Chapter 1.5: The Future of Public Health Investments: Lessons from the COVID-19 Pandemic

Public health practice is only possible when different stakeholders, from policymakers to civil society representatives, come together to tackle health problems to improve people’s health, protect people from falling sick, and confront the catastrophic health expenses that the illness entails. The chapter looks at whether such collaborations were successful during the COVID-19 pandemic and what more is needed to increase the resilience of the health systems and populations to face any future health risks.

An assessment of recent public health indicators shows that though a lot of gains have been made in India, many indicators still do not compare favorably with other low- and middle-income countries. There is also a lot of disparity between different states. The Indian Public Health Standards set the template for investment in infrastructure and skills, but there are gaps that need to be addressed to improve functioning.

In the initial stages of the pandemic, there was a lack of coordination and collaboration between the different arms of the government responsible for a concerted, evidence-based response. There was a lack of trust in the decision-making capabilities of the primary-level health workforce, and the local communities and civil societies were not supported adequately. There was no shared responsibility in tackling the pandemic. This improved toward the end of 2020, but the deluge of cases during the Delta wave in 2021 once again incapacitated the health systems, leading to extremely high morbidity and mortality. The COVID-19 pandemic has reemphasized the need for establishing a public health cadre that could be tasked with the responsibility of managing health emergencies and routine planning equally effectively. Investment in infrastructure for rapid response surveillance systems, skilling of existing human resources, and giving authority to plan and act at district and sub-district levels is essential, and the return of investment on such interventions will be evident through improved life expectancy and health-related quality of life in the near future.