The Covid-19 crisis has tested the resilience of India's health system. Shortage of personnel and underfunded infrastructure are amongst the symptoms of India's ill public health system. In the first article of this new series on health issues in India, Christophe Jaffrelot, Senior Research Fellow at CERI-SciencesPo/CNRS and Vihang Jumle, Data Analyst and IT Engineer, provide an analysis of the effects of the pandemic on the national as well as the state level. This article underlines India’s significant regional disparities and assesses the impact of the virus across the country.
As of October 30 2020, India has recorded the second biggest number of Covid-19 cases (8 million), next only to the US (9.2 million). India is third on the number of deaths (121,144), behind Brazil (159,033) and the US (234,222). It is currently third on the number of active cases (595,074), after the US (3 million) and France (1.1 million), and second on the number of critical cases (8,944 in India, and 16,931 in the US). These figures may reflect a certain underestimation, as India ranks low on "tests per million" (at 77,813), while the US ranks near 19th (at 427,446). Moreover, test positivity for India is 7.5%, while for the US it is 6.5%.
8 million cases when evenly distributed over 1.3 billion (for India) would of course paint a rosier picture than distributing 9.2 million cases over 331 million (for the US). But cases in India are not evenly distributed: they are clustered in major cities and select states with varying fatality ratios. For instance, cases per million in New Delhi stands at 18,964 with a fatality ratio of 1.7% (out of 100 people), Andhra Pradesh stands at 15,658 cases with a fatality ratio of 0.8%, and Maharashtra stands at 13,644 cases per million with a fatality ratio of 2.6%. On the contrary, some states like Rajasthan only have 2,503 cases per million and a fatality ratio of 1% and some exceptional states like Gujarat have only 2,531 cases per million but a high fatality ratio of 2.2%. This regional disparity, therefore, calls for a deeper investigation at the state level to better assess the impact of Covid-19 in India. Before that, we will analyse the effect of the pandemic at the national level in the context of a chronically underfunded public health system.
Why is the Indian Public Health System Lagging Behind?
The pandemic has brought to the forefront the shortage in medical staff and infrastructure in India. As of September 2019, India had 1 medical doctor for every 1,404 people and 1.7 nurses per 1,000 people, lower than the WHO recommended 1 medical doctor and 3 nurses for 1,000 people. In comparison, in 2017, the US had 26.12 doctors per 10,000 people, Brazil had 21.6, China had 19.7 and India had only 7.7. For nurses per 10,000 in the same year, the US stood at 145.48, Brazil stood at 97.37 (this increased to 101.19 in 2018), China stood at 26.6 and India stood at only 21 (this reduced to 17.27 in 2018).