student essay the disproportional impact of covid 19 on india

How has education technology impacted student learning in India during COVID-19?

Subscribe to the center for universal education bulletin, emiliana vegas , emiliana vegas former co-director - center for universal education , former senior fellow - global economy and development @emivegasv sunhwa lee , and sl sunhwa lee principal social sector specialist - asian development bank unika shrestha us unika shrestha social sector economist - asian development bank.

August 23, 2021

This blog summarizes the report, “ Ed tech and educational opportunity during the COVID-19 school closures: A case study of Chennai, Tamil Nadu .”

India has been one of the hardest-hit countries by COVID-19. Beyond the staggering impact on human life, COVID-19 has greatly disrupted access to education in India, with 247 million primary and secondary school students out of school. While school systems in India and across the world have made efforts to reach students at home through various means, recent estimates of the impact on learning and socio-emotional well-being suggest that the poorest children will be hurt the most by the pandemic-related school closures.

Indeed, school closures have compelled education systems to quickly devise and apply different modes of remote learning such as radio, TV, and various other types of online tools. But access to this education technology (ed tech) differs across and within countries—with students in high-income countries and communities much more likely to have access to online, virtual schooling than their peers in low- and middle-income countries and communities. Thus, an important question is to what extent will student learning and progression in school, especially among primary-school-aged children in low- and middle-income settings, be affected by the global school closures? Further, how will the COVID-19 school closures cause inequality in learning among girls and boys, among poor and affluent children, and across communities and countries of varying income levels?

To answer these questions, we conducted a household survey in February of this year in a southern city of India—Chennai in the state of Tamil Nadu—with financial support from the Asian Development Bank and in collaboration with J-PAL-India. Chennai is the largest urban center in Tamil Nadu and is India’s sixth most populous city. Due to Chennai’s dense population, families typically have several nearby private and government school options, which provide a ripe setting to explore how the use of ed tech differed between different types of schools—both prior to and during the COVID-19 pandemic. Additionally, India offers a fertile environment for this study’s data collection as a leader in large-scale education reform and ed-tech application among developing countries. The diversity in its large population offers useful lessons applicable to many different contexts.

Alarmingly, 1 in 5 children in our sample were enrolled in schools that do not offer any remote instruction during the school closures, and even among the children whose schools had begun remote instruction, only slightly more than half attended all the classes.

Our goal was to get a better picture of primary school-aged children’s daily educational experiences during the COVID-19 school closures, and especially how students and teachers are using ed tech. We were particularly interested in understanding how these learning experiences may differ among children from low- and high-income households and between children attending private and government (publicly funded) schools.

Our survey findings

Our findings further indicate that during the pandemic-related school closures, students in private schools and those from households with high socioeconomic status (SES) have more access to digital devices and are more engaged in regular educational activities than their peers in government schools and from low-SES households. As Figures 1 and 2 show, children enrolled in private schools and from high-SES households had higher rates of access to digital devices—such as smartphones, internet, and computers/laptops—than their peers in government schools and from low-SES households. These preliminary results shed light onto a likely growing inequality of educational opportunity and suggest the need for policymakers to support access to regular learning opportunities at home for children from low-SES households in government and private schools. Other emerging evidence from the COVID-19 school closures suggests that ensuring students have access to even low-tech interventions, such as SMS text messages and phone calls, can help mitigate the potential learning losses.

Figure 1. Share of students with access to educational resources, by household income

Figure 2. Share of students with access to educational resources, by school type

Prior research has shown that the impact of school closures in low-income countries may differ by gender, as girls are often expected to help out with household chores and/or assist parents in caring for younger siblings. However, our study shows an encouraging pattern, where girls are more likely than boys to have access to digital devices for learning and to engage in more regular educational activities (see Figures 3 and 4). Nevertheless, this finding suggests the need for further analysis into why boys may be losing out on educational opportunities, and what strategies may be most effective to increase learning among both girls and boys in India and other low-income countries.

Figures 3. Share of students with access to educational resources, by gender

Figure 4. Frequency of engagement in educational activities, by gender

Altogether, these preliminary results shed light onto a likely growing inequality of educational opportunity in India and around the world, suggesting the need for policymakers to broaden access to continuous and equitable learning opportunities across the student population.

