The coronavirus pandemic surging throughout the world has well and truly reached India. Currently, there are 5,095 active cases of the novel coronavirus across the nation. Thirty states and Union territories have been affected. It is unlikely that the rest will also stay immune.
It is a worrisome situation given India’s population, the living conditions of the vast majority, and the current state of our healthcare system. But can it force the Indian government to do what it has so deliberately neglected over the last several decades? Can it compel the government to strengthen our public health system as so direly needed, not just for the moment but for the long term?
The Indian government’s response to the pandemic has, thus far, been fairly positive. It implemented a nationwide lockdown quite early, unlike several developed nations. It was the right step given the country’s situation. There is an urgent and towering need to reinforce the public health sector which will have to be at the forefront of this battle.
From all accounts, the government has mobilised all of its resources to do precisely that. But let us not fool ourselves. The crisis facing the nation has gripped the government not because millions of ordinary Indians will be infected, or because hundreds of thousands of them may need critical care, but because the virus does not differentiate between the poor and vulnerable masses, and the powerful privileged class. It spreads via droplets and the powers that be cannot control that. And when the privileged fall prey to it, they will also have to turn to the public health system for treatment and care.
The private health sector in India has flourished in the past three decades at the cost of the public sector. Budgetary allocation for health has consistently fallen way short of that recommended by experts. The government has ignored the desperate appeals for strengthening public hospitals all these years.
Instead, it has employed a deliberate shift from publicly provided healthcare and propped up the private healthcare industry and now private health insurance. The result, as to be expected, is a public health sector that seems about to come undone now that an unprecedented challenge to healthcare has suddenly surfaced.
It is in this scenario that healthcare staff at government hospitals will risk their lives in the fight against the coronavirus. The private sector may have more beds and more personnel, but it also has no obligation to treat. It may take in patients, but only as many as it comfortably chooses to. It will not treat more than it has the capacity or desire for. Nor will it invest in augmenting its capacities for a crisis that is, however serious and massive, a temporary one. The onus for that falls on the public health system. Hence the government’s frenzied efforts to increase its healthcare capacities – beds, ICUs, equipment, medicines – across the country. No effort is being spared.
But what happens outside this crisis scenario? What was the case three months ago when no one had heard of COVID-19? The poor and the marginalised, and even the middle class, faced the same shortage of critical treatment options every single day even then. They struggled to find care, they suffered from unaffordable and inaccessible services, and many died – as they will continue to do when this pandemic subsides, unless there is a drastic restructuring of our health system.
The Indian population faces a remarkable shortage of healthcare personnel and infrastructure. There is only one government doctor for more than 11,500 people in India as opposed to one for every 1,000 as recommended by the WHO; only one government bed for about 2,000 people, medicines are in constant short supply, the private health sector is completely unaffordable, and whatever services are available are significantly skewed towards the benefit of the rich and the urban.
Estimates suggest that deaths due to COVID-19 may be between 30,000 and 170,000 in India. However tragic this figure may be, it is far lower than the 2.4 million deaths caused annually due to poor quality and lack of healthcare where and when it is needed most, or the misery of poverty that 55 million Indians face each year due to healthcare costs.
What the government needs to do, besides the current injection of desperate life-saving drips, is to build up the public health system on an ongoing steady basis. It needs to inject the necessary funds, and the government efforts visible today, as a continuous feed instead of merely under desperate circumstances.
It needs to show that it is committed to providing healthcare to its citizens every day, not just today, not just in case of exigencies. The government has the moral duty to ensure that healthcare is available and accessible to every citizen even when there are no cataclysmic sudden needs. If the current pandemic is proof of anything, it is that there is no substitute for publicly provided healthcare. In short, it is time to breathe life not just into desperately sick COVID-19 patients but into our entire public healthcare system.
The coronavirus pandemic has the potential to cause untold damage and loss but it can also serve as a greater good if our government wakes up from its self-induced slumber and converts an emergency augmentation of public health services into a long-term overhaul.
Dr Anjali Chikersal is a doctor of medicine, an independent public health researcher and former senior fellow at Centre for Policy Research, New Delhi. She has worked on numerous projects with the Ministry of Health and Family Welfare, NHSRC, NACO and the Planning Commission.