Public health infrastructure, while improving, requires collaborative efforts to combat the threat of infectious diseases
India’s battle with infectious diseases is a critical aspect of its healthcare journey, shaped by the nation’s vast, diverse population and socio-economic challenges. From tuberculosis to malaria, dengue, and more recently, COVID-19, infectious diseases remain a constant threat to public health, particularly in densely populated regions. The pandemic, however, acted as a tipping point, underscoring the urgent need for a comprehensive, future-ready public health infrastructure capable of swift responses to outbreaks. In this cover story, we explore the current state of India’s public health infrastructure for infectious diseases, recent advancements, challenges, and a forward-looking roadmap for preparedness.
The existing state of public health infrastructure in India
A self-assessment done by the government in June 2024 has revealed that most public health facilities, including district hospitals and primary health centers, fall significantly short of essential standards. Only 20 per cent of these facilities meet the required benchmarks for infrastructure and resources, while a troubling 42 per cent have scored below 50 per cent. In response, the government has launched an initiative to upgrade 70,000 facilities within 100 days, with inspections and funding support provided under the National Health Mission. This underscores the urgent need for reforms to improve healthcare delivery and ensure equitable access to quality services across the country.
According to data from the Indian Public Health Standards (IPHS) dashboard, only about 20 per cent of the assessed facilities achieved a score of 80 per cent or higher, meeting essential standards for infrastructure, staffing, drugs, diagnostics, and equipment. This reflects a widespread gap in basic healthcare provisions across most public health facilities.
Of the facilities assessed, 42 per cent—equating to 17,190 facilities—scored below 50 per cent, highlighting critical deficiencies in key healthcare areas. Additionally, 15,172 facilities fell within the 50 per cent to 80 per cent range, further indicating varying degrees of inadequacy throughout India’s public healthcare system.
Targeted investment in infrastructure and enhanced monitoring could fill the gaps.
Dr R Kishore Kumar, Founder Chairman, Pediatrician and Neonatologist, Cloudnine Group of Hospitals, Bengaluru mentions that India’s public health infrastructure is like a neglected child – Health being a state subject – has traditionally not been looked after well by the centre and states have always had other priorities.
“The country has made remarkable strides in eradicating diseases like smallpox and polio because it has been a directive of WHO and international organisations including Rotary International have contributed significantly, and it has established national programs for tuberculosis (TB), malaria, HIV/AIDS, and other communicable diseases – but research in these areas have been very slow and almost negligible for a country of our size. However, the COVID-19 pandemic exposed critical gaps in the health system, particularly in areas like disease surveillance, healthcare delivery, and resource allocation. Without research and data analysis – we won’t be going anywhere.”
Dr Avinash Phadke, President and Mentor, Agilus Diagnostics mentions, “India has substantially improved its public health facilities over the years that exist; however, it still faces limitations due to high population density, geographic as well as economic division. It involves central and state schemes and programs, which operate with different capacities and assign resources to Indian states. Although the level of healthcare infrastructure is comparatively higher in urban areas, rural areas remain behind in terms of infrastructure facilities, which leaves them dragged behind in responding to infectious diseases in the first instance.”
Primary Care Centers (PHCs) and Community Health Centers (CHCs) form the backbone of India’s healthcare system, but they often lack adequate resources, personnel, and technological integration, particularly in tier 2 and 3 cities and rural regions. Urban centers may have more advanced facilities, but the uneven distribution of healthcare services leaves rural populations particularly vulnerable.
Shyamal Santra, Associate Director of Health and Nutrition, Transform Rural India also share some stats and said, “Rural Health Statistics from 2021-22 reveal significant shortfalls: 25 per cent of Sub Centres (SCs), 31 per cent of Primary Health Centres (PHCs), and 36 per cent of Community Health Centres (CHCs) are lacking. There is a shortfall of 4,335 physicians and 294 pharmacists, with an even greater deficit in tribal areas. Specialist shortages are severe, with 83.2 per cent fewer surgeons, 74.2 per cent fewer obstetricians, and 81.6 per cent fewer paediatricians than needed. The acute shortage of trained health professionals and infrastructure impacts quick response.”