Looking ahead, it will be crucial for governments to enact strategies to help students recover from the learning losses suffered during the school closures and to return to school. Such a strategy may include:

• Working closely with the health authorities, plan to reopen schools safely as soon as possible.
• Assess each child’s foundational literacy and numeracy skills as soon as possible to help teachers and parents develop personalized interventions to ensure that each child can get back on track to develop these critical skills.
• Expand access to digital devices and connectivity among educators and students, along with guidance and support to teachers on ed-tech resources that are best aligned to each student’s learning level. While ed tech is not alone going to ensure children learn, it can be a tool for educators, students, and parents to facilitate learning continuity during school closures and allow for more student-centered, engaging instruction in and outside the classroom.
• Provide socio-emotional support to educators and students, recognizing that the pandemic has not only caused learning loss but also emotional trauma in too many households.

You can access the full report here .

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Sunhwa Lee is a principal social sector specialist and Unika Shrestha is a social sector economist at the Asian Development Bank, which provides financial support for the Center for Universal Education.

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This is how COVID-19 lockdowns affected India's schoolchildren

When the pandemic hit, India had about 265 million children enrolled in school. Image:  REUTERS/David Talukdar

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Stay up to date:.

• Nearly 40% of students in underprivileged households in India have not been studying during school closures, according to a new report.
• Only 1-in-4 children in India have access to a digital device, and nearly half of the children in rural India have no means to study online.
• As a result, India is experiencing a significant drop in literacy levels.
• It's feared that this could cause more children to drop out.

There’s growing evidence that Covid-19 has left India’s schoolchildren significantly worse off academically.

In the absence of physical classrooms and without the devices or internet necessary to access online school, nearly 40% of students in underprivileged households have not been studying at all.

These findings are part of the School Children’s Online and Offline Learning report, or School for short, coordinated by researchers Nirali Bakhla, Jean Drèze, Vipul Paikra, and Reetika Khera, based on a 15-state survey of nearly 1,400 households in August. About 60% of the households reside in rural India, a share slightly less than for the population as a whole, and 60% are representative of Dalit and Adivasi communities. To gauge the impact on less privileged families, volunteers focused on households where children were likely to be enrolled in classes 1-8 in public schools, rather than private ones.

When the pandemic hit, India had about 265 million children enrolled in school , including primary and higher levels, with most of them relying on public systems.

Since March 2020, schools in India have been shut for the most part, and have only intermittently reopened for high school students. The conversation around reopening has been punctuated by worry that a potential third wave of Covid-19 will primarily impact children as they are not at present able to be vaccinated.

Have you read?

This is what matters in education, according to the world’s best teacher, india vs virus: voices from the covid front line, covid-19 forced a billion children out of school - here’s how we can save their education.

The report highlights India’s stark digital divide and explains why, despite fears of Covid-19, over 90% of parents surveyed want schools to reopen.

No devices for online school

By the Indian government’s own estimates , at least 30 million schoolchildren have no access to smartphones or devices to attend school online. This number is likely far greater in reality. Unicef, for instance, estimates that only one in four children has access to a digital device and the internet.

Findings in the School report point to nearly half of the children in rural India having no means to study online. There are several other hurdles that have also stunted their education.

Schools have also been unable to extend significant support to such children, often leaving families to navigate the intricacies of the internet on their own. This is harder for families where their children are first-generation learners and no adult at home is able to assist with coursework.

Some teachers, though, were greatly invested in their students and have tried to help them overcome these barriers. “The survey uncovered an impressive range of initiatives taken by caring teachers. Some convened small-group classes in the open, or at someone’s home, or even at their own home,” the authors noted. “Others recharged the phones of children who were short of money, or lent them their own phones for online study.”

Yet, these were exceptions and not the rule. A majority of the students, especially from India’s marginalised caste or tribal communities, suffered greatly because of school closure.

Losing literacy

Using the country’s literacy rates for ages 8-12 and 10-14 from the 2011 Census as a base for comparison, the study found that children from Scheduled Caste and Scheduled Tribe (SC/ST) families had experienced a significant drop in their ability to read even simple sentences.

