The central government has shown immense ‘political will’ by imposing severe lockdown measures to contain the COVID-19 pandemic. While various arms of the state have been summoned to ensure that the ‘lockdown’ is successful, there seems to be no such urgency to ‘lock-in’ private hospitals to address what has been declared as a national emergency.
In a recent column, Indu Bhushan, the CEO of Ayushman Bharat, approached the private sector with kid gloves, seeking cooperation, but not requisitioning it. During this period of acute crisis, one would have thought that the central government would have been far more proactive in requisitioning the private sector to provide emergency services, rather than merely plead and urge.
The National Disaster Management Act, in fact, has provisions for the state to requisition required services to handle precisely such emergencies. In the case of the COVID-19 pandemic, private hospitals should play an important role in dealing with the moderate and severe cases that require hospitalisation, making their ICU facilities and isolation wards available. Some state governments have in fact requisitioned private hospitals to supplement the public sector. However, the experience so far has been mixed.
The preparedness of private hospitals in dealing with the COVID-19 epidemic and the extremely variable quality of services in the poorly regulated private sector is now becoming apparent. Even internationally accredited hospitals in Mumbai and Delhi were ill-prepared to deal with the outbreak of coronavirus.
A large number of health workers in these hospitals tested positive since they did not have adequate Personal Protection Equipment (PPEs) for doctors, nurses and other staff members. Once the positive cases were identified, some of these hospitals shut down. While there are reports of a few corporate hospitals offering treatment for COVID-19 cases, this does not amount to a systemic strategy for engaging a highly differentiated private sector.
The lack of PPEs affects both private and public hospitals and a large number of doctors and nurses in the latter have also tested positive. The difference, of course, has been that while private sector hospitals simply shut shop claiming inadequate capacity and capability, public sector hospitals have to plod on, exposed to all the risks. All public sector hospitals continue to provide services despite the multiple challenges and constraints they face. In several states, retired government doctors and nurses have been re-employed to meet staff shortages.
One way in which the private sector can be requisitioned to help the public sector would be through the redeployment of staff from the former to the latter. Another way in which private hospitals can step in and help would be by providing routine care and addressing special needs that arise out of the epidemic and the lockdown.
Bhushan has appealed to the private sector for its wholehearted participation in the fight against COVID-19. This was premised on the 71st round of the National Sample Survey that shows that a large section of the population is dependent on the private sector for outpatient and in-patient care. Data regarding this has been available to the government for a while now.
It is surprising that such information was not used in health care planning by NITI Aayog. Or does this demonstrate a lack of communication between multiple authorities – the NITI Aayog, the Ministry of Health and the Ayushman Bharat that are addressing the COVID-19 pandemic? Is the second week into the lockdown not a little late for prescriptive suggestions from a government institution that administers a public insurance scheme?
Those administering Ayushman Bharat ought to have drawn up plans for including the private sector as part of a broader strategy of public-private partnership in the management of COVID-19. The lockdown has affected livelihoods of millions in the unorganised sector, small, medium and large businesses. They are being forced to bear the losses imposed on them by the government’s policy of a lockdown. By the same logic, the government ought to have demanded that the private sector also chip in and show its commitment to the national effort.
In the midst of a humanitarian crisis and a national effort to address the same, the hospital committee of a premier business organisation, FICCI, and a private consulting firm, Ernst and Young, have only sought to promote the interests of the private hospital sector. The FICCI report highlights the financial distress that private hospitals face due to a drop in patient footfall.
This distress is minuscule compared to the distress of those who have lost their livelihood due to the lockdown. The demands being made include indirect tax reliefs, exemptions, waivers like recoup amounts equivalent to ineligible GST credits paid on procurements for a stipulated period; customs duty or GST exemption on essential medicines, consumables and devices for treatment of COVID patients; waiver or reduction of health cess on medical devices, extension of time under the EPCG scheme etc. income tax benefits and deferment of statutory liability payments without interest, the penalty for a stipulated period (3-6 months) and a rebate on the commercial rate of power for a stipulated period.
The private healthcare sector is more focused on seeking government support for itself, rather than volunteering to partner with the government in dealing with a public health crisis.
Rama. V. Baru and Ramila Bisht are professors at the Centre for Social Medicine and Community Health, JNU.