Managing India’s COVID Crisis through Human Capital Reform

Abhishek Yadav contributed to this article.

After soldiering through the first COVID-19 wave with a national lockdown and a relatively low death count, India lost a devastating battle with the second wave. Total deaths, which peaked in April, have climbed up to nearly 400,000, but are likely grossly under-reported as per numerous accounts by journalists and medical experts. Two variants of the virus, Delta and Delta Plus, have been identified and are likely to have driven the surge. However, there is no doubt that many lives could have been saved with better decision-making on the part of the Government of India (GOI).

News and social media have highlighted the scramble for oxygen tanks and hospital beds, which were in short supply because the GOI could not procure them in time for the peak in cases. It was NGOs and social media that coordinated with COVID wards to provide patients beds and oxygen tanks. Drugs to treat COVID such as remdesivir were sold on the black market for high prices. The government failure could not be more apparent.

A third wave is inevitable. The second wave hitting urban areas was widely covered by international media, but the press has hardly covered its encroachment into rural areas. Bodies were found washed up on the Ganges river because cremations could not keep up with higher death counts coinciding with the surge in cases.

However, the problem extends beyond the failures of the current administration. Policy-makers have routinely placed a low priority on healthcare, resulting in poor infrastructure. At less than 4%, India’s healthcare expenditure as a share of its GDP is abysmally low. For comparison, that same measure is about 17% in the US, 10% in Brazil, and 12% in Germany. It is therefore no surprise that India lags in numerous healthcare indicators, with a doctor to patient ratio less than the global standard of 1:1000. The government yielded the provision of quality healthcare to the private sector, but this serves the elite, urban section of Indian society at the expense of the rural, the low income, and even the urban middle class.

Stocking up on basic amenities including hospital beds, drugs, and PPE for doctors would likely prepare the country for an inevitable third wave. However, this is just the tip of the iceberg. Long-term solutions must entail reforming India’s healthcare system from the ground up.

First, the GOI must strengthen the human capital in the healthcare sector. After all, what good are more oxygen tanks, ventilators and hospital beds if there are not enough medical personnel to administer them? So far, on the recommendations of cardiac surgeon and medical entrepreneur Dr. Devi Shetty, the GOI has allowed medical schools to dispatch final year students, as well as qualified nurses with a BSc or GNM degree, to work in COVID wards. Furthermore, the central government has provided these medical professionals the following incentives: a prestigious award, the Prime Minister’s Distinguished COVID National Service Samman to enhance their employment opportunities, and coverage under a special insurance scheme.

However, the incentives in place do not go far enough. A quick primer on Indian medical education: Indian medical exams are administered first after medical school to gain entry in post-graduate program. This is known as the NEET-PG exam. After post-graduate training is complete, budding Indian doctors must crack an additional, notoriously difficult exam. Dr. Shetty has further suggested that post-graduates who work a year in the COVID wards should be cleared from those exams because they would have proven their competence. Medical students who assist with COVID care should be given grace points when taking the NEET-PG exam. The same exam clearance incentive could also apply to nurses. We strongly recommend that the GOI also implement these policies – there should be no dearth of incentives provided to budding Indian medical professionals.

Second, the number of deaths in the medical community is alarming and appalling. The Indian Medical Association said that 798 doctors died of COVID across the country during the second wave, of whom 128 lost their lives in Delhi and 115 in Bihar. Doctors dying is alarming news for a country like India that suffers from a shortage of medical professionals. The doctor-patient ratio in India is already less than 1:1000 – with each additional loss, more patients are put at risk. This situation could easily worsen if India cannot protect its healthcare workers.

Even more worrying, there are numerous disturbing reports of violence against doctors, including a mob attack on a health professional by a deceased person’s relatives. On the 18^th of June, doctors protested in New Delhi against this violence, with the slogan ‘Save the Saviours’. Around 350,000 doctors participated, demanding laws on violence against medicos. It is essential to provide safe working conditions for healthcare professionals. India’s shortage of medical professionals, despite medicine being a highly sought career, is also in part due to high emigration rates. This emigration must be addressed, and improving working conditions for doctors would go a long way to doing so.

In the short-term fight against COVID, safety measures must be taken to protect doctors, both medically and from public violence. Priority in providing hospital beds and treatment should go to doctors rather than be saved for VIPs. Other potential measures include pre-orders of PPE kits, priority vaccination to doctors and their family members, as they are also at high risk, and mental health resources for doctors. The Indian government is allocating additional funds for the health sector and COVID management, but this allocation should be just the starting point; we urgently need more investment in the medical sector.

COVID is not the end, and in the long-term, reform must be sweeping. As we move towards an unpredictable future and different viruses all around the globe, the government should constitute a pandemic task force to ensure that the country is prepared for outbreak. Provision of minimally acceptable healthcare can no longer be the domain of private organizations; the GOI must increase its healthcare budget. In 2020, it was announced that the healthcare budget would double to $30.1 billion – even this is not enough. Healthcare must penetrate to rural areas, where healthcare workers often do not wish to work. Healthcare reform in India is a dire need that will continue even after coronavirus is no longer a leading cause of death. India is not just in need of reform in the healthcare sector – it needs a healthcare revolution.