According to census data, literacy level in the 10-14 group reached 91% a decade ago. However, other reports have different findings regarding literacy levels. A 2018 Annual Status of Education report noted that about half of students in class 5 could pass its tests of fundamental reading skills .

The census counts a person literate if they “can both read and write with understanding in any language.” In the School survey, a child is counted as literate if he or she was able to read a test sentence in the local language either “fluently” or “with difficulty.” (The sentence was “Since the coronavirus pandemic, schools have been closed.”) Given the survey’s more generous definition of literacy, the study author’s argue the results should not have registered a dramatic decline. But they did.

“The contrast between the School and Census figures is too stark to be plausibly explained by the underprivileged background of School children,” they add.

“To look at this another way, the ‘illiteracy rate’ in the 10-14 age group among rural SC/ST households in the School sample (39%) is more than four times as high as the average for all children aged 10-14 in the School states 10 years ago (9%),” the authors noted. “Such are the combined effects of chronic inequality and a lopsided lockout.”

This bleak scenario is considerably worsened by the fact that children are being automatically promoted to higher grades, and will only lag further behind as classes become more challenging. And many will likely end up dropping out.

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The Effects of COVID-19 on Students in India

SEATTLE, Washington — The coronavirus pandemic has significantly changed everyday life for people across the globe. As a developing country with the second largest population in the world, India is dealing with the full consequences of COVID-19. One obstacle the country has faced since the pandemic hit is in continuing a quality level of education for their students. The effects of COVID-19 on students in India have brought many issues to light, but communities across the country have rallied in support of their students in a multitude of ways.

Overall Effects

Since the coronavirus first appeared, 320 million students in India have been directly affected by school closures. Closures have pushed India towards a modernized, digital style of teaching. However, this solution comes with its own unique set of problems.

The National Sample Survey of 2017 to 2018 reported that only 23.8% of Indian households had any type of internet access. Furthermore, there is a gender disparity in internet access. Only 16% of women have mobile internet access compared to 36% of their male counterparts. In addition to the gender gap, there is a class divide in place with the impoverished students of India having the least access to the internet.

What Is Being Done

Urvashi Sahni, the founder and CEO of the Study Hall Educational Foundation , has worked toward reaching out to as many students as possible and successfully connected to 70% of their student body. Also, teachers are utilizing digital volunteers in continuing education for low-access students by using methods such as teaching through phone calls or messages.

Another issue emerged when panic quickly spread among communities due to COVID-19, but teachers did their best to put families at ease. With many of their students being financially affected, instructors sent out e-flyers with information on relief measurements provided by the government of India and other organizations. Furthermore, instructors provided detailed, scientific information about COVID-19 to ensure both students and parents were well-educated on the virus. SHEF and teachers have put efforts into alleviating the impact of COVID-19 on students in India.

Education in India

India ranks first for the world’s largest youth population at an astounding 600 million people under the age of 25 . This statistic is significant in the sense that not only does the current education climate affect India , but it also affects global education. Many graduating seniors are facing travel and financial restrictions, reducing the overall number of students that will pursue education overseas.

Also, entrance exams have been postponed and, in turn, delayed admission processes for many seniors. Expanding outside of grade school, graduating college students will find themselves in a low-demand job market. The difficulty of finding a job during a pandemic will increase India’s overall unemployment rates. Regardless of these challenges caused by the pandemic, positive changes are occurring.

Positive Changes to Education in India

For graduating seniors in grade school, guidance counselors are equipped to provide both emotional and educational support for their students. They aim to ensure that seniors feel comfortable discussing how the coronavirus has affected their personal lives, while also providing a list of options best fit for them in regards to pursuing higher education. Although there will be fewer students studying abroad, universities and colleges in India will be enhanced with many top-tier students attending national schools.

Another benefit of digital teaching is that teachers can participate in enhanced collaborative learning. This style allows instructors from different countries to connect and support one another in teaching their students, which builds a global, mutually beneficial relationship. Despite all the barriers, communities are displaying resilience in alleviating the consequences of COVID-19 on students in India.

Lasting Impact

The pandemic has presented a whole new set of challenges that countries are currently attempting to overcome. India is just one of the countries that have been affected in numerous ways. India is currently dealing with the millions of students directly affected by this pandemic. Despite its barriers, India has proven its country’s willingness to support the education of its future generation.