Dr Madhuri Somani, Consultant microbiologist and infection control Officer, PSRI Hospital, New Delhi throws light on a very relevant point. She mentions, “COVID-19 was testament to the potential of our public health capabilities. But, where do we currently stand in handling infectious diseases especially in the time of antimicrobial resistance and emerging threats like Monkeypox and Zika virus to name a few”
She mentions that, “Currently, there is a huge disparity between urban and rural areas as microbiology and molecular diagnostics laboratories are primarily concentrated in the former. Strengthening them throughout the country should be the foremost prerogative ,because if an infectious disease diagnosis cannot be made , the clinician is left with no option but to treat an infection blindly. “Super bugs” : The drug resistant bacteria ,viruses ,fungi and parasites , can only be detected in Well-equipped laboratories ,with a gamut of tests like culture and sensitivity ,molecular diagnostics , ancillary serology to guide appropriate clinical treatment ,trained clinical microbiologists and paramedical staff with an indepth knowledge of Antimicrobial resistance( AMR) . Research and public health funding into affordable diagnostic tests and Point of care tests should be prioritised. NAATs are molecular tests, which are being used in our National TB elimination programme ,is an apt example.”
The role of disease surveillance and management
Effective disease surveillance is crucial for identifying outbreaks early and mounting timely responses. While India has made strides in developing its surveillance systems, significant challenges remain. The Integrated Disease Surveillance Programme (IDSP) is an important initiative, but it suffers from inconsistent reporting, limited data integration, and reliance on outdated methods in some areas.
Talking about the challenges, Dr Gunisha Pasricha, Principal Scientist, Infectious Diseases, MedGenome said, “Challenges regarding data quality and integration persist with inconsistent reporting and a lack of standardised protocols hindering effective surveillance. Coverage in rural areas is often limited, primarily due to insufficient healthcare infrastructure and personnel. Furthermore, the lack of specialised training in infectious disease management limits healthcare providers’ capacity to respond effectively to outbreaks. India continues to experience frequent outbreaks of diseases like dengue, cholera, and influenza, which strain the public health infrastructure. The rise of new infectious diseases and the resurgence of previously controlled diseases present significant challenges to surveillance and management efforts.”
“Gaps in the system include the need for comprehensive training programs in infectious disease management, such as expanded master’s in public health (MPH) courses and specialised residency programs. Further genomic sequencing should be integrated into routine diagnosis and surveillance. Additionally, increasing public awareness about disease prevention and control can enhance community participation in surveillance efforts”, she added.
Dr Dileep Raman, Cofounder and Chief of Healthcare, Cloudphysician also opines that “Strengthening the integration of digital tools While the Indian government has initiated efforts like the Skill India Program, these need to be significantly scaled up to meet the growing demand, especially in infectious disease management Garima Malhotra Associate Partner, Praxis Global Alliance Currently, there is a huge disparity between urban and rural areas as microbiology and molecular diagnostics laboratories are primarily concentrated in the former. Strengthening them throughout the country should be the foremost prerogative Dr Madhuri Somani Consultant microbiologist and infection control Officer, PSRI Hospital Challenges regarding data quality and integration persist with inconsistent reporting and a lack of standardised protocols hindering effective surveillance Dr Gunisha Pasricha Principal Scientist, Infectious Diseases, MedGenome EXPRESS HEALTHCARE October 2024 20 cover) in disease surveillance can improve granular and disease specific data capture and analysis, leading to faster and more effective responses. Expanding diagnostic capabilities will ensure more accurate reporting and reduce reliance on estimations.”
According to Dr Sandeep S Reddy, Consultant-Department of Infectious Diseases, Ramaiah Memorial Hospital, despite the advancements in technology and communication, the real-time data collection, analysis, and response mechanisms are not fully optimised, with many states still relying on manual methods, leading to delays in identifying and responding to outbreaks. Thereby existing in poor coordination between different levels of government (central, state, and local) and between public and private healthcare providers.
The strengths of India’s disease surveillance lie in the scale of its public health programs, particularly its ability to collect data from a wide range of sources. However, weaknesses are evident in terms of inter-agency coordination, data analysis capacity, and the use of predictive analytics to preempt future outbreaks. Improving infrastructure in tier 2 and 3 cities and rural regions should also be prioritised. By investing in regional healthcare facilities and enhancing their connectivity to national disease control centers, India can create a more resilient network to respond to health crises.
