The Covid-19 pandemic has amplified the borderless and globalised nature of health threats while making preparedness a watchword for policymakers, public health experts, and healthcare professionals around the world. Given the big implications as a key indicator of economic resilience, the Global Health Security (GHS) Index data reflects the pandemic preparedness of countries around the world. Here’s a look at the GHS Index 2021 data on how India has fared in overall development and how equipped India is to bounce back from another epidemic shock.
The Global Health Security Index assesses countries across six categories, 37 indicators, and 171 questions. The six chief categories are: Prevent, Detect, Respond, Health, Norms, and Risk each of which is further analysed for different indicators and seeks answers to different questions vis-à-vis individual countries.
While India has shown persistence in certain areas, given the weaknesses in a few areas as per the GHS Index data, India needs to look into it.
Delivers undistinguished performance in Prevent category
According to the GHS Index 2021, with a ranking of 85 among 195 countries and a score of 29.7, India has exhibited a rather undistinguished record in the Prevent category. Within this category, its ability to track and monitor anti-microbial resistance has been found to be most disappointing with a global rank of 84 despite having released a National Action Plan for AMR and established an Antimicrobial Resistance Surveillance Network in the country. The poor score is also possibly to do with persisting high use of antibiotics in the country that are recommended for restricted use by the WHO, notwithstanding low per-capita consumption overall. Similarly, it is perhaps due to the lack of a national action plan on zoonotic diseases (another indicator within Prevent) as a whole – despite bringing out a manual on Zoonotic Diseases and coming up with a National Action Plan for Rabies Elimination – that it is ranked relatively average for this indicator at 55. Furthermore, on biosafety and biosecurity indicators, the fact that India is ranked 58th on biosecurity and 70th on biosafety implies that it is relatively better prepared to protect its biological materials and agents. In fact, India needs a national biosecurity policy and formal legislation for negotiating biological disasters. However, one bright spot within the Prevent category has been India’s record on dual-use research and the culture of responsible science on which it has been ranked 13th overall.
India ranks better in Detect than Prevent
If India has been unimpressive in prevent category, it has definitely fared better in detecting category of the GHS index 2021 with an overall rank of 51. It is a matter of pride that on laboratory systems strength and quality indicators, the country has been taken to be in the numero uno position in the world. India’s laboratory capacity for detecting priority diseases including national diagnostic capacity for WHO-defined core tests and capacity for testing during public health emergencies has been found to be second to none. However, somewhat curiously, India has fared relatively poorly on the related indicator of laboratory supply chains. With a rank of 58, its sample transport system and the ability to scale up transport and testing systems during emergencies seem to fall short. Similarly, on case-based investigations mapping the ability to identify, locate and treat or isolate individuals with infectious diseases, it has been ranked unremarkably at 47th. However, for real-time surveillance and reporting, India has fared commendably with a 19th rank. Yet within the detect category, India has stumbled the most on surveillance data accessibility and transparency indicator with a lowly rank of 95. This illustrates poor EHR coverage and accessibility, inadequate data integration, issues of privacy and confidentiality of health data, and insufficient data sharing mechanisms with neighbouring countries. India was ranked 48th in epidemiology workforce, again a somewhat mediocre outcome. Against the estimated need for 1000 trained epidemiologists every year, India has merely over 300 epidemiologists in the country today.
Health category a paradox
At 56th rank, India appears to be placed reasonably well in this category given its large population, low per capita income, and longstanding healthcare accessibility gaps. However, on a closer look at indicators such as healthcare access entailing criteria such as access to primary level health services and a constitutional guarantee for the right to medical care, its abysmal 193rd rank is clearly a bottom-of-the-heap performance. On the other hand and rather paradoxically, it has also exhibited world-class efficiency within this category by ranking first on indicators such as communications with healthcare workers during a public health emergency and infection control practices, and availability of equipment. India’s 37th rank on medical countermeasures and personnel deployment also depicts its resilience in a public health situation.
Has a mixed record in the Norms category
While the overall 92nd rank denotes a poor performance for the norms category, there are positives too. For instance, India has emerged among the best-performing countries on indicators such as International Commitments (ranked 1st) and Commitment to Sharing of Genetic & Biological Data & Specimens (ranked 12th). Yet, it is rather perplexing to find that on a somewhat similar indicator of cross-border agreements on public health and animal health emergency response, it is ranked unflatteringly 137th alongside the poorest-performing countries. However, India has performed reasonably well on indicators such as financing for epidemic preparedness and emergency response (43rd rank) and International Health Regulations (IHR) reporting compliance and Disaster Risk Reduction (49th rank).
Mediocre in Risk and most wanting in Response categories
Although India has delivered mediocre in the risk category with an overall rank of 74, its ability to respond has been found to be most wanted on the GHS index with a global rank of 139. And within the response category, it has been ranked 51st on the emergency preparedness and response planning indicator, an average performance also suggesting the need for a unified and dedicated public health emergency-focused law in the country. It is heartening to note however that on indicators of Emergency Response Operation and Exercising Response Plans, India has done decently ranking 15th and 19th respectively highlighting that we do ‘act’ with what we have. Importantly enough from the standpoint of linking health with security, it has achieved a moderately good ranking of 44th for the indicator linking public health and security authorities. What has really brought down India in this category is its performance on Access to Communications Infrastructure and Trade and Travel Restrictions on which it has been ranked at an alarming 176th and 171st respectively underlining the enormous need for augmenting its public communications infrastructure as well as regulating trade and travel better during public health emergencies.
The Way Forward
In sum, with an overall ranking of 66 distilled from an assortment of positives, negatives, and mixed records, India’s pursuit of Global Health Security can be termed as ‘evolving’ with plenty of room for improvement leveraging technology through telemedicine, m-health, and digital platforms or apps can significantly contribute to the training, supervision, and facilitation of healthcare delivery at remote locations.
With India’s G20 presidency in 2023, leadership in Southern Asia, and the 5th ranking among lower middle-income countries, India is in an optimal position to push towards more equitable International Health Reforms (IHR) and Sustainable Development Goals (SDGs).
Views expressed by Deepak Sharma, Co-Founder & CEO, MedLern
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