– Bolorzul Dorjsuren

Photo: Flickr

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Assessing impact of the covid-19 pandemic, on the socio-economic situation of vulnerable populations through community-based monitoring.

The COVID-19 pandemic and the ensuing lockdown had adversely affected peoples’ lives, particularly the marginalized sections of the populations with loss of livelihoods, food shortage and disruptions in access to health services and education. This Report is based on findings using Community Based Monitoring (CBM) in seven states over four rounds during the period June-July till December 2020. The Report has brought out the voices of the vulnerable populations, as they experienced disruptions caused by COVID-19 pandemic.

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COVID-19 and its impact on educational environment in India

Affiliations.

• 1 College of Management and Commerce, Srinivas University, Karnataka, India.
• 2 College of Business Administration, Kingdom University, Riffa, Bahrain.
• 3 Department of Economics and Finance, College of Business Administration, University of Bahrain, Zallaq, Bahrain. [email protected].
• 4 Department of Commerce, Mangalore University, Karnataka, India.
• 5 Department of Postgraduate Studies and Research in Commerce, St. Aloysius College (Autonomous), Mangalore, India.
• PMID: 34981385
• PMCID: PMC8723802
• DOI: 10.1007/s11356-021-15306-2

The impact of COVID-19 has revamped all aspects of human life including education sector, and it has completely changed the educational environment across the globe. Due to the pandemic, the methodical functions of educational institutions have stopped, and new phases have started like online class, online evaluation, and indoor activities. Students are the vital players in education sector, and their opinions play an indispensable role while formulating the policies by the government. In the pandemic, students' perspective on education environment finds new dimension. Therefore, this paper has made an honest attempt to know the coastal Karnataka students' stance on college educational environment. In this study, six major components of education environment are considered, namely (1) online class, (2) teaching and learning, (3) evaluation, (4) college administration, (5) extracurricular activities, and (6) teachers. The study is descriptive in nature, and data was collected from 347 college students of Coastal Karnataka. To support the main objective, a hypothesis has been developed with the help of review of literature and is tested by using ANOVA and independent t-test. The path analysis is used to analyze the casual relationships among components of college educational environment, overall perception, and student performance. The result of the study found that the college students have positive perception towards online class (M=3.14), teaching and learning (M=3.704), evaluation (M=3.38), college and administration (M=3.83), extracurricular activities (M=3.87), and teachers (M=3.63). The result of the hypothesis testing revealed that there is no significant difference in the student perception towards various components of college education system. Path analysis results show that there is relation and effect between components of college education, overall perception, and students' performance. The study concludes that students agree with policies and actions taken by colleges to carry out classes during COVID-19 pandemic irrespective of demographic and educational difference.

Keywords: COVID-19; Education; Educational environment; Post-pandemic; Students.

© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

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Impact of Covid-19 on study abroad: How students can adapt and succeed

Covid-19 has significantly impacted international admissions for students seeking higher education. the global response to the pandemic has led to widespread disruptions in travel, testing, and application processes. here are some key considerations for students to adapt and succeed in the current environment:.

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Covid-19 has instigated transformative shifts across various sectors, and one area profoundly affected is international education.

Despite the challenges posed by the global health crisis, there have been substantial positive impacts on the ability of international students to pursue education, especially in the United States and Canada.

These changes, ranging from enhanced admissions policies to increased opportunities for building strong academic profiles, present a new and dynamic landscape for aspiring students.

ENHANCED ADMISSIONS POLICIES

One of the most prominent adaptations in the aftermath of the pandemic is the modification of admissions policies by numerous universities. Traditionally, standardised tests such as the GRE, GMAT, and SATs play a pivotal role in determining a student's eligibility for admission. However, in response to the challenges posed by Covid-19, many institutions have made these tests optional.

This shift not only simplifies the application process but also expands access for international students who might face difficulties in taking these tests, thereby making education more inclusive.

