Preparedness of the states in India to fight the pandemic

Abstract

Background: The World Health Organization’s Global Health Survey Index (GHSI) ranks India at a 57/195 for her preparedness and response to the COVID-19 pandemic. Since this pandemic has already claimed more than 1,54,500 number of Indian lives, and also because growing global interconnectivity as well as industrial animal husbandry exponentially expands, it becomes clearly evident that there is a need to understand the lessons learnt from India’s response to COVID-19 in order to be better prepared for future challenges. This paper assesses governmental actions and policies of the past year to precisely find out what worked and what not. All analyses are at the state-level. Methods: To make the comparisons, we used the cross sectional data of the states on covid-19 infections. We captured the death and infection rates and split the states along the median to identify the more and less seriously impacted states. This yielded four quadrants. One, the states having both, more infection and more death rates. Two, the states having more infection but less death rate. Three, the states having less infection but more death rate. Four, the states having both, less infection and less death rate. The documentary analysis of steps taken by government and health infrastructure availability was done to arrive at the conclusions. Results: Briefly, the paper has three findings. One, the states with the highest infection rates were paradoxically not the states with the highest testing rates. Two, the states that have suffered with the highest infection and death rates were the states that lacked the most, in terms of medical facilities like hospitals, PPE kits, isolation beds in the hospital, and ventilator machines. Three, paradoxically, the economically better states were not that effective in preventing the spread of pandemic. In order to save management costs, these states ended up consuming the surplus and being less efficient. Proxy indicators suggest that players and stages had an impact on the coordination costs. Also, the interest, engagement and competency of players also effected the coordination costs. The logistic and coordination costs were more when the group of people governing the centre and state were of different ideology. The costs have high impact at the times of urgency and disaster management. The less infected states were those who were able to adopt hyper local approach and multipronged strategies. In this way, these states reduced coordination costs and leveraged the strength of private players like NGOs, volunteers etc. Conclusion: The paper recommends three lessons to be learnt from the pandemic to meet future challenges. One, the states with the highest infection need to increase testing rates. It requires more laboratory systems to detect and report more and more people. It also require data integration to take preventive steps. Two, the states that have suffered with the highest infection and death rates can no longer measure the health infrastructure in terms of per capita expenditure on health. The medical facilities needs to be measured in terms of hospitals, PPE kits, isolation beds in the hospital, and ventilator machines per 1000 population. Three, the states have to set up efficient procedures to minimize currency conversion fee for logistic and coordination costs. The players, stages, engagement, competency and interest may be examined to optimise the coordination costs. The government through policy initiatives can encourage hyperlocal approach, multipronged strategy and adoption of legal processes and technology solutions. The findings drawn in this paper highlight the differences in strategies adopted by the states. It gives us a nuanced view of socio-economic challenges and health infrastructure. It also provides insights on how the states can leverage/pool the resources so as to create a better ecosystem and preparedness for future calamity, if it occurs. In turn, it will foster overall growth in the country.