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Kate Tulenko: Epidemic in India: Shortage of health workers leaves gaps in epidemic prevention

Updated: Jan 6, 2023

Kate Tulenko

Dr. Kate Tulenko is the former Director of the U.S. Government's Global Health Workforce Program and the former Coordinator of the World Bank's African Health Workforce Program. Her research interests are in the areas of human resources for health, digital health/e-health, global health security and health systems strengthening. Her recent research includes Hospital Staff retention: a Rapid Approach to Identifying incentive programs, Preferences of Trainee Health Professionals working in rural clinics in Uganda: a Discrete Choice Experiment, and Health Worker Mismatch in the United States.


Epidemic in India: Shortage of health workers leaves gaps in epidemic prevention

1.What has India's Covid-19 outbreak revealed about its public health system?


It has been known for quite a long time that India is not investing enough into its public health system. The WHO recommends that developing countries invest at least 15% of their GDP into their health system and India has only been investing 3.6% of GDP (out of pocket and public expenses), one fourth of what it should invest. It is important to know that India’s health challenge is not just about the shortage of oxygen, pharmaceutical medical supplies, clinics, and hospitals. India has one of the largest shortages of health workers in the world. India’s health worker density (the number of physicians and nurses per 1,000 population, is 0.9 while the WHO recommends at least 2.3 to meet the most basic public health needs. People are often surprised to hear this because they see Indian nurses and physicians around the world, and they think there are sufficient numbers of them, but unfortunately they are not.


2.What do you think of the fact that under-graduate doctors have to work in India because doctors are not sufficient during the outbreak of COVID-19?


Unfortunately, almost every country with a severe COVID outbreak has had to use health professional students to pitch in the fight. While the students will learn some important skills, gain a lot of experience, and make a difference, there are number of concerns. There is concern for the students’ safety due to the differential in power and their difficulty negotiating for personal protective equipment (PPE). Another issue is the students’ mental health. Evidence shows that seasoned health workers experience fewer mental health problems during crises than newer health workers. These students just aren't prepared for what they are going to see. The last concern of course is the interruption of students’ schooling and how they will be able to catch up and not create an even greater health worker deficit in these countries.


It is important to remember that health workers have rights, and they have a right to personal protective equipment. Also it is important that leaders who understand health workers’ experience are making decisions during the pandemic. Some of the worst decisions that we have seen during COVID-19 have made by non-clinicians who do not understand what it is like to be out on the front line.

3.It is reported that "the whole world is giving aid to India, but where are the supplies going". What is your opinion about the Indian government's management of distribution process?


There was initial criticism because some supplies remained in ports and customs for several days.But now the distribution system seems to be more robust. Remember, the challenge is not just about getting oxygen to hospitals, but then deciding who gets that limited oxygen once it is there.


4.What do you think of the specific anti-epidemic measures that Japan may take for the Tokyo Olympic Games?


This is a fast changing conversation. At the time I'm writing this the Japanese Olympics are still on. But they've may very well be cancelled. The latest news has been that 10,000 volunteers have quit over COVID concerns. Many local municipalities also expressed concerns that their health systems were so overloaded due to COVID that they would not be able to sufficiently care for athletes who either were injured or had COVID. Regarding specific anti-epidemic measures that Japan can take for the Olympics, these measures are the same as all countries have been taking for COVID: mass vaccination, reducing crowds, requiring athletes to be vaccinated, and reinforcing good hand hygiene through reminders and hand sanitizer stations.


5.What do you think is the impact of the pandemic in India on the upcoming Tokyo Olympics?


The question isn't necessarily the impact of the Indian outbreak but the impact of the COVID outbreak in general. There is concern about the multiple variants, especially the delta variant which is more infectious and deadly. Luckily the COVID vaccine protects against the delta variant and Japan is pushing to vaccinate more of its population.


Organizer: Yu Zhuohan

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