RECORD NUMBER OF STUDENT VISAS

In addition to the changes in admissions policies, the U.S. and Canada have issued a record number of student visas. This surge in visa acceptances further facilitates the entry of international students into these countries. The streamlined visa processes contribute to a positive impact on students, ensuring that not only is admission more accessible, but the bureaucratic hurdles to studying abroad have also been significantly reduced.

CONTINUED HYBRID LEARNING OPPORTUNITIES

Universities have adapted to the new normal by offering hybrid learning opportunities. The pandemic has accelerated the integration of online courses into traditional, on-campus education. This adaptation allows students to diversify their learning experiences and expand their skill sets. Whether on campus or halfway across the world, students can now access a plethora of courses, contributing to the enrichment of their academic profile.

VIRTUAL INTERNSHIPS

One of the most noteworthy changes brought about by the pandemic is the rise of virtual internships. Previously, the concept of securing an internship before physically arriving in the host country was rare. However, the increased prevalence of remote work has paved the way for international students to engage in virtual internships from the comfort of their home countries. This not only provides a head start in gaining practical experience but also showcases adaptability and resilience, qualities highly valued in today's dynamic work environment.

In a nutshell, while the Covid-19 pandemic has presented myriad challenges, it has also ushered in positive transformations in the realm of international education. From flexible admissions policies and increased visa acceptances to the proliferation of online courses and virtual internships, students now have more opportunities than ever to adapt and succeed in their educational pursuits.

The key lies in embracing these changes, leveraging the new avenues available, and proactively shaping one's academic journey in this evolving landscape.

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Impact of COVID-19 on healthcare system in India: A systematic review

Megha kapoor.

1 Laboratory of Disease Dynamics & Molecular Epidemiology, Amity Institute of Public Health, Amity University, Noida, Uttar Pradesh, India

Karuna Nidhi Kaur

Shazina saeed.

2 Amity Institute of Public Health, Amity University, Uttar Pradesh, Noida, India

Mohd Shannawaz

Amrish chandra.

Despite an extensive healthcare system in India, the COVID-19 Pandemic created havoc upon the existing Indian healthcare system by disrupting the supply of essential healthcare services to patients. It has also highlighted the significant-quality discrepancies of healthcare facilities between the rural-urban areas and between public and private healthcare providers. The not so advanced healthcare system of India was exposed through the lack of oxygen and essential drugs required for the treatment of COVID-19. Additionally, during the pandemic period there was a drastic decline in seeking non-COVID-19 disease related healthcare services. The objective of this systematic review is to determine whether COVID-19 has impacted the healthcare system in India.

Introduction

India, the second most populous country in the world has been severely impacted by the ongoing COVID-19 pandemic since it’s emergence. COVID-19 has impacted every sector in the country including healthcare. Indian healthcare system crumbled under the massive burden of the global pandemic highlighting the gaps and challenges in the existing health delivery system.

COVID-19 or Coronavirus is an upper respiratory tract infection of high virulence. It was formerly known as ‘2019-nCoV’ and is caused by the SARS-CoV-2 virus. 1 It first originated from Wuhan city, Central Hubei province of China in December 2019. Several clusters of patients with viral pneumonia of unknown origin were reported to be epidemiologically associated with the Hunan seafood market, Wuhan, China. 2 Soon, cases of pneumonia were reported in other parts of the world as it spread rapidly crossing the borders of China. A massive number of people started losing their lives in China and following its spread to other countries; it was declared a public health emergency of international concern on 30th January 2020 by World Health Organization (WHO). After more than 118,000 cases in 114 countries, and 4291 people lost their lives, COVID-19 was declared as a pandemic by World Health Organization (WHO) on 11th march 2020. 3 As the countries continued to struggle with a lack of resources and capacity the viral outbreak spread rapidly worldwide, infecting millions of people all across the globe including India.

Those infected with Coronavirus disease (COVID-19) exhibit a varying range of symptoms ranging from mild to moderate. It affects people of all ages; however, the risk of serious infection increases with advancing age. Patients infected with coronavirus disease and presenting with pre-existing co-morbidities such as diabetes, asthma and cardiovascular diseases (CVDs) are more vulnerable to experiencing unfavourable outcomes or experiencing death.

