to focus on making profits off exporting nationally made vaccines instead of actually administering them to citizens and investing in vaccination campaigns. This made the population more prone to higher infection rates and even during this peak pandemic times, 94 vaccination centers in Mumbai were closed for three days because of a lack of vaccination stock. Both securing stock and improving distribution need to be made immediate priorities by the Indian government.
For those in India, aid is coming. Oxygen, vaccinations, ventilators, and ambulances are being supplied by foreign countries with urgency to India. However, these alone will not be able to put an end to the second wave. Urgent policy changes are needed from the government level to speed up vaccinations, provide those in rural areas with healthcare, and reinforce hospitals. Pray for India and speak up for Indians, change needs to happen.
It is such a sad state in India, it's great to get an insight into what's happening. I hope everything calms down soon. Great post!
TheQuietGirl
www.quietgirlblog.com
Thanks for the insight! It is good to gain some information about the situation in India. I pray that the people can find some peace soon!