The pandemic and the subsequent lockdown have highlighted gaps in India’s public healthcare system, providing lessons for a new health-based agenda
The COVID-19 pandemic has brought out the stark inadequacy and abysmal neglect of the public healthcare system in India. Even after 50 days of lockdown, the Government seems to have not learnt from the experience of tackling the deadly virus. In state after state, government hospitals are overwhelmed by the number of patients and the lack of treatment facilities. The state of government hospitals in the hotspot city of Mumbai provides a grim illustration.
The Government has displayed a smug satisfaction by turning a blind eye to the actual state of affairs. The testing being done is still far below what is required. It is only 1.8 per thousand. Extensive contact tracing and isolation of suspected cases id not being pursued in a systematic manner in many places. Kerala is a notable exception. There is, despite the prolonged lockdown, still no clear picture of the actual spread of the disease and its intensity in geographical terms. As for deaths due to COVID-19, there is a gross underestimation of the deaths reported. At present, it is 0.2 per lakh. This is not only due to weak and faulty systems of reporting but also due to policy decisions in some instances like in West Bengal.
The COVID crisis has brought out an image of the utter failure and lack of social responsibility of the private health care sector. With some exceptions, by and large, private hospitals have not risen to the occasion and deployed their resources to tackle the disease. This has had a direct bearing on the fight against the disease because private hospitals account for 93 per cent of all hospitals and 64 per cent of all hospital beds.
Faced with such a situation, one would have expected the Centre to take urgent, remedial measures to strengthen and expand the public health system. This requires an immediate and substantial enhancement of public expenditure on health on a war-footing. But nothing of that sort has happened.
The Rs 20 lakh crore package announced by the PM has proved to be an exercise in deception. The additional expenditure for the government is only 1 per cent of the GDP instead of the promised 10 per cent. Moreover, in this package, the allocation for health in terms of the money provided is only Rs 15,000 crore which is part of the 1.7 lakh crore package announced in the first instance in April.
The Union Cabinet, on April 22, approved the Rs 15,000 crore investment package for the COVID-19 emergency response and health preparedness. It decided to use this amount in three phases. Rs 7,774 crore was meant for immediate use and the rest for medium-term support, i.e., from one to four years. All that the state governments are to get in the first phase is Rs 3,000 crore in additional funds; 28 states and eight union territories will get paltry shares of this amount. Health is a state subject and it is the states who have to bear the brunt of the expenses for dealing with the epidemic. But they have been ill-served by these meagre funds allotted to them.
The Finance Minister, in the fifth and final tranche of the package, made more promises but no concrete commitment of funds. She said public expenditure on health will be increased; that investments at grassroots for health and wellness centres both at the rural and urban levels are going to be ramped up; all districts will have infectious diseases hospital blocks (no timeframe for this) and public health labs will be set-up at the block level.
The leaders of the ruling party have not learnt the key lesson of this pandemic – the necessity to have an extensive and efficient public health system. The Government continues moving in the direction of privatisation of health. We have already seen what increase in public expenditure entails for the Modi government. The National Health Policy announced by the Modi government in 2017 proposes to increase public expenditure on health from the current 1.15 per cent of GDP to 2.5 per cent by a distant 2025. It talks of public-private partnership in expanding district hospitals. So the promised infectious diseases department in district hospitals may be based on the privatised model if it ever materialises.
The current regime is responsible for messing up the COVID-19 response and not acting on the advice of epidemiologists and health experts. It is constantly peddling the idea that the pandemic is under control and India is doing well compared to many other countries. It ignores or underplays the fact that the infection rate is rising exponentially and we are unprepared to face the surge in cases when the lockdown ends. All it is concerned with is to quickly project itself as the 'winner' in this 'Mahabharata', which the PM had initially said on March 25 would be won in 21 days.
The issue of an expanded and invigorated public health system should, therefore, be a priority in the alternative agenda. The fight for such a public health system is a political issue which concerns the basic wellbeing of the people of India.
Views expressed are personal