A healthy individual can acquire COVID-19 infection directly by coming in close contact with an infected individual through the droplets emitted during sneezing or coughing. It can also be transmitted indirectly after coming in contact with contaminated surfaces such as door knobs. It affects every individual differently with cough, fever, sore throat, tiredness and lethargy being the most common symptoms of the illness. Individuals can also develop few lesser common symptoms such as loss of taste, diarrhoea, irritation of the eyes and rash on the skin among others. An individual can develop shortness of breath or experience difficulty in breathing and requires urgent medical attention. These symptoms may take 4–5 days to appear after coming in contact with a virus or as long as 14 days and can also be asymptomatic.

The first wave

In India, the first case of COVID-19 infection was reported on 27TH January 2020, when a 20 year old female with a travel history of China presented with a sore throat and dry cough in the emergency department of General Hospital, Thrissur, Kerala. 4 Since then, COVID-19 has taken a serious toll in India and worldwide. To prevent the spread of COVID-19 infection, the Government of India announced a nationwide lockdown for 21 days on 24 March 2020, which was further extended. It was not until 30th May, that the government uplifted the restrictions in an ‘unlock’ phase-wise manner. Throughout, national advisories were generated and the norm of ‘social distancing’ and ‘work from home was introduced. People were advised to practise social distancing, wear masks and avoid going out unnecessarily and only people of ‘essential services such as doctors, nurses, police and home services were exempted. These preventive measures allowed the Indian Healthcare delivery system to prepare for the pandemic. These measures stopped the further spread of COVID-19 infection and the efforts of the Indian Government to contain the viral spread were applauded internationally. India has experienced three COVID-19 pandemic waves till now with a massive surge during the second wave in March 2021. 5

The second wave and Indian healthcare system

The first wave had a low infectivity rate since the lockdown was imposed and individuals practised social distancing. Therefore, it largely affected the economy and livelihoods of Indians without any serious implications on the healthcare system. However, during march 2021, the country witnessed the most dangerous second wave that created havoc as individuals started taking preventive measures more casually due to ‘pandemic fatigue’. This was characterized by an increasing number of cases between 25 and 50 years of age, a shortage of essential medicine and equipment, and medical professionals. 6 Indian healthcare system failed to meet daily oxygen demand, Intensive Care Units (ICU) beds and oxygen beds due to which many hospitals had to turn the patients away, resulting in higher mortality rates. This lead to the disruption of routine immunization procedures, and treatment of Non-communicable and communicable diseases. 7 This revealed the overstretched and overburdened existing Indian Healthcare system. This also highlighted the failing healthcare management system and lacking public health system and efficient healthcare models in India. The Indian government failed to respond to the second wave effectively unlike the first wave.

The third wave of COVID-19 in India

With the emergence of the new Omicron variant of SARS-CoV2, the cases increased in January 2022. 8 The majority of the cases were asymptomatic or mildly symptomatic. With increased administration of the COVID-19 vaccine, the patients admitted in ICU were mostly unvaccinated or with pre-existing co-morbidities. The demand for hospital beds, oxygen beds and ventilators were low and mostly remained unoccupied.

The third wave was different from the first two waves due to various factors such as low virulence of the omicron variant despite high transmissibility and administration of either single or both doses of COVID—19 vaccine to the adult population, authenticating the effectiveness of the vaccine.

Therefore, the COVID-19 pandemic has significantly disrupted the healthcare systems in India. Hence, this review aims to describe the impact of COVID-19 on the healthcare system concerning the patient visit and reception of treatment, diagnostic tests done and referral services in India. It is necessary to conduct this review as it will aid in developing new healthcare models in order to manage the COVID-19 pandemic at present and prevent any further waves from arising in the future.

Health care system in India

A sound and effective healthcare system enable the country to respond to a pandemic efficiently by overcoming the challenges and barriers encountered in providing healthcare.

The Indian healthcare system is a mixed framework, including both public and private healthcare service providers. However, a large proportion of private healthcare providers are present in urban India, providing, secondary and tertiary healthcare services. 9

The objective of this systematic review is to determine the impact of the COVID-19 pandemic on the healthcare system in India.

Rationale: The rationale for this study is to investigate the impact of the COVID-19 pandemic on the healthcare system in India, considering the challenges, gaps and disruptions experienced during this global health crisis.

