Critical Care Crisis: Mapping of India’s ICU Inequalities

It forms the backbone for any development that a nation undertakes, and perhaps nowhere else but in the availability of critical care facilities like Intensive Care Units will this be more evident. India, being a country with a huge population and diversified socio-economic realities, is at an interesting juncture. Recently presented data on bed distribution in the ICUs has brought forth an overtly stark disparity in this sector of healthcare, which speaks to the dire need for some form of transformation.

The State of ICU Bed Availability: A Snapshot

The Leaders

Uttar Pradesh, India’s most populous state, has 14,070 beds in ICUs. Yet, over 70% of these-10,257 beds-are in the private sector. So, while private sector development may indicate supply-side demands, this raises serious concerns regarding affordability and access for poor people. Similarly, Karnataka, which has 13,105 beds, indicates an aggregate balance. Yet, there is definitely a proper way to satisfy the needs of its citizens living in rural areas.

The Under-served

At the other extreme, Bihar and Jharkhand represent the worst scenarios: with a total number of only 583 and 539 public ICU beds, respectively. These numbers are shamefully inadequate for their large populations and reflect deep-seated systemic neglect. The health infrastructure in these states falls short of even the most basic critical care needs.

The Regional Divide

Wealthier states like Maharashtra, Tamil Nadu, and Gujarat have far better ICU infrastructure compared to economically weaker states like Odisha, Chhattisgarh, and northeastern regions. Urban areas dominate ICU availability, leaving rural regions, where nearly 65% of India’s population resides, underserved.

What the Data Shows

Private Sector Boom

The private health sector has recently grown rapidly in India, especially in urban areas. It now accounts for almost 75% of the country’s ICU beds. Such rapid growth meets demand in urban areas but presents a challenge for low-income populations. Private care is inaccessible to millions of people because of its unaffordable costs, adding to health inequity.

Public Sector Shortcomings

Public health infrastructure in India is rather underdeveloped, especially in states with high population densities and low per capita incomes. States like Bihar and Jharkhand show the acute deficiency of investment in critical care, leading to poor health outcomes. Public facilities are often overcrowded, understaffed, and under-resourced.

Regional disparities

The availability of the ICU bed reflects the socioeconomic inequities of India. Richer states with better GDPs and health expenditure have better infrastructure for critical care, whereas poor states are lagging. This disparity reminds one of the uneven prioritization of healthcare resources.

Statistics Speak Louder Than Words:

• ICU Bed-to-Population Ratio: India has 2.3 ICU beds per 10,000 people against 34.7 in the US and 12.5 in China.
• Rural Differences: Though more than 65% of the population of India is rural, the actual distribution of ICU beds shows less than 20% availability there.
• Lessons from COVID-19: States with fewer ICU beds, like Bihar and Uttar Pradesh, accounted for mortality rates nearly 1.5 times higher compared to those with better infrastructures like Kerala and Tamil Nadu.

The Impact: Lives at Stake

Affordability Crisis

For a state like Uttar Pradesh, private dominance in ICU means that critical care does not come cheap. With nearly a third of the population below the poverty line, the distorted financial load either pushes families into debt or denies them ICU care altogether.

Urban-Rural Divide

This acute lack of access to ICUs is very dangerous in life-threatening emergencies, including road traffic accidents, severe infections, or complications of obstetric origin. This divide is seen within Karnataka: while Bengaluru has all the major critical care facilities, even basic critical care is unavailable in the rural districts.

Public Health Emergencies

The COVID-19 pandemic tore the blindfold off and showed India in its true dire condition of critical care. Those states that had less ICU beds struggled in the management of patient inflow, with resultant avoidable loss of life. These existing gaps in the ICU infrastructure are a time bomb waiting to go off for any future public health crisis.

The Way Ahead: Creating Resilience in Health Care

1. Strengthening Public Healthcare
   States should invest more in public healthcare infrastructure, particularly in under-served areas. This means establishing more ICU facilities, trained healthcare professionals, and equipping hospitals with modern technology. For example, Bihar and Jharkhand need focused funding to plug the critical gaps in care.
2. Public-Private Partnerships
   Public-private partnerships can therefore have a revolutionary effect on this. Incentives can be provided to the private sector hospitals for increasing their penetration into rural India, or partnership with them could be used for establishing subsidized ICU facilities. Models of successful PPPs like the Primary Healthcare Centers program of Tamil Nadu can be employed as models.
3. Leverage Technology
   Telemedicine and AI uptake in health solutions make the access to the ICU scalable and affordable. The remote monitoring systems aided by AI diagnostics reduce the load on physical ICUs and offer adequate scope for timely intervention.
4. Equitable Distribution of Resources
   A national-level task force must work on the equitable distribution of health resources. Richer states must support the weaker ones through inter-state collaborations so that no region is left behind.

5. Capacity Building
   Training health professionals about critical care is of utmost importance. India has to increase the burden of intensivists, nurses, and technicians to meet the demand for ICUs.

A Health Care Revolution is Needed

The gap in the availability of ICUs is not just some number; it translates into lost lives and communities left behind. These gaps have to be resolved using a multi-faceted approach involving government policy, private sector engagement, and technological innovation.

The Indian healthcare system is at an important crossroads. Equitable distribution of resources, strengthening of the public healthcare system, and use of technology will ensure that critical care reaches every citizen irrespective of geography and income. The time has come to turn this reality check into a ‘call to action.’ Lives depend on it.

Dr. Prahlada N.B
MBBS (JJMMC), MS (PGIMER, Chandigarh). 
MBA in Healthcare & Hospital Management (BITS, Pilani), 
Postgraduate Certificate in Technology Leadership and Innovation (MIT, USA)
Executive Programme in Strategic Management (IIM, Lucknow)
Senior Management Programme in Healthcare Management (IIM, Kozhikode)
Advanced Certificate in AI for Digital Health and Imaging Program (IISc, Bengaluru). 

Senior Professor and former Head, 
Department of ENT-Head & Neck Surgery, Skull Base Surgery, Cochlear Implant Surgery. 
Basaveshwara Medical College & Hospital, Chitradurga, Karnataka, India. 

My Vision: I don’t want to be a genius.  I want to be a person with a bundle of experience. 

My Mission: Help others achieve their life’s objectives in my presence or absence!

My Values:  Creating value for others.