The role of technology and digital health
Technology has the potential to revolutionise how India manages infectious diseases. Artificial Intelligence (AI) and machine learning (ML) are already being used to predict outbreaks based on climate data, migration patterns, and other factors. Moving forward, AI could help forecast disease trends, enabling proactive measures rather than reactive ones.
Dr Sunil Rana, Associate Director and Head- Internal Medicine, Asian Hospital, Faridabad shares, “To expedite data collection, processing, and dissemination, IDSP, for example, made use of information and communication technology (ICT) networks during H1N1 outbreak. These expenditures aided in the resolution of a number of issues, such as the capacity to reach out to isolated communities, increase private sector participation, and promote the use of other forms of communication including voicemail and email.”
Telemedicine is another critical component. During the pandemic, telemedicine provided an essential bridge between patients and healthcare providers. By expanding telemedicine infrastructure, especially in rural regions, India can make healthcare more accessible while ensuring infectious diseases are managed without overcrowding urban hospitals.
Dr Phadke opines that what remains central to embracing technology is the ability to enhance India’s public health frameworks. New interventions in the field of digital health like the National Digital Health Mission (NDHM) are opening innovations towards better data integration and patient handling. Telemedicine has emerged as an important means of providing healthcare to distant communities increasing the rate of diagnosis and treatment.
Mobile health platforms, coupled with wearable devices, can further bolster early detection and monitoring of infectious diseases, empowering citizens to track symptoms and receive medical advice remotely. Digital health ecosystems that integrate such technologies into a cohesive platform will be key to streamlining healthcare delivery.
Dr Raman also shares, “Mobile health applications can also empower individuals to monitor and report symptoms, contributing to a more comprehensive surveillance network. Mathematical modeling and machine learning are particularly useful for predicting disease trends and outbreaks by analysing datasets and identifying patterns. Additionally, technology helps track antimicrobial resistance, providing data for developing new treatments and vaccines.”
Workforce capacity and training
A robust healthcare system depends on a well-trained workforce. Capacity building for healthcare workers, particularly in infectious disease management, is vital. The lack of trained personnel in rural and remote areas exacerbates India’s healthcare challenges.
Malhotra stresses, “Over 75 per cent of healthcare professionals are in urban regions, leaving rural areas critically underserved. This urban concentration of healthcare providers, coupled with the limited availability of specialists in rural Community Health Centres (CHCs), poses a substantial challenge in managing infectious diseases. The shortage of trained public health professionals, including epidemiologists and microbiologists, further hampers effective disease monitoring and response. To address these gaps, enhancing training and skill development programs is crucial. While the Indian government has initiated efforts like the Skill India Program, these need to be significantly scaled up to meet the growing demand, especially in infectious disease management.”
Santra also suggest, “Adopting the ‘neighbourhoods of care’ model, which engages families and communities in prevention and early detection, is essential. It empowers communities with knowledge and skills for local action is built around supportive community networks and a knowledge system, and emphasises that healthcare challenges cannot be addressed through medical or clinical interventions alone – it integrates the needs, values, and aspirations of individuals, families, and communities, providing a well-rounded solution to health concerns in under-resourced areas.”
Continuing medical education (CME) programs, combined with on-the-job training and digital learning platforms can also ensure that healthcare workers are up to date on the latest treatment protocols, surveillance technologies, and public health strategies.
Dr Ravishankar Polisetty, a former cardiac surgeon turned translational Ayurvedic researcher highlights that, “More government hospitals, medical colleges, and expansive healthcare infrastructure can help address the healthcare needs of India’s growing population. The creation of over 1,70,000 Ayushman Arogya Mandirs (family health centres) across the country is also a significant effort to improve access to primary healthcare in both rural and urban areas. A recent EY-FICCI report on ‘Decoding India’s Health Landscape’ states that by 2047, the country will require 12.5 million qualified doctors and 15 million nurses.”
Way forward
Looking ahead, India’s strategy to combat infectious diseases must focus on creating a comprehensive, multi-layered health infrastructure that integrates disease surveillance, technological innovation, and workforce capacity building.
Public health infrastructure, while improving, requires bold initiatives and collaborative efforts to effectively combat the threat of infectious diseases. The lessons learned from the COVID-19 pandemic must shape a new era of preparedness, where rapid responses, technological innovations, and well-trained healthcare workers form the cornerstone of a future-ready system.
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