Material and methods

Study design.

This systematic review was conducted on the available online published studies in high-quality journals related to COVID-19 impact on healthcare services in India.

Search strategy

A thorough extensive literature search was conducted between 14 February 2022 and 20 February 2022 on the electronic database ‘PubMed’ for quality studies published between time period 2019 and 2022 using the search strategy (impact) AND (COVID-19) AND (healthcare system) OR (Primary Health centre)) OR (secondary health centre)) OR (community health centre)) OR (tertiary health centre))) OR (hospital)) OR (government)) OR (private)) AND (India).

The following keywords and Medical Subject Headings (MeSH) entries were used:

COVID-19, healthcare system, India.

Studies that met the eligibility criteria were selected based on the inclusion and exclusion criteria after screening the database for this systematic review.

Inclusion and exclusion criteria

This systematic review included the studies conducted in the English language during the COVID-19 Pandemic assessing the healthcare system in India. Studies involving outpatient clinics visit, hospital admissions, diagnostic tests done, minor and major surgeries and case referrals were also included.

Studies which were conducted in private clinics & not involving government, primary, secondary and tertiary centres, along with the studies conducted on the physical & mental health status of healthcare providers through surveys were excluded as shown in Table 1 .

Summary of excluded studies.

Data extraction

After completion of the initial screening process, a total of seven articles were selected to be included in this systematic review. The study selection process is illustrated in Figure 1 , representing the PRISMA (Preferred reporting items for systematic reviews and meta-analysis) flow diagram for this systematic review.

PRISMA flow diagram of the systematic search.

From the selected articles following data was extracted by preparing an MS Excel spreadsheet: title of the study, study objectives, study methodology and conclusion.

Table 2 shows the summary of all the included articles in this systematic review.

Summary of included studies.

According to the objective of this systematic review the results described based upon the Impact of the COVID-19 Pandemic on the health care system in India on various parameters – number of outpatients, number of inpatients, number of patients undergoing minor and major surgeries, emergency trauma cases, patients undergoing nonurgent elective procedures.

Impact of COVID-19 on cancer care in India

From the seven included articles in this review, two articles described the disrupted oncology services in India by comparing these before and during the pandemic. A cohort study to describe the impact of COVID-19 on cancer care in India compared the oncology services provisions by cancer patients between 01 March 2020 and 01 March 2020 with similar duration for 2019 and concluded that there was a 54% reduction in new patient registration, 46% reduction in patient follow-up visit, 36% reduction in hospital admissions, 37% reduction in outpatient chemotherapy, 49% reduction in number of major surgeries, 52% reduction in minor surgeries, 23% reduction in patients accessing radiotherapy, 38% reduction in pathological diagnostic testing, 43% reduction in radiological diagnostic tests and 29% reduction in palliative care referrals. It also found that there was more reduction of oncology services for larger metro cities than smaller cities. 10 Another study, A retrospective analysis from western India determining the impact of the COVID-19 lockdown on Cancer care stated reduced patient visits and number of treatments received during the lockdown with chemotherapy being the most common treatment received. 11

Impact of COVID-19 on nephrology services in India

Only one study out of the seven included studies described the impact of the COVID-19 pandemic on nephrology and transplant services at a tertiary care centre, in Ahmedabad, India. The study concluded that there was significant reduction in a number of outpatients and inpatients between April 2020 and June 2020 when compared with a similar duration in 2019 almost by 50%. There was also a reduction in donor transplants, haemodialysis and nonelective procedures such as renal biopsies and arteriovenous fistulas during March 2020. 12

Impact of COVID-19 on ophthalmic care in India

Three out of seven included studies reported the impact of COVID-19 on ophthalmic care in India. A study conducted at a tertiary care ophthalmic institute in India reported a decrease of 97.14% in the routine patient visit, a decline of 35.25% in emergency outpatient visits, a decrease in routine and emergency ward admissions by 95.18% and 61.66% respectively, a reduction of elective surgeries by 98.18%, decrease of 58.81% in emergency surgeries, reduction of 99.61% in the number of donor corneas collected between 25 March 2020 and 15 July 2020 with comparison on previous year data of the same duration. 13 A study conducted in rural eye centres of Southern India reported that between 23 March 2020 and 19 April 2020, the total number of patients reduced during the lockdown-I period versus pre-lockdown. Only essential procedures were performed and most of the patients were treated for conjunctivitis. 14 A third study, which was conducted in a tertiary eye care Institute reported that there was a reduction in the number of patients presenting with ocular trauma in their emergency department during the lockdown as compared to the previous year. 15

