Public health infrastructure in shambles.
In a government hospital in Meerut in Uttar Pradesh, an Indian Express report says many patients bring their own folding cots; many other lie on the floor on bed sheets. And such are the deplorable conditions in the two government hospitals in Patna; a report in ThePrint says patients are reluctant to get admitted to these hospitals. They prefer to be treated at home, and gods forbid, are even willing to die at home.
In a way, both these reports sum up the crumbling health of the rural healthcare infrastructure. The two reports also provide a glimpse of the enormity of the crisis at hand given the deep and worrisome inroads the virus is making into the rural areas. The more you travel in the interior, the more you realise how a decrepit rural healthcare infra is itself gasping for breath. If only India had a robust health infrastructure in the rural areas, tackling the pandemic would have been relatively much easy. To give you an idea of the deplorable conditions, in an Assembly constituency in Abohar district in Punjab, only one hospital caters to 68 villages. This hospital has no oxygen beds. Imagine the situation elsewhere in the country.
In fact, before the second wave hit the urban areas with a deadly ferocity, much of the public rural health infrastructure was already in ruins. We ignored it because it didn’t affect us. Several studies have meanwhile shown how a rural family, when one of its members falls ill, easily slips below the poverty line. They often have to take loans to repay the medical bills and that pushes them still deeper into indebtedness.With nearly 74 per cent of the population in rural areas banking on the private sector for medical treatment, health care has gone dreadfully beyond the means of the poor, adding on to the huge economic distress the rural population is already reeling under.
As city hospitals run out of oxygen, medicines and beds amidst a deadly surge of the disease, with harried friends and relatives appealing desperately for help on the social media, there is a belated realisation that the public health infrastructure in the cities is at the brink of a collapse. Most hospitals had run out of beds, and disturbing visuals of many patients being taken by their relatives from one hospital to another to get admission, has certainly shaken up the urban middle class. The tragedy is lit large, with many families in the cities having lost a near and dear. Open your Facebook timeline, and you are sure to be confronted with pictures as well as tributes being offered to a number of family friends and other acquaintances who have succumbed to the virulent disease. Unlike the pandemic last year, when death figures were only a number, the second wave has provided a face to these casualties.
People now realise that many lives could have been saved if timely medical help, including hospital admission, was possible. Lack of adequate health infrastructure therefore is being rightly blamed for the rise in death numbers. But let’s be very clear. Before we blame the system, isn’t it a fact that we remained a mute spectator when the public health infra was being privatised? Didn’t we fail to question the mainline economists and media when the policy thrust was on drastically cutting the public sector investments in health, education and agriculture to reduce the budgetary fiscal deficit? We kept quiet because somewhere at the back of our mind we thought Mujhe Kya (how does it affect me). As long as you could afford the private hospitals you thought you had nothing to worry.
I am not sure whether the death dance we witness all around will wake us up from deep slumber. But as someone wrote on Twitter: “Can’t even say Covid-19 caught us with pants down, it came by invitation ... after the pants were sold in a Fire Sale. “ He was referring to a Down to Earth (Aug 15, 2017) report titled: ‘Government hospitals on sale’ which clearly stated how the government was handing over public health infra in cities, town and villages to the private sector. Niti Aayog had then suggested privatisation of the district hospitals on public private partnership (PPP) mode. And don’t forget, how many corporate big wigs, media personalities and even policy makers had applauded when medical tourism by top private hospitals was being encouraged. Even prior to that, some well-known economists had been calling for a cut in social sector investments to keep the fiscal deficit within limits. In fact, every budget discussion in Parliament had kept its eyes on the fiscal deficit.
Last year, in 2020, Niti Aayog had again come out with a 250-page policy document: ‘Schemes to link new and/or existing private medical colleges with functional district hospitals through PPP’. It spelled out a roadmap on how to privatise the public sector health infrastructure drawing from the ‘best practices’ abroad. Again, except for a few health activists questioning the move, everyone had kept quiet.
That’s the problem. Our mainline economists are always quick to cut paste the ‘best practices’ from western countries. Without trying to find out firsthand what the real needs of the country are, they find it easy to look abroad. I wonder how could they escape seeing the public sector National Health Service (NHS) of UK, which is rated among the most efficient in the world. Anyway, the privatisation thrust gels very well with the dominant economic thinking that calls for cutting down on social sector spending – including health, education, food and agriculture. If there is less money available for public health, how can we expect a robust health infrastructure to be built? Just because the World Bank/IMF have advocated for stiff austerity measures, and the FRBM Act had set an upper limit of a stringent 3 per cent fiscal deficit to be achieved by 2021, does it mean that we have to blindly follow what international bodies tell us? Why do we have to go by the dictates of the credit rating agencies, which as well know rank countries on the direction they follow towards privatisation, in other words encourage privatisation of profits and socialisation of costs.
Sadly, successive governments continued to follow the prescriptions to cut down fiscal deficit. They neglected the health sector.
In a country where the public sector investments in health is too low at present, only 1.20 per cent of the GDP (15thFinance Commission has promises, and that too in the midst of pandemic last year, to raise it to 2.5 per cent by 2024,) I thought mainline economist would demand a substantial increase in public health spending. They in fact called for reduction in public expenditure on health and education (and also food). After all, if after the reports submitted by 14 of the successive Finance Commissions, public sector investments in health is around 1 per cent of GDP, isn’t it time to point to the flawed economic rationale behind it? The question that also needs to be asked is how has China been able to invest 5 per cent of its GDP on public health? How have the other emerging economies, Brazil and South Africa, invested 9.2 per cent and 8.1 per cent of their GDP on public health, respectively?
The second wave has exposed the chinks. This call for a larger public debate on what kind of economic policies are best suited for a country like India. Hope the catastrophic second wave will make us rethink, force policy makers to take a re-look at the economic policies that are required to meet the challenges of an Atmanirbhar Bharat. #
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