NEW DELHI: Prime Minister Narendra Modi’s call for social distancing through the imposition of a “Janata curfew” has become more important now because India’s medical and health infrastructure will not be enough to tackle a mass outbreak of Covid-19, according to several doctors and officials of the Ministry of Health that The Sunday Guardian spoke to.

A senior official of the Ministry of Health said that India is still at stage 2 of the Covid-19 outbreak and the government is trying all possible methods to stop or slow down stage 3 of the pandemic.

“If we reach stage 3 of the pandemic, India’s healthcare system will collapse, given the fact that we are such a huge country with a massive population. We will not be able to cater to so many patients at one time. The medical staff would be overwhelmed, there would be a huge shortage of ICU beds, and the entire infrastructure will collapse. This is why we need to follow the Prime Minister’s call for social distancing at this hour,” the health ministry official quoted above said.

Health experts and medical professionals have also pinned the blame on the failure of successive governments to improve the public healthcare system in India.

India’s public health expenditure has remained at 1.2% to 1.6% of the total GDP between 2008-09 to 2019-20 compared to other developing nations such as Brazil and South Africa whose expenditure on public healthcare has remained between 7.5% to 8% of their GDP. Among India’s neighbours, Bhutan has a public healthcare budgetary allocation of 3.6% of its total GDP and Bangladesh at 2.2% of its GDP. Developed nations like the United States and Germany have kept their expenditure much high on public healthcare at about 8.5 to 9.5% of their total GDP.

The budgetary allocation for the Department of Health Research has remained poor. While the Department of Health and Family welfare gets 97% of the Ministry of Health and Family Welfare’s budgetary allocation, the Department of Health research, which includes the Indian Council for Medical Research (ICMR), gets just 3%, amounting to Rs 2,100 crore in financial year 2020-21.

Per capita expenditure on public health in India has also been low for several years. According to the National Health Profile 2019, India’s per capita public expenditure on health in nominal terms is Rs 1,657 (2018-19), which is much lower than countries like Sri Lanka where it is three times more and Indonesia where it is twice more than India. India for several years has also been battling with a shortage of doctors. The WHO (World Health Organisation) mandates that the doctor to population ration should be 1:1000, while India has a doctor-population ration of 1:1,404, as of February 2020.

For people living in rural areas and completely dependent on government healthcare facilities, the doctor to patient ratio is abysmally low with 1:10,926 doctors as per National Health Profile 2019.

India also has a shortage of trained nurses and midwives; registered nurses and midwives in India are a little more than 2 million, many of whom are not trained in caring and handling of patients during an outbreak of infectious diseases. The WHO mandates that the population to nurse ratio to be 1:483.  Medical professionals fear that if a massive outbreak of the virus takes place like what has happened in Italy or Iran or Spain and for that matter in China, India would not be able to cope. Many doctors and medical professionals have argued that India should go for massive testing in order to stop stage 3 (social transmission) of the outbreak in India. A health ministry official said: “We currently have about 2 million test kits for testing coronavirus and if we have to go for testing everyone or even asymptomatic patients, it will turn into a chaos and we will run out of test kits when we will need them the most. At this stage, it is best avoidable to test asymptomatic patients.”