Impact of the COVID-19 pandemic on the clinical practice of trauma and orthopaedics

A single epidemiology study out of seven studies included in this article, which was conducted at a tertiary care centre in New Delhi, explained various outcomes of the COVID-19 pandemic on the practice of orthopaedics and trauma through comparison between the pandemic period and pre-lockdown. It stated a reduction by 71.93% in outpatient attendance, a reduction of 59.35% in inpatient admissions, 55.78% reduction in surgical procedures including arthroplasty surgery, trauma and arthroscopic surgery during the pandemic period. 16

This study is being conducted to investigate the impact of the COVID-19 pandemic on the health care system in India by a systematic review approach based upon the eligibility criteria, seven articles related to the purpose of the study were screened after inclusion and the final analysis was prepared. The included studies defined various parameters – number of outpatients, number of inpatients, number of patients undergoing minor and major surgeries, emergency trauma cases, patients undergoing nonurgent elective procedures, follow-up visits for assessment of the impact of the COVID-19 pandemic on overstretched and overburdened health care system Of India. The studies included in this article reported that the COVID-19 pandemic has sharply affected the health care services in India including cancer care, nephrology services, ophthalmic care, trauma practice and orthopaedics care.

The COVID-19 Pandemic has led to a disrupted healthcare system which has subsequently impacted non-COVID disease conditions. The observed reduction in the number of new patient registrations, hospital registrations, major and minor surgeries, and transplant procedures as summarized in various studies during March 2020–April 2020 could be due to fear of infection among patients. The patients residing in rural parts of India found it difficult to access health services in metro cities due to travel restrictions during the lockdown period and this has led to delays in early screening, correct diagnosis and appropriate treatment which is of grave concern. These patients may present with advanced stages of the disease and create a backlog of patients by overloading the healthcare system.

Hospitals faced certain challenges that inhibited them from providing appropriate care to the patient such as- many hospitals being converted to COVID-19 dedicated treatment facilities and as result, they faced a widespread shortage of Personal Protective Equipment (PPE) supplies. Hospitals reported a shortage of adequate staff as they were themselves exposed to the virus. Various hospitals reported lack of necessary medical equipments such as ICU beds and Ventilators which was a major threat.

Despite the lockdown and various challenges encountered, hospitals realized the need of improving the accessibility of healthcare through teleconsultation along with in-person visits during these challenging times. In the absence of direct consultations to the patients, telemedicine was conducted to address the concerns of outpatients and therefore, reduce their need to visit the hospital.

In general, the COVID-19 Pandemic has posed a serious threat to all aspects of the healthcare system in India by affecting the activities of hospitals that provide treatment services to patients for non-COVID-19 diseases.

The results of this study show that Indian Healthcare System during the COVID-19 pandemic has suffered serious challenges, which can be a wake-up call because due to delayed diagnosis, a large number of patients will present with advanced stages of the non- covid-19 disease such as cancers, which may require emergency treatment. Strengthening of the Indian healthcare system is required so that it does not crumble under future pandemics if any. Need of the hour is a robust healthcare model and effective healthcare policies with regular updates to manage the current pandemic along with more emphasis on telemedicine as this is not the last pandemic that India will face. In conclusion, the COVID-19 pandemic has significantly impacted the healthcare system in India.

Limitations of the study: This study has limitation regarding language inclusion, as the researchers’ proficiency was limited to English, resulting in the exclusion of articles written in other languages. Another major limitation is the bias as the he papers relies on available online published studies in high-quality journals, which may introduce a bias towards studies that have been published and accessible. There may be relevant studies that have not been included in the review, potentially leading to a skewed representation of the impact of COVID-19 on the healthcare system in India.

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding: The author(s) received no financial support for the research, authorship, and/or publication of this article.

Ethical statement: No Ethical approval is needed.