How India can improve urban public health with lessons from COVID-19

(Credit: Unsplash)

This article is brought to you thanks to the collaboration of The European Sting with the World Economic Forum.

Author: Suchi Kedia, Community Specialist, Regional Agenda – India and South Asia, World Economic Forum & Harshita Agrawal, Associate, IDFC Institute

  • During COVID-19, platforms were developed to track case numbers, fatalities and hospital bed availability, but this technology is sorely lacking for other diseases.
  • Healthcare data needs to become a policy focus for urban public health in India, where cholera, tuberculosis, dengue and Ebola are still prevalent.
  • Infrastructure investment, increased budgets and more health personnel will also be necessary to build a more robust healthcare system going forward.

Almost exactly a year ago, India recorded its first COVID-19 case. While the pandemic can arguably be considered a black swan event, it has exposed deeper cracks in its cities public health sector. COVID-19 is already projected to roll back progress on a number of socio-economic indicators; unaddressed, poor public health will exacerbate existing challenges.

Going forward, we need to take a closer look at the COVID-19 and non-COVID-19 disease progression in India’s cities, the lack of data, inadequate infrastructure and insufficient budgets.

The disease burden in cities differs compared to rural regions and is continuing to change. Pathologies such as cholera, tuberculosis, dengue, H1N1 and Ebola are still prevalent in urban India. A 2018 survey in Delhi revealed that40% of its population has had dengue at least once in their lifetime owing to a certain mosquito found in urban areas.

The study also reveals that, while the spread of dengue depends on temperature and rainfall, the degree of urbanization is also a contributing factor. Specifically, poor housing conditions can lead to diseases being carried by insects and rodents, as well as respiratory infections from poor ventilation and low-grade cooking material. SARS and the novel coronavirus have also added to the disease burden, especially because of their spread in megacities and travel between them or rural-urban and urban-urban migration.

Going forward, healthcare data needs to become a policy focus for India. With the COVID-19 pandemic, there emerged a number of platforms to track case numbers, fatalities, hospital bed availability and so on. State governments such as that ofTamil Nadu built GIS platforms to track containment zones and hotspots of infection, thereby deploying the necessary resources to the areas that required them.

Similarly,, a volunteer-based, private platform on state-wise contagion rates and testing has been an important source of COVID-19-related information. However, such data is grossly lacking when it comes to other healthcare problems. Healthcare data in India is largely unavailable or fragmented.

This stems from the nature of delivery of health services in the country: citizens in urban and rural areas interact with the healthcare infrastructure through a number of private and public delivery points with no single system integrating and acting on the information, as has been done for COVID-19. Moreover, with allied issues such as rising pollution and inadequate sanitation leading to other illnesses, data on healthcare concerns, coupled with other city-level data, needs to be significantly ramped up and utilized for better policymaking.

COVID-19 has also laid bare several fissures in India’s public health infrastructure and investment, particularly in cities. During the last decade, less than 2% of India’s GDP has been invested in healthcare; China and the US’s healthcare investment hovers at around5% and 17% of GDP, respectively.

At the local level, budgets have increased. Between 2015-16 and 2017-18, the healthcare budget in Mumbai and Delhi has gone up, each by41% and 26%. However, the focus is unevenly on secondary and tertiary care, rather than primary care. While expenditure on hospitals was 74% of Mumbai’s health budget, only 26% was spent on dispensaries. Cities deserve specific attention: 75% of India’s current healthcare infrastructure can be found in cities, and every minute, 25-30 people migrate to urban areas from rural ones. If city-level healthcare services are not adequately scaled, the current disease burden will only be exacerbated.

We recommend improvements in data collection, infrastructure investment, budget alterations and personnel training in healthcare. Using big data in healthcare with electronic health records, government records, laboratories and insurance companies can provide a rich source of information to healthcare providers to assess clinical risk and genetic susceptibilities. Combining healthcare data with other parameters related to transport and housing, for instance, could be used to generate healthcare plans and deploy healthcare services in real time to those who need it the most.

Simultaneously, however, while framing healthcare data collection and usage, it is important tobalance individual privacy and data protection with institutional transparency and accountability. Government documents were being shared on WhatsApp that outlined details of COVID-19 positive patients, including their names and home addresses. This practice began to discourage people from getting tested even if they exhibited symptoms to avoid stigmatization by their neighbours. The new National Health Stack will create extensive health profiles of individuals, but the health data management policy of the National Digital Health Mission must be followed.

As we rebuild from the pandemic, it becomes important to create and monitor certain thresholds for public health infrastructure based on population. For example, regardless of whether an area is classified as rural or urban, if it has a certain population level, it would benefit from having a hospital rather than a single physician clinic. Establishing such benchmarks (in terms of physical infrastructure, specialization of personnel, relevant support staff) and reworking them as necessary, can go a long way in building a population with a healthy life expectancy in India where low state capacity falls short of the demands of secondary or tertiary care.

Further, given the burden on urban healthcare systems, budgets need to be expanded to improve healthcare infrastructure supply aligned with the disease progression in cities. This must result from greater decentralization of finances and responsibilities, as well as revenue from health tourism.

