Isn't dominant economic thinking behind the crumbling public health infrastructure?

Public health infrastructure in shambles. 

Pic courtesy - Outlook India

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 (15^thFinance 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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Lockdown: Agriculture serves as the lifeline

When people across the country are confined to their homes the only pressing requirement they have is for food – and that too three times a day. Whether you are rich, sitting comfortably in your homes and trying out new recipes to prepare a fresh dish every other day or you are a poor migrant struggling to find a banana that you can still eat from the rotten heap lying on the banks of Yamuna river, food is after all a basic human necessity.

It is at this difficult time of a lockdown that the often repeated phrase -- agriculture is the mainstay of the Indian economy – not only becomes obvious, but is firmly established.

But imagine the chaos if the country didn't have enough food at these testing times? Imagine if we had followed the prescription of our mainline economists who had wanted food stocks limit to be reduced to feed only 20 per cent of our population? Imagine if we had dismantled the APMC mandis and done away with crop procurement as the industry had always wanted us to do? Even despite having a record foodgrain surplus – 77 million tonnes, at least three times more than the requirement -- still 96 per cent of the lakhs of migrants did not get their share of dry rations, says a study.

The avalanche of migrants heading back home after the lockdown was imposed, travelling on foot for hundreds of kilometres, without an assured supply of food, has provided a visual image to a monumental crisis that was building up for decades. The massive reverse migration, and subsequent efforts being made by the state governments to provide temporary shelter and food to those struck on the way, has brought forth another hidden dimension of the ongoing agrarian crisis. Urban centres had failed to ‘absorb’ the migrant workforce, maintaining a clear cut social distance from the migrants, and when the daily wage link was suddenly snapped the teeming work force felt abandoned.  

A majority of these migrant workers are unlikely to return soon. The fact that they took the hard decision to tread back home to be with their families, where they wouldn’t be at least facing hunger, speaks volumes of the flawed economic thinking which actually pushed people out of the rural areas to migrate into the cities because the cities needed cheap labour. With farm prices kept low to keep food inflation under control, and at the same time provide cheaper raw material to the industry, agriculture was deliberately kept impoverished. Despite being denied their rightful income, farmers continued to produce a surplus for the country year after year.

The lockdown coincided with the rabi harvest season. This year, despite unseasonal rains, production was expected to be bountiful. But with people asked to stay indoors, and with restaurants, hotels and dhabaspulling down the shutter, the demand for perishable vegetables and fruits collapsed. Reports of farmers re-ploughing fields of cabbage, cauliflower, raddish, peas and other vegetables poured in. Tomato farmers dumped the harvest in the crop fields. Premier products like strawberry had to be fed to cows. Button mushroom rotted. The demand for premier Alphonso mangoes, grapes, banana and even plantation crops like coffee, tea, cashew nuts and spices faced price crash. Poultry suffered the worst. Milk, fisheries and flowers were similarly badly hit.

Shortage of farm labour compounded the existing crisis. Even in case of wheat, where a record 106 million tonnes of grain is to be harvested, paucity of farm workers has hit harvesting operations. Although the government has for all practical purposes kept agriculture, horticulture, plantation crops, fisheries and animal husbandry out of the lockdown provisions from April 20, procurement of wheat is slowly picking up. But interestingly, while it is agriculture that suffered a severe blow during lockdown 1.0, the impression being generated is that the rural areas are relatively better off.

This crisis apart, the bigger question is whether the pandemic will change the way we look at agriculture? Whether agriculture will receive priority in public policy? Or once the fire-fighting operations are over, it will be back to square one. While the State’s role in health and education is expected to expand, will agriculture also emerge on the top of dominant economic thinking? Will a relook at agriculture bring back the focus on making agriculture economically viable? These are questions that need to be seriously deliberated because the policy changes after Covid-19 will determine the future of agriculture.

Corona virus pandemic therefore has come as a loud knock at a time when the dominant economic policies were aimed at propping up the industrial sector. Over the past few decades, agriculture had been systematically ignored in policy planning. The best reflection for this perhaps comes from the declining public sector investments in agriculture. Between 2011-12 and 2017-18, public sector investments in agriculture hovered between 0.3 to 0.4 per cent of the GDP for a sector which employs 50 per cent of the total workforce. It is futile to expect a miracle in agriculture without providing adequate investments commiserating with the population involved.

With agriculture emerging as the strong pillar of the economy at these difficult times, it should be abundantly clear that any further effort to marginalise farming will be politically suicidal. While agriculture will need a total revamp, and with huge investments the challenge will be to provide farmers with a remunerative price and being assured a monthly income. At the cost of repeating again, an OECD study had shown Indian farmers lost Rs 45-lakh crore between 2000 and 2016-17 by being denied their rightful income. Imagine if Rs 45-lakh crore (or Rs 2.6 lakh crore every year) was paid to farmers, there would have been hardly any possibility of farmers abandoning agriculture and migrating to the cities. Post Covid-19, let’s aim at Sabka Saath Sabka Vikas and Sabka Vishwas.

This is not a wishful thinking. It is an idea whose time has come. #

Saved by Plough. Orissa Post. April 18, 2020
https://www.orissapost.com/saved-by-the-plough/ 

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When billionaires are willing to sacrifice human beings for the sake of economy ..

As coronavirus spreads, the rich are buying lavish bunkers to escape the virus. This one in Germany is spread over 76 acres. 

Pic reproduced from -- Los Angeles Times  

Let’s be very clear. As Robert Reich, a professor of economics at the University of California at Berkeley and the ex-Secretary of Labour in former US President Bill Clinton’s first term put it: “The problem is the virus, not the economy.” Prime Minister Narendra Modi too echoed this when he told G-20 leaders to put human beings first, and then look at economic targets.

