With over 312,000 cases registered on April 21st India’s daily caseload is now the highest of any country since the pandemic began over a year ago. With an overall caseload over 15 million, the second highest after the United States, the country’s fragile health infrastructure is being pushed to a breaking point. Reports from state after state suggest that patients and their families are scrambling to secure hospital beds and governments are struggling to provide oxygen and critical life-saving medicines for serious patients.
Several health facilities, including AIIMS in Delhi, which have been treating large numbers of non-COVID patients through the pandemic have suspended routine OPD services. Doctors, nurses and other healthcare professionals are being diverted to COVID-only duty as states convert non-COVID hospitals into COVID treatment centres. As we had witnessed during the lockdown last year, it is likely that health care services will be affected due to local restrictions already in place in a number of states and union territories, and health facilities either shut down or converted for delivering pandemic related services. Furthermore, restrictions on mobility and fear of health centres also reduce access to health care services, including family planning and reproductive health services. With ASHAs, ANMs and Anganwadi Workers diverted to COVID care and limited outreach services such as Village Health, Sanitation and Nutrition Days (VHSND), the effect in rural areas is magnified.
Population Foundation of India’s own analysis of the first lockdown shows that there have been severe drops in access to contraception, ante-natal care services and institutional deliveries. In Bihar, Rajasthan and Uttar Pradesh, adolescents reported an unmet need for reproductive health services, especially menstrual hygiene products. While it is commendable that the Ministry of Health and Family Welfare (MOHFW) included reproductive health services in the list of essential services, women’s access to high quality uninterrupted services have been impacted.
A recent UNICEF report, Direct and Indirect Effects of COVID-19 Pandemic and Response in South Asia, estimates that disruptions due to the pandemic will result in significantly higher numbers of maternal and child deaths, unwanted pregnancies and disease related mortality in women and adolescents than in previous years. India alone is likely to record an additional 154,000 child deaths. Maternal deaths are estimated to rise by 18% and stillbirths by 10%. Of the 3.5 million additional unintended pregnancies estimated due to disruptions in access to reproductive healthcare, 3 million are likely to be in India.
The unmet need for family planning services is already high and disruptions to health services will have far-reaching consequences for the health of women. Research suggests that as a result of the pandemic, 26 million couples in India will have no access to contraceptives. The inability to access contraceptives is likely to result in an additional 2.4 million unintended pregnancies and close to 2 million Indian women will be unable to access abortion services due to COVID 19.
Emergency situations, such as this pandemic, require even the strongest health systems to reorganise and prioritize the needs of vulnerable populations. India’s fragile healthcare sector is not equipped for the unprecedented rise in COVID-19 cases in this second wave. With only 5 hospital beds per 10,000 population and 8.6 physicians for every 10,000 people the country does not have the infrastructure for a crisis of this enormity. Moreover, inefficiency and acute shortages have not kept pace with the growing needs of the population. Under these prevailing circumstances there will also be severe implications for not only routine health services but also the COVID-19 vaccine roll-out. Challenges remain for the states as existing nursing personnel are expected to undertake both COVID-19 vaccination as well as provide routine health care services, including reproductive health services and immunisation. The differential pricing that has been proposed as the vaccine is opened to people below 45 will further underscore health inequity and inadequate supplies. It is likely that those who are most vulnerable or living in remote areas that are distant from health facilities will not have access to vaccination.
The disruption to essential health services due to the high burden of COVID-19 cases demonstrates the need to build health systems that have the capacity to not only cater to the ever-increasing demand for health services but also withstand crises such as this one. Shifting government priority to focus on health management and disease prevention is critical. So is ensuring greater equity in accessing healthcare – improving public health infrastructure is vital to ensuring quality health care for all.
Frontline health workers have been the face of India’s fight against COVID over the last 12 months. Greater investments in their capacity building during and beyond the pandemic is necessary, given that they represent the first and often only point of contract with the public health system for rural women.
The COVID-19 pandemic poses one of the biggest health and humanitarian crises India and the world has ever witnessed. It has exacerbated existing challenges to public health, particularly for the most vulnerable and marginalised. As the government fire-fights to realign and redirect resources to where they are needed most, we must recognise that this pandemic has underscored the importance of investing in public health and prioritizing universal health coverage to ensure uninterrupted essential health services for India’s most vulnerable.
(The article was co-authored by Poonam Muttreja, Executive Director of the Population Foundation of India and Mandira Kalra Kalaan, Associate Director, Communication, Population Foundation of India.)
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NDTV – Dettol Banega Swasth India campaign is an extension of the five-year-old Banega Swachh India initiative helmed by Campaign Ambassador Amitabh Bachchan. It aims to spread awareness about critical health issues facing the country. In wake of the current COVID-19 pandemic, the need for WASH (Water, Sanitation and Hygiene) is reaffirmed as handwashing is one of the ways to prevent Coronavirus infection and other diseases. The campaign highlights the importance of nutrition and healthcare for women and children to prevent maternal and child mortality, fight malnutrition, stunting, wasting, anaemia and disease prevention through vaccines. Importance of programmes like Public Distribution System (PDS), Mid-day Meal Scheme, POSHAN Abhiyan and the role of Aganwadis and ASHA workers are also covered. Only a Swachh or clean India where toilets are used and open defecation free (ODF) status achieved as part of the Swachh Bharat Abhiyan launched by Prime Minister Narendra Modi in 2014, can eradicate diseases like diahorrea and become a Swasth or healthy India. The campaign will continue to cover issues like air pollution, waste management, plastic ban, manual scavenging and sanitation workers and menstrual hygiene.