Why you don’t need an epidemic for the public health system to collapse

By Priyal Vijayvargiya*

The first COVID-19 case in India was detected on January 30, the same day that WHO declared it a public health emergency of international concern. Around 10 million cases have been recorded in the country since then with around 150000 casualties. While the crisis has shaken the entire world, the situation has been particularly challenging for India and the struggles have shone a spotlight on the inadequate public healthcare system in India. It has shown how you don’t need an epidemic, however predictable, for the public health system to collapse. It is a matter of routine that patients share beds and doctors are overworked.

India ranks 112 amongst 191 countries in the world when it comes to health, behind most of its neighbors including Bangladesh. The public expenditure on health in India is only 17.3% of the total expenditure. The same is 24.9% in China, 45.4% in Sri Lanka, and 44.1% in the USA. The low health standards in the country is a reflection of this. The situation is so bad, that in India, there is only one government allopathic doctor for every 10,189 people, one government hospital bed for every 2,046 people, and one state-run hospital for every 90,343 people.

To gain more perspective on the crippling public healthcare system in India, we reached out to Shobha Shukla and Bobby Ramakant of CNS. According to Bobby, India’s biggest mistake is its failure to learn from its past mistakes. For instance, despite battling TB for years, India still has a large number of recurring cases each year. This is given the fact that TB is now easily preventable and curable. The lessons learned from India’s long struggle with what has now become the world’s most infectious disease killer should have highlighted the gaps in the existing infrastructure and the need for better distribution networks for healthcare. These learnings would have been very crucial especially in testing times like the one we are facing currently.

The inadequacy of the public healthcare system is aggravated by the fact that even access to these services has been highly imbalanced. Rural, hilly and remote areas of the country are underserved as compared to urban areas and cities. The SC/ST and poor people are particularly far away from modern health services.

Bobby firmly believes that health can be accessible to all only when India can find successful ways to mitigate this unequal access. To combat COVID-19 and all such future crisis, India needs to adopt an all-inclusive rights-based approach to healthcare where health is available first to the poorest of people who need it the most. Thailand presents an exemplary case of how this can be achieved. Thailand’s investment in the 30 Baht scheme and their decision to increase healthcare investment in smaller towns and villages while simply maintaining standards in bigger cities during the economic recession, has transformed the healthcare scenario in Thailand and has put them in a suitable position to offer universal health coverage in the present day.

According to Shobha Shukla, this rights-based approach translates to having a feminist approach to healthcare. Unlike a popular misconception, feminism is not matriarchy but is rather solidarity, power-sharing, and sensitivity. Shobha Shukla narrates her experience about how she has seen many women thrown out of their house because of TB. While women are considered as mere caregivers and hence neglected, by empowering them we can definitely further the cause of healthcare for all.

In conclusion, for India to adopt a rights-based approach where everyone receives equitable treatment and access to proper healthcare, the political agenda needs to take a back seat and a sustainable model needs to be implemented. COVID-19 has dissolved the boundaries between rich and poor, it has made us realize the need and importance of a healthcare system that is accessible to all. It has shone a light on the gaps that exist in the current healthcare system and the shortcomings in it.

While the full scale of policy responses to combat COVID-19 and its impact is still unclear, few things which India should learn from the experience are pretty clear. In the long term, India should aim for more investments in health infrastructure, ensuring continuity of regular health services, and improving its health distribution network to ensure equitable access of healthcare to all. Help should be provided to people present at the bottom of the pyramid based on need and not a privilege. India will also have to cautiously adjust its spending, attract industrial investments to spur growth, and address the rising unemployment. While India will have to remain in crisis mode for now, based on the current status of COVID-19 and the lessons from its early response few more important lessons can be learned, things which the Indian government should prioritize. It can also take a few measures to handle the current crisis effectively.

To start with India should harness the capacity of its budding private sector for laboratories, test kits, and supplies and increase its testing capacity. To supplement this, the government will also have to increase the density and capacity of testing sites and laboratories and improve the existing healthcare distribution network. It should also focus on helping the disadvantaged migrant workers who have suffered significantly in the current pandemic times. Policies for them should be formulated to make provision for affordable housing, emergency employment schemes, and access to social entitlements and service provisions. India should also focus on maintaining regular access to essential critical health services and the distribution of vaccines and preventive drugs. Both the central and state governments should look to expand strategic investments and partnerships with the private sector, development partners, and community health workers to strengthen surge capacity and ensure continuity of health provision.

In the short run, it should also ensure measures to implement enable effective social distancing and quarantine procedures. People should also understand their responsibilities and act accordingly. Lastly, the government should introduce and ensure national data privacy laws to improve India’s health emergency response and safeguard against data privacy concerns.

*Second-year student from IIM Ahmedabad

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