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India has the world's fastest growing outbreak of Covid-19 in absolute numbers - reporting more than 10.1 million infections as of December 22, 2020. Covid-19 has not only affected the economic growth of the country but has also impacted the core component of human development – a long and healthy life.

HDI measurement and public health

An article titled, ‘Covid-19: Rethinking human development’ by Shreya Mishra and Prachi Mittal published by Observer Research Foundation (ORF) states that three core indicators - life expectancy (at birth), knowledge (mean years of schooling) and standard of living (Gross National Income per capita) - are taken into consideration for measuring human development.

According to many observers, the HDI is a critique of the ‘economic growth before people’ model of development. The current model of calculating human development has not been perfect because of the lack of emphasis on epidemic prevention mechanisms within public health while measuring performances of nations. The article states, “Public health is defined as the science and art of preventing diseases, prolonging life and promoting health and efficiency, through organised community efforts for control of community infections, sanitation of the environment, etc.” The HDI with its emphasis on life expectancy has till now focused on reducing the impact and occurrence of endemic diseases, without laying equal focus on epidemics. Under the present circumstances, measuring epidemic management capacities of nations to hedge the progress made in life expectancy becomes important.

Health infrastructure

Media reports show that the lockdown in India adversely impacted both routine and critical health services. A bloombergquint.com report titled, “India’s Health ‘Time Bomb’ Keeps Ticking, and It’s Not Covid-19” by Rangini Saxena informed that critical immunisations were missed by more than a million children. Furthermore, hospital births witnessed a sharp decline indicating many women went through childbirth at home which was unsafe and lacked medical facilities. The latest government data also showed that outpatient critical care for cancer plunged by 80% from February.

Health infrastructure is an important indicator for understanding the healthcare delivery provisions and welfare mechanism in a country. Infrastructure in this context refers to the basic support for the delivery of public health activities. Sudhir K. Khandelwal, Department of Psychiatry, Holy Family Hospital, formerly Head, Department of Psychiatry, Chief, National Drug Dependence Treatment Centre, All India Institute of Medical Sciences (AIIMS), New Delhi, in an article titled ‘Debating the process, impact and handling of social and health determinants of Covid-19 pandemic’ published in the Indian Journal of Social Psychiatry discussed about the healthcare system in India. The article states, “There are now more than seven lakh hospital beds in the country. There is a huge rural-urban divide, with more than two-thirds of the beds located in urban areas. This should be kept in mind that the rural population constitutes about 66% in India and has dismal health infrastructure.”

The bloombergquint.com report also adds that India’s public healthcare system is understaffed and there is an acute scarcity of hospital beds. Moreover, the intensive care capacity is low with poorly trained staff. India has 1.7 nurses per 1,000 people which is 43% less than the World Health Organization recommendation and there is a dearth of doctors as well. The pandemic has been instrumental in exposing the loopholes of the Indian healthcare system.

Meagre health allocation

Khandelwal writes that India spends only 1.3% of its GDP on health for its 1.3 billion population while the spending of the developed countries on healthcare amounts to almost 10% of the GDP. The government has claimed that the lockdown period was utilised to revamp the healthcare system and for the procurement for PPEs and testing kits. However, reports of shortage of beds and healthcare workers turning away patients seeking Covid-19 treatment, as well as patients demanding treatment for other diseases indicate the continuing distress in the healthcare system even after the period of complete lockdown. T. Jacob John, one of India’s top virologists and the former head of the Indian Council for Medical Research’s Centre for Advanced Research in Virology in an interaction with bloombergquint.com said that India “takes no crisis seriously” since it deals with so many.

According to several experts, a higher investment in healthcare may not yield immediate results but will certainly improve human capital by increasing productivity and lowering infant mortality. A report titled, ‘Covid has exposed our underfunded healthcare system’ in The New Indian Express by Vinayak Jadhav spoke about the ambitious National Health Policy which promises doubling health spending from the existing 1.3% of Gross Domestic Product (GDP) to 2.5% by 2025. Incidentally, the US spends $10,000, or over `7 lakh per person per year on healthcare and yet it is still struggling with the Covid-19 pandemic. In India, spending on healthcare has increased from `1,008 in 2015 to reach `1,944 in 2020.

It is clear that an emphasis on the basic requirements is of utmost importance for determining the HDI of a country. India definitely requires a higher investment in its healthcare system. A long and healthy life is a primary component in determining the HDI index and without a developed healthcare system, a high HDI rank is not achievable.