Five years after lockdown: Is India prepared for another health crisis?

Five years ago, on March 25, 2020, India came to a standstill as the first nationwide lockdown was imposed to curb the spread of Covid.

 

The pandemic was an undeniable stress test for healthcare systems across the globe, exposing weaknesses and forcing nations to rethink their preparedness.

 

Five years later, it is time to assess whether India is better prepared for another public health crisis.

 

The Covid outbreak initially exposed India’s healthcare vulnerabilities. Hospitals were overwhelmed, oxygen shortages turned deadly, and an overburdened workforce struggled to keep pace. However, the system geared up to the challenges later, particularly with its vaccination programme. 

 

 

In the years that followed, government spending on healthcare has remained abysmally low. 

 

Public health expenditure as a percentage of gross domestic product (GDP) rose from 1.2 per cent in 2019-20 to 1.5 per cent in 2021-22, only to fall again to 1.3 per cent in 2022-23. 

 

This modest increase was largely driven by state governments, whose healthcare spending rose from 0.9 per cent of GDP in 2019-20 to 1.1 per cent in 2020-21, a level that has been maintained until 2024-25. 

 

However, at the national level, the Union government’s allocation to the Ministry of Health and Family Welfare has steadily declined from 0.32 per cent of GDP to just 0.28 per cent.

 

By comparison, most developed nations allocate between 6 and 10 per cent of GDP to healthcare. 

 

The National Health Policy 2017 envisaged increasing health spending at least 2.5 per cent of GDP by 2025 — a target that was initially set for 2022.

 

However, with healthcare spending stagnating, India has fallen short of its targets and is unlikely to meet the 2025 goal without a drastic increase in investment. This under funding threatens to derail any progress made in fortifying healthcare infrastructure.

 

The shortage of healthcare professionals is another pressing concern. In 2020, India had just 0.7 doctors per 1,000 people. That figure has only marginally increased to 0.79 in 2024, still well below the global average of 1.6-2.5. Countries like Germany and Japan boast over four doctors per 1,000 people.  

 

One of the clearest indicators of India’s lagging preparedness is hospital bed availability. According to World Bank estimates, India had 1.6 hospital beds per 1,000 people in 2021, a decline from 1.7 in 2014. In contrast, China has expanded its capacity significantly, reaching five beds per 1,000 people by 2020. 

 

About two decades ago, in 2005, India and China were comparable at 1.9 beds per 1,000 people. However, China has since made significant progress, while India has seen a decline in its hospital bed density.

 

India has, however, recorded a decline in out-of-pocket expenditure (OOPE) — expenses directly paid by households at the point of receiving healthcare. According to National Health Accounts estimates for 2021-22, OOPE fell to 39.4 per cent of total health expenditure (THE) from 48.8 per cent in 2017-18. 

 

Despite this improvement, India’s OOPE remains significantly higher than global standards. For instance, in many European nations, OOPE accounts for less than 20 per cent of the total healthcare spending.

 

Countries with robust universal healthcare systems, such as the UK and Canada, have figures below 15 per cent. Expansion of the government's flagship health scheme — Ayushman Bharat — to those above 70 years may have reduced OOPE further. 

 

Lessons of the last pandemic have prompted discussions on the need for sustained healthcare investments. As global trends indicate an increasing emphasis on health spending, India's capacity to bolster its healthcare system will be crucial in determining its readiness for future public health challenges.