But as the world grapples to contain the spread of the deadly coronavirus pandemic, the voice to sacrifice people – especially grand-parents – for the sake of the economy, is growing. In an interview with Fox News, Texas Lt Governor Dan Patrick, said that grandparents should be willing to die for the sake of America’s economy, and for the sake of younger generation. He said people should be smart to survive, but wanted people to return to work. However, at no stage in the course of his interview did he say that he being a grandfather himself, with six grand children, is willing to sacrifice his life. Obviously he thinks he is smart enough. And of course we know the ultra-rich as a class are smart to always maintain a physical distance from the rest of the society. Sales of bunkers with special air-filtration systems, escape tunnels and assured food supplies for one year are going up.      

And if you think Dan Patrick is alone in carrying such repugnant views, just hold on. US billionaire Tom Golisano told the news agency Bloomberg: “The damages of keeping the economy closed as it is could be worse than losing a few more people.” At a time when number of people testing positive is increasing in a geometric proportion, crossing 82,000 in the US (as on Mar 27 morning), and the number of those succumbing to the virus are steadily growing, billionaires are instead busy raising concern over dwindling profits and therefore the urgent need to restart the businesses. With nearly half the global population under a virtual house arrest, with industries having pulled down shutters, and with international and domestic travel at a standstill, the Wall Street Journal in an editorial Rethinking the Coronavirus Shutdown wrote: “no society can safeguard public health for long at the cost of its economic health.”      

If you’re still not shocked, take a look at what columnist Thomas Friedman wrote in New York Times: “Let many of us get the coronavirus, recover and get back to work – while doing our utmost to protect those most vulnerable to being killed by it.” As if human lives don’t matter, and the death rate from Coronavirus infection is nothing more than a set of statistics, like the way policy makers view farmer suicides in India, another advocate of ‘choose the economy’ refrain, another US billionaire, Dick Kovacevich, was quoted as saying: “We’ll gradually bring those people back and see what happens. Some of them will get sick, some may even die, I don’t know.”

The US President Donald Trump tweeted on Sunday: “We cannot let the cure be worse than the problem itself. At the end of the 15 day period, we will make a decision as to which way we want to go.” This was before the infection rate zoomed in America. Far away in Brazil, the far-right President Jair Bolsonaro calls the coronavirus outbreak as a ‘little flu” and thinks the media is ‘tricking’ people of the severity of the crisis primarily to topple his government. He is not in favour of a lockdown in his country.

With such insensitive responses pouring in from the rich and mighty if you are wondering what kind of a 

society we are living in, where economics takes precedence over what might turn out to be gravest of human tragedies, let me tell you it has historically been more or less like this. When the British government asked the then Viceroy of India, Lord Wavell, to explain the reasons behind millions of people (3 to 4 million) who perished in the Bengal Famine in 1943, the Viceroy wrote back saying that these poverty-stricken people in any case would have died. As we all know, Nobel laureate Amartya Sen’s seminal work later had shown that there was no shortfall in food production in 1943 and the resulting famine was the outcome of British government’s deliberate policy of diverting food elsewhere. But instead of accepting the blame for depriving the poor of food, Winston Churchill is reported to have shifted the blame for the famine to poor Indians, saying they were "breeding like rabbits." Much earlier, at the time of the Irish Famine between 1845 and 1849, during which time an estimated one million people died of starvation and another one million migrated, the deaths from starvation were perhaps nothing more than a collateral damage. 

At the 150^thcommemoration of the Irish Famine at Cork in Ireland, I vividly recall the mayor of the city in his opening remarks saying what kind of society existed in Ireland at that time when people were dying of hunger from the failure of the staple potato crop, devastated by potato blight disease, the Colonial masters were busy loading ships with corn to be carried to Britain. From the starvation deaths to the pandemics – including the Spanish Flu in 1918 which killed roughly 20 to 25 million people – many political economists view it as a subjugation of the ordinary people by a small section of the elite.

At these pressing times, Robert Reich finds it ‘morally reprehensible’ on how corporations are exploiting the crisis. The US Senator Bernie Sanders said “When we say it’s time to provide health care to our people, we’re told we can’t afford it.” But when the stock markets feel jittery, there is no shortage of money. Out from the hat the US government pulls out $1.5 trillion to calm investor’s worries. This is true globally. Hopefully, when everything calms down, the world may see a behavioural change as well as encounter a dramatic change in economic thinking.

Nevertheless, saner voices dominate. The global response to combating the pandemic is on right track -- limiting the spread. India’s response with a nationwide three-week lockdown is a step ahead of the international curve, and rightly so. After all, if you survive the crisis you can always rebuild the economy. #

In America, economy first. The Tribune. April 1, 2020

https://www.tribuneindia.com/news/comment/in-america-economy-first-63839?fbclid=IwAR0lBeOCa4dEoXVRrAfsrop_P_ZjBHxTNZyeA3fHoaXkJm-PvESeRRQhcPU

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No need to panic; India has enough food stocks to tide over Corona Virus crisis

People throng to malls in panic to stock essential items in wake of coronavirus outbreak. 

Pic: socialnews.xyz

As European Union sealed its borders in a desperate attempt to put the brakes on the ferocious spread of the corona virus pandemic, a young Indian student returning from Italy recounted how the battle for a loaf of bread has intensified in a country which is perhaps the worst hit by the spread of the deadly virus. An Indian NRI couple returning to America a few days ago, after spending two months of holidays in India, were shocked to find that the price of wheat atta they usually would buy for $ 10 a bag has now skyrocketed to $ 90.

As hordes of worried shoppers have been stockpiling supplies of food, toilet paper and other groceries day after day amidst corona