Moreover, along with an increase in the budget, there needs to be capacity to manage that spending. With the increasing use of technology and healthcare analytics to treat diseases, healthcare professionals will have to acquire skills to harness data and interpret it to provide decision-making support to medical practitioners. Over and above this, as COVID-19 has highlighted the need for management of epidemics and pandemics, there must be a mandate for public health professionals in government.

These steps are not exhaustive and are not sufficient to tackle the current pandemic. However, with adequate planning, they can guarantee a more robust system to deal with the next one, and build a more healthy population and productive economy – along with resilient cities in the process.

(Kadambari Shah, Senior Associate, IDFC Institute, contributed to this article.)

the sting Milestones

Featured Stings

Can we feed everyone without unleashing disaster? Read on

These campaigners want to give a quarter of the UK back to nature

How to build a more resilient and inclusive global system

Stopping antimicrobial resistance would cost just USD 2 per person a year

EU finally to extend sanctions on Russia despite arguments; Greece again in Europe’s spotlight

What is the Internet of Things?

Scale of displacement across Myanmar ‘very difficult to gauge’, says UN refugee agency

EU migrant crisis: Germany, France and UK to show the way. Will the rest of the EU follow?

Global Recovery: The EU disburses SDR 141 Million to the IMF’s Catastrophe Containment and Relief Trust

Joint  EU-US Statement on  the Global Methane Pledge 

“Joining forces to #BeatPollution”, a Sting Exclusive by the Head of UNEP in Brussels

This is what CEOs around the world see as the biggest risks to business

How scientists are turning living cells into the tiny factories of the future

COVID-19 is threatening the lives of migrant children held in US custody

The COVID-19 recovery can be the vaccine for climate change

At G20 Summit OECD’s Gurría says collective action vital to tackle global challenges

UN rights chief ‘appalled’ by US border detention conditions, says holding migrant children may violate international law

Why trade wars have no winners

GSMA Announces Final Event Lineup for Highly Anticipated 2019 “MWC Los Angeles, in Partnership with CTIA”

EU leading in global agri-food trade

Member States’ compliance with EU law in 2018: efforts are paying off, but improvements still needed

The widely advertised hazards of the EU not that ominous; the sting is financial woes

South Korea once recycled 2% of its food waste. Now it recycles 95%

MEPs adopt Technical Support Instrument to speed up post-COVID-19 recovery

MEPs demand end to EU arms exports to Saudi Arabia

The ECB ‘accidentally’ followed IMF‘s policy advice for growth and job creation by printing more money

Brexit: European Commission publishes Communication on preparing for the UK’s withdrawal from the EU

The gender gap of medicine in 2018

Why our future relies on more inclusive and transparent innovation

What’s behind South Korea’s elderly crime wave?

European Commissioner for Youth wants young people to be at heart of policy making

EU: All economic indicators in free fall

Stop wars disguised as peace missions

Young translators at EU schools – Commission opens registration for 2020 translation contest

Social, cultural diversity ‘an enormous richness, not a threat’ Guterres declares calling on investment for a harmonious future

ECB money bonanza not enough to revive euro area, Germany longs to rule with stagnation

Five avoidable deaths per minute shows urgent need for action on patient safety

Towards a seamless internal EU market for industrial goods

Digital Green Certificate is the right move but speeding up vaccination is key

Myanmar doing too little to ensure displaced Rohingya return: UN refugee agency chief

Brexit: UK business fear of a no-deal scenario preparing for the worst

How man and machine can work together in the age of AI

MWC 2016 LIVE: Orange targets VoLTE and Voice over Wi-Fi; strikes Google partnership

75 years after Auschwitz liberation, antisemitism still threatens ‘foundations of democratic societies’

UNESCO food and culture forum dishes up fresh serving of SDGs

European markets itchy with short-term disturbances

Bioethics: how to recover trust in the doctor-patient relationship

This Kenyan company makes fuel from human poo

“Healthcare system and socioeconomic inequities”-through the lens of developing nations

China repels EU allegations of export subsidies

Germany’s fiscal and financial self-destructive policies

Cameron readies to support ‘yes’ for Britain in the EU

How Bangladesh’s leaders should respond to the economic threats of COVID-19

Civil protection: Parliament strengthens EU disaster response capability

Where are fleeing Afghans finding refuge?

Why the 33,000 staff European Commission did not have a real contingency plan for the refugee crisis?

MEPs approve the EU’s new culture programme

Human Rights breaches in Russia, Afghanistan and Burkina Faso

From raised fists at the 1968 Olympics to taking the knee: A history of racial justice protests in sport

Trump’s Russian affair spills over and upsets Europe

Why is Merkel’s Germany so liberal with the refugees? Did the last elections change that?

MEPs vote for upgrade to rail passenger rights

Mobile technology saving lives: changing healthcare with simple technology solutions

European Defence Fund on track with €525 million for Eurodrone and other joint research and industrial projects

More Stings?


  1. Yes. It can do wonders if it learns from Covid-19. Thank you 😊

Speak your Mind Here

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

%d bloggers like this: