A quick scan of India's public health statistics will likely have these  grim takeaways:
 
* Diarrhoea kills 80,000-100,000 children each year
* Cervical cancer kills nearly 70,000 women annually
* Of the 100,000 women delivering babies, 130 do not survive to hear the first cry of their baby
* Nearly 220,000 deaths are reported due to tuberculosis year after year
 
These were just a few of the public health challenges that needed serious government and policy interventions. Medical specialists, public health policymakers, scientists, NGOs, academic and healthcare institutions and the government were seized of the problems.
 
Corporations and NGOs were playing a role in addressing spread of disease through their CSR interventions aimed at educating the community, screening of vulnerable groups before the ailments show up in full fury. A memorable public service commercial titled “Haath, Muh and Bum” (Hand, Face and Bum) by Hindustan Unilever, a consumer-goods multinational comes to mind as a smart way to spreading awareness of communicable diseases among India's children under five years, half of who fall ill frequently, leading to serious repercussions on their development. Using scores of bubbly kindergarten and primary school goers this commercial promotes basic hygiene awareness like washing hands with soap, drinking only clean water and use of toilets in the community.
 
Cut to early 2020, the Sars-Cov-2 virus showed up in Wuhan province in China and in less than six weeks has got the entire world under its grip. Everyone talked of safe distancing, frequent hand washing, first promoted by a young Hungarian doctor Ignaz Semmelweis in a Vienna Hospital in the 19th century.  Yet, by May 17, the global tally stood at over 315,000 dead, 4.71 million cases, and 1.73 million recoveries. With over 1.5 million cases, the USA, the most scientifically advanced nation in the world, accounted for 89,932 deaths, that is over a quarter of global fatalities.
 
Thanks to an early imposition of lockdown India seemed to have gone relatively unscathed until end April 2020. With 90,927 positive cases and 2,872 fatalities on May 17, recording a big jump in the past week, India stares at a grim situation. Undoubtedly, the numbers will grow, the economy will get a beating. And those at the bottom of the pyramid will suffer the most.
 
Clearly for Indian healthcare system fighting Covid-19 is full of challenges they never expected to face. Corona warriors, from epidemiologists, public health professionals, hospital administrators, intensivists, pulmonologists to the lowest in the chain, testing lab technicians are giving their best, often at great personal risk. Thousands of ill-paid ASHA (accredited social health activists) and Anganwadi (rural child care) workers and the overworked health workers are bearing the brunt. The Indian drug manufacturers are ramping up to produce the vaccine once it is discovered and approved.
Yet, it appears that the healthcare system may be fighting a losing battle.  No matter how the Covid-19 pans out for 1.3 billion Indians, the Indian healthcare system, with all its facets ranging from medical education and research, to nursing and biomedical engineering, public health to clinical research, will need a fresh look. India needs to create a specialisation wise authentic database of specialists that can be deployed in medical emergencies. While India may procure 40,000 ventilators, the sad truth is that the required number of specialist anaesthetists may not be simply available at each of these locations.  
 
The most efficient method would be for the Indian government to fund upgrade of 700 plus district hospitals into medical and nursing colleges to bridge the acute demand-supply gap of medical graduates and nursing staff. Eminent cardiologist Dr Devi Shetty estimates the cost of upgrading district hospitals into medical and nursing colleges will be $7 billion dollars, about one-tenth the cost of setting up new medical colleges.
 
These hospitals can handle medical needs of 100 million families covered under Ayushman Bharat. In the long run this capacity-building effort will help India become supplier of medical and nursing professionals worldwide who can bring in billions of dollars of forex.
 
In addition, for every researcher of the calibre of Dr Gagandeep Kang, the first Indian women to be invited to the Royal Society, London, India must get back into the country or rope in scientists like Prof Devi Sridhar, Chair of Global Public Health at the University of Edinburgh, and Dr Siddhartha Mukherjee, oncologist, Columbia University, to build a culture of medical research.
 
India needs to collaborate with the world’s best institutions to improve public health services to better the health of community through education, policy-making and research for disease and injury prevention. A reputed global institution like the School of Public Health and Community Medicine at UNSW Sydney, Australia can be roped in the prepare professionals in public health in distant education mode. The George Institute, Sydney that lent its support system for deployment among ASHA workers can be tapped for strategies to focus on prevention and management of health problems to reduce the need for complicated specialist care provided at the tertiary level.
 
India spends only 1.28 percent of its GDP (2017-18) as public expenditure on health. It is far lower than even some poorer countries. Health Minister Harsh Vardhan recently conceded this point.  Speaking in parliament, the minister said the National Health Policy 2017 envisages augmenting public health expenditure to 2.5 percent of the GDP by 2025. The policy recommended that state governments should spend more than 8 percent of their budget on the health sector by 2020, which most of them are not doing by far.
 
As COVID-19 cases rise in the coming weeks, scarcity of beds and health professionals in India will become an even bigger issue. India has stopped investing in public health or on hospitals, which saw the emergence of the private sector hospitals, whose services will remain out of reach for poor people despite the recently launched Ayushman Bharat insurance scheme. None of these specialist hospitals is treating positive patients; so the burden is being felt by often rundown government hospitals and overworked medical staff, which are bound to fall short of expectations in the face of such a mega-crisis.
 
(The writer is a strategic communications counsel. The views expressed are personal. He can be contacted at sanjiv.kataria@gmail.com )