2021 in numbers: Health services
Disruption in non-Covid health services continued this year
Data from India’s rural health facilities shows that in the January-May period, child immunisations this year were higher than in 2019 after falling in 2020. The fall in 2020 was likely because of a harsh lockdown, because the decrease in immunisations was the biggest in the months of the lockdown. The increase in 2021 suggests that India’s universal vaccination programme was going back to normal this year after lockdowns became less harsh, although the second wave’s peak in May did affect it. This cannot be said of other outpatient, inpatient, or emergency services, where fewer patients availed health services this year than in 2019.
51.7 million patients had accessed outpatient services in 2018 in the January-May period, the only months for which data is available in 2021. The number of such patients in this period increased to 59.1 million in 2019, but dropped to 48.2 million in 2020. In 2021, the number of such patients grew 3.9% year-on-year, but at 50.1 million, was still 15.3% less than in 2019. While outpatient services were used less than in 2019 in all months in the January-May period, the fall was the biggest in the months of April and May, when hospitals and other health facilities were overwhelmed with the second wave of the Covid-19 pandemic in India.
This data is from the Health Management Information System (HMIS) of the National Health Mission, to which around 200,000 health facilities – largely government ones in rural areas – report their data. Since the actual number of health facilities reporting to the HMIS varies from month to month and year to year, a per hospital figure would give a more accurate picture of the trend in such services. This data on the number of reporting facilities has not been published since last year. However, that child immunisations were recovering in 2021 but not other health services suggest that a decline in health services did continue in the first half of this year.
To be sure, not all kinds of diseases were treated less than usual in 2021 in outpatient departments. The number of patients with hypertension and diabetes – which make up around half of the cause-wise outpatients recorded in the HMIS – were higher in 2021 than in 2019 in the January-May period. However, ophthalmology (dealing with the eye) and dental departments – which make up the next 40% of patients -- saw 34% and 42% fewer patients in 2021 than in 2019.
Inpatient services, where patients are admitted to the health facility, saw an even bigger fall compared to 2019: 22% decrease in January-May 2021 compared to January-May 2019. These services were affected significantly even in January and February although May was the most adversely affected month for such services too. The decrease in number of women patients was bigger than for male patients in all months except January. Among different diseases for which inpatient data is available, only dengue patients were admitted more in 2021 than in 2019.
The decrease in emergency patients was bigger (25% compared to January-May 2019) than in outpatients and inpatients. However, not all decrease in emergency patients is likely to be due to the burden put on health facilities because of the second wave. Some of the decreases is also likely because localized and less harsh lockdowns were in place during the second wave too. This could have reduced the number of accidents taking place.