Indian health care system and its preparedness for outbreak such as NIPAH: A contrasting study across Indian states

Abstract

The May of 2018 was trending not just for its record-breaking temperatures as usual but also for a rare outbreak which was hardly heard of in India before. Nipah broke out in the southern state of Kerala and went on to claim 17 lives. In Kerala, a state which is one of the most advanced when it comes to healthcare, most of the infections took place inside the hospital premises. This gave rise to a very concerning question – How would have this panned out, had it been a lesser prepared state in terms of healthcare? The broader question being – How prepared is the Healthcare System in India to deal with an outbreak like Nipah? Healthcare in India is a state affair. It has been in shambles ever since India’s independence. Through this report, a state-wise study was done to judge their respective preparedness and recommendations are given based on findings. The states under study are Kerala, Uttar Pradesh and Odisha. The current system in place to deal with outbreaks and epidemics comprises of the National Centre for Disease Control (NCDC) which supervises the Integrated Disease Surveillance Project (IDSP). IDSP is aimed at a decentralised IT based laboratory surveillance. It focuses on integration and decentralisation of surveillance with a Central Surveillance Unit (CSU) at Delhi, State Surveillance Units (SSU) in all States and UT and District Surveillance Units (DSU) at all district levels. 97% of the districts are covered under IDSP and all data entries are made online. But, most of the data is outdated and the integrity is also questionable. When we talk about the deficiencies of our current system, India has always had paucity of human resources in the healthcare sector. The WHO benchmark requires 25.4 healthcare workers per 10,000 population but India lags behind at a meagre 11.9 per 10,0006 . The shortages of medical personnel in our system is also quite acute. 18% of the total health centres are without a qualified doctor while about 38% are without a lab technician and 16% are without a pharmacist. A major consequence of these statistics is that a huge population receive improper or no healthcare at all. To add to the misery, departments of preventive and social medicine in all the medical colleges have been inadequately equipped due to comparatively lower prestige and poor staff quality. This specialisation is among the least preferred among medical students. When it comes to resources allocation, India has one of the lowest health expenditures as a percentage of GDP among the developing and developed countries. India currently spends only 1% (2018) of its GDP on healthcare . It’s so dire that only 15% of the population is health-insured. This results in catastrophic healthcare expenditures on the part of the patients. In 2015, an astounding 8% of the Indian population slipped below poverty line because of such unanticipated catastrophic expenditures. Expenditure on preventive and social medicine forms an even smaller proportion. As a result of resource deficit, India has been lagging in developing infrastructure with increasing population. The shortfall in recommended number and the actual number is erringly high with 19% in SCs, 22 % in PHCs and 30% in CHCs. The IT infrastructure, which is as a result of the efforts made by the IDSP, is not that well-off either. The biggest problem that remains is misreporting or non-reporting of data so as to ensure good performance on paper. While the data is there, it is not readily consumable by public. There have been initiatives by Government where National Informatics Centre (NIC), has designed, hosted a website data.gov.in to make various government data readily available and have visualisation tools to make it easier to comprehend. Yet the data is mostly outdated and too cluttered and full of noise to be readily consumable for researchers and other interested parties. Besides, awareness also poses a severe problem. People still lack the all-important exposure to crucial information that is issue in public interest . Poor knowledge is not just limited to the benefits but extends to basic knowledge about the diseases. One more issue that the system faces is self-medication. This is the one downside of partial-awareness. It is also one of the biggest reasons behind the growing pathogen resistance to antibiotics . This also results in late or improper reporting of a potential outbreak. To tackle all of the above deficiencies, one may promptly blame the government for not spending enough and cite that the best recommendation will be to increase the spending as a percentage of GDP so as to ensure adequate per capita spending. The report keeps this thought aside and tries to focus on seating the current assets, leveraging the technological advent and booming services industry in India. To start, the typical citizen needs to be aware of the protocols, which can be incorporated in core curriculum and propagated through media. Moreover, publishing data in the readily consumable format will help crowdsource the detection mechanism to some extent. This is extended by rewarding the relevant research work annually to ensure that the academia is excited about finding new solutions and in turn make this area of expertise more interesting to study. The cherry on the top will be government enabling and managing a platform where the best practices states can provide consultation services to states in need, whose cost will be borne by centre, ensuring part payment to individual and part to organisation. This will take away the geographical concentration risk, which may lead to corruption being predominant. All in all, at the core lies the efficient use of resources, incorporating protocols at institutional and citizen level, predicting needs correctly and establishing and enabling the right framework to tackle outbreaks like Nipah.