[Answered]It is said that India has been a ‘hot zone’ for the emergence of new zoonotic (animal-derived) pathogens for over a decade. In light of this, discuss the need of strengthening healthcare infrastructure to handle any risk of epidemics in India.

India, being a tropical nation, faces a high risk of epidemics. According to the Global Health Security Index 2019, most Asian countries, including India are facing significant risks and are unprepared for outbreaks of major infectious diseases. The recent epidemics of Nipah virus and acute encephalitis syndrome call attention to the important changes that need to be made in the country’s public health infrastructure to prevent any situation of future epidemic.

Need of strengthening healthcare infrastructure:

1. Rapid urbanisation: The rapid urbanisation has raised new challenges to sanitation and healthcare. Given its urban congestion, the slum clusters around the cities and poor waste disposal system, India is at high risk of epidemics.
2. Socio-economic factors: There are demographic and socio-economic factors that put India at strong risk for communicable diseases, including its large population and changes in agricultural practices that introduce zoonotic pathogens like swine flu, Zika etc.
3. Geography of India: Sub-tropical climate provides a ground for germination of diseases. Due to a cumulative effect of poverty, population load and climatic factors India’s population is seriously susceptible to diseases.
4. Less number of hospitals: Penetration of healthcare infrastructure is much lower than that of other countries and than the global average. The bed density in the country is 0.7 per 1,000 population, far below the global average of 2.6 and WHO benchmark of 3.5. There are only 23,582 government hospitals, according to the National Health Profile 2018.
5. Poor Rural healthcare: More than 70% of India’s population lives in rural areas and there are only 25,650 primary health centres to cater to their needs. According to health information only 31.5% of hospitals in the total are situated in rural areas.
6. Shortage of staff: India faces a shortage of about 6 lakhs doctors, one million nurses, and a large number of paramedical staff.

Measures to improve healthcare infrastructure in India:

1. Improving strong surveillance: The first step for improving defence against outbreaks is strengthening surveillance mechanisms. The early detection must be focused on surveillance and monitoring.
2. Investing in research and development (R&D): The management of an infectious disease outbreak is greatly dependent on vaccine development. The efforts must be made for rapid pooling of resources and financial assistance for R&D in vaccination of emerging threats of epidemics.
3. Collaborative effort: Central and state health agencies must act in tandem. The media, too, must help in increasing awareness without triggering panic.
4. Multi-sectoral coordination: Adequate public health systems and multi-sectoral coordination at early, local stage play an important role in containing diseases that could lead to national and global spread like SARS and Ebola.
5. Working with international agencies: National governments and international health agencies should work together to adopt urgent measures towards building the resilience of public health ecosystems in preventing and combating infectious diseases.

The solution to combating infectious disease outbreaks lies in sustained, collaborative and institutionalised global efforts. States have a clear obligation to define their responsibilities and enhance their contributions to make the country safer.