The COVID-19 pandemic has proven to be an unprecedented health and humanitarian crisis that has exposed the inadequacies in our health infrastructure and lack of preparedness to handle large-scale health emergencies. The existing scenario has underscored the importance of investing in and strengthening India’s public health system, which is the primary means of affordable healthcare for the poor and marginalized populations. 

Although the catastrophic aftermath of the pandemic has been largely attributed to an avalanche of cases which have overburdened India’s health infrastructure, our chronically underfunded public healthcare system and lack of emphasis on primary healthcare delivery has had a major role to play in magnifying the impact of COVID-19. A limited resource envelope for the health sector has affected the quality, reach, and provisioning of adequate health care services. It has also resulted in widespread inequities in distribution of health infrastructure and health personnel. 

The rural healthcare infrastructure has, for long, struggled with severe shortage of resources, lack of basic supplies, and a skilled health workforce. According to the Rural Health Statistics 2019, there is a shortfall across all levels of frontline health workers. As against a total requirement of 157411 male health workers at the Sub-Centres, there is a shortfall of 62% of male health workers at these facilities. Similarly, while the requirement for female health assistants/Lady Health Visitors at the primary health centers (PHCs) is 24855, only 55% of them are in position with a shortfall of 48%. About 60% of the PHCs fall short of male health assistants and 26% PHCs in the rural areas and 44% of PHCs in the urban areas do not have an ANM. The penetration to the lowest level of the healthcare system in remote corners is inadequate, leading to overburdening of the urban healthcare systems, particularly for tertiary care. These challenges have been further exacerbated during the emergency response to COVID-19 and the subsequent Lockdown which severely impacted access to essential non-COVID-19 related healthcare services, especially for vulnerable population groups.

Women and girls have been facing compounded hardships during the COVID-19 crisis, given the intersecting burdens of gender discrimination and inequality. For instance, school closures due to the pandemic have impacted access to mid-day meals and sanitary napkins for adolescent girls. Findings from a three-state study conducted by Population Foundation of India in April-May, 2020 showed that a little more than half (56%) of the young girls interviewed reported having an unmet need for sanitary pads. The lack of agency among women to exercise their reproductive choices have prevented many women from accessing and negotiating contraception, putting them at greater risk of unintended pregnancies and compromised health outcomes. Recent projections have shown that the inability to access contraceptives during the lockdown is likely to result in an additional 2.4 MILLION unintended pregnancies in India while 1.85 MILLION Indian women will have compromised access to abortion services in the near term due to COVID-19. A recent report by UNIADS has estimated that the COVID-19 pandemic has impacted contraceptive access for more than 25 million couples in India.  

Much of what we do and say today will influence how the pandemic impacts us in times to come. Going forward, COVID-19 must be viewed as a unique opportunity to redefine and reimagine healthcare in India, by promoting health literacy and self-care among people. Health systems strengthening and increased health budget allocation is the need of the hour.  The Government must re-evaluate and revamp the public health system in order to ensure system preparedness to combat health emergencies at scale. Southern states of India are proof of the fact that a well-balanced and equitable health system has the ability to withstand the worst possible crisis. In contrast, it is virtually impossible for an unprepared health system to suddenly step up to the challenge of a public health emergency of the magnitude of COVID-19. The resilience of the frontline health workers must be built and the government must focus on health management and prevention instead of disease management and treatment alone.  Efforts also need to be made to ensure that the COVID-19 response doesn’t take away from other essential health services. Civil society and philanthropic organizations need to step up, as they always have, to support communities, and vulnerable sections of society. Finally, it is imperative to ensure that all emergency measures adopted in the face of the pandemic are inclusive of all sections of society and ensure no one is left behind. 

(The writer is Sr. Manager, Knowledge Management and Partnerships, PFI. She is a health scientist and holds a PhD in Cell Biology from the George Washington University (GWU), Washington D.C.  She currently works with the research and evaluation team at Population Foundation of India and is a technical expert on health issues. Views expressed are her personal.)