Journal of Clinical and Diagnostic Research. 2020 Sep, Vol-14(9): AB01-AB03 1 1 DOI: 10.7860/JCDR/2020/5365.14061 Health Management and Policy Section Challenges in Delivering Optimal Healthcare to COVID-19 Patients: Focus on Delhi, India Editorial INTRODUCTION The public health scenario in India is grim. It is an open secret that India doesn’t spend adequate public money on healthcare. Interestingly, the public sector health expenditure is only 25%, compared to 75% in case of the private sector. In case of other countries, the public sector bears 50% of the total health expenditure. The Government of India’s healthcare budget is deplorable, which currently stands at a meagre 1.15-1.5% of the Gross Domestic Product (GDP). In stark contrast, the United States’ health budget accounts for 18% of the GDP. Looking at the National Health Profile of India (2018), it is clearly evident that the per capita expenditure on healthcare is only USD 100 (after adjusting for purchasing power parity). In comparison, the US spends a staggering USD 10,224 per capita on healthcare annually. This dismal health spending in India has led to a severely weakened health system that is literally crippled and incapacitated [1]. When the current COVID-19 crisis is superimposed on the already fragile health infrastructure, one can easily imagine the immense strain that has been put on the health system as a whole. This is reflected in the available statistics for India on the prevailing pandemic. At the time of writing (28 August 2020; 11.00 AM IST), the total number of cases and deaths in India were 3,325,971 and 61,529 respectively. The corresponding figures for Delhi were 150,027 and 4,369 respectively. Importantly, Delhi is currently the sixth worst affected state in India, following Maharashtra, Tamil Nadu, Andhra Pradesh, Karnataka, and Uttar Pradesh [2]. DELHI GOVERNMENT’S STRATEGY FOR TACKLING COVID-19 The Delhi Government has planned a 5-pronged approach [3] to tackle the COVID-19 crisis in Delhi, which are briefly highlighted below: •฀ Ramping-up bed capacity: The number of beds dedicated to COVID-19 patients have been ramped-up in Delhi over the past two months. In this initiative, banquet halls, hotels and private nursing homes are being acquired to boost the bed capacity in the National Capital. These include 11,000 beds in 80 banquet halls, 4,000 beds in 40 hotels, and 5,000 beds in private nursing homes [4]. In this regard, 117 private hospitals have been instructed to reserve 20% of beds for COVID-19 patients [5]. Additionally, 500 railway coaches have also been allocated to the Delhi Government by the Central Government, which has added a further 8,000 beds [6]. Besides these, the Central Government and Delhi Government have jointly inaugurated the Sardar Patel COVID Care Centre and Hospital at the Radha Soami Satsang Beas, Chhatarpur, New Delhi on 27 June 2020. This COVID-19 centre is the world’s largest, with a bed capacity of 10,000 [7]. However, since almost 78% of beds dedicated to COVID-19 patients are currently lying vacant [8], the Delhi Government is thinking of delinking the hotels from the hospitals [9]. •฀ Testing and isolation: Currently, large-scale COVID-19 testing is being carried out across Delhi. Delhi is currently conducting the third-highest number of tests in the country, only after Assam and Andhra Pradesh. The exact number is 7,210 tests per million per day [10]. Moreover, around 600,000 test kits have been acquired by the Delhi Government so that testing is not hampered [3]. •฀ Serosurvey and screening: A comprehensive house-to- house serological survey is being conducted in Delhi, which has a target sample size of 20,000. This will help to screen for potentially infected COVID-19 patients, as well as develop a better understanding of recent and past infections by measuring the levels of IgM and IgG antibodies, respectively [3]. •฀ Oximeters, oxygen and oxygen concentrators: One of the cardinal features of COVID-19 is a sudden drop in blood oxygen levels. Hence, close monitoring of the oxygen level of blood is crucial for preventing breathing problems. For this purpose, pulse-oximeters are vital, which are being supplied by the Delhi Government to all home quarantined COVID-19 patients [11]. Also, oxygen cylinders can be ordered by home quarantined COVID-19 patients via telephone, in order to increase convenience and efficiency [12]. The Delhi Government has procured 4,000 oxygen concentrators in order to ensure that sufficient oxygen cylinders are available [13]. •฀ Plasma therapy: Administration of plasma from cured convalescent patients have shown significant benefit in saving the lives of active COVID-19 patients. The Lok Nayak (LNJP) Hospital in New Delhi has reported a reduction in the death rate by more than 50%. Other hospitals in Delhi that are conducting plasma therapy trials include the All India Institute of Medical Sciences (AIIMS), Ram Manohar Lohia (RML) Hospital and five prominent private hospitals [14]. CHALLENGES IN HEALTHCARE DELIVERY Disparities in Healthcare Personnel in India [15] Of the various categories of healthcare professionals in India, doctors and nurses make up 39.6% and 30.5% respectively, of the total health workforce. Of all the doctors, 77.2% are allopathic, while 22.8% fall under the category of AYUSH (Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homoeopathy), which constitute the traditional systems of Indian medicine. There are significant disparities in the distribution of healthcare professionals across the country. The majority of healthcare professionals prefer to work in urban areas, with an urban to rural ratio of 1.45:1. In fact, it is quite surprising that of all health workers, 59.2% work in urban areas, where only 27.8% of the population resides, while 40.8% work in rural areas, where the majority (72.2%) of the population resides. There are also large variations in doctor density across India. For example, the high-income state of Punjab has 2.6 times higher doctor density than Bihar, which belongs to the low-income strata. The urban-rural divide is also evident in the KAUSHIK BHARATI 1 , AARTI GARG 2 , SUNANDA DAS 3 Keywords: COVID-19, Delhi, Healthcare, India, Patients