The pandemic is shifting to rural areas where health facilities are abysmal

Newer patterns are emerging in India’s Covid-19 surge with cases crossing a million mark and the deaths at 26,000. While 10 urban centres including Pune, Thane, Mumbai, Hyderabad, Bengaluru, Delhi, Chennai, Kolkata, Ahmedabad and Guwahati still account for at least half of the active Covid-19 cases, the pandemic has now shown a distinct spread into backward States and rural areas. In fact, the case growth rate has fallen below the national daily average of 3.4 per cent in States where the infection had charted an extremely worrisome course so far. In Delhi particularly, from an average daily growth rate of 4 per cent on July 1, the case rate has dramatically fallen to 1.6 per cent by July 15. In Maharashtra too, the rate is slowing down — from 3.3 per cent per day on July 1 to 3 per cent on July 15. In Tamil Nadu, it has gone down from 4.9 per cent to 3.1 per cent in the last two weeks. But the advance of the disease in States such as Bihar, Uttar Pradesh, Jharkhand, Chhattisgarh, Assam and West Bengal (besides Andhra Pradesh and Kerala) presents greater challenges to policymakers.

Unlike the metros with their disproportionately high concentration of super speciality hospitals and doctors, the number of healthcare infrastructure and health providers in these regions is abysmally low. The National Health Profile, 2019, created by the Central Bureau of Health Intelligence estimates the total number of doctors in the most populous State of Uttar Pradesh to be around 77,549. In Bihar, the third most populous State, this number is 72,016. The contrast with Karnataka with 1,20,261 doctors and Tamil Nadu with 1,33,918 and a smaller State such as Kerala with 59,353 doctors is among the many variables that explain the far healthier Human Development Indices in the southern States. It is no surprise that they have been better at combating the pandemic thus far. The statistics are similar for the number of nurses, midwives, pharmacists, beds and intensive care facilities.

The trends are clear and policy focus needs a similar shift. The total number of government hospitals in Bihar is an abysmal 1,147 with about 11,664 beds. UP similarly has 4,635 government hospitals and 76,260 beds if the numbers collected by the Central Bureau of Health Intelligence are any indication. Needless to say, this needs urgent augmentation. The Centre needs to transfer funds and resources. Technology should be deployed to coordinate activities across regions. The Railways, with immediate access to 3,637 doctors that includes specialists and surgeons, can be roped in as can the nurses and paramedical staff in central hospitals. Time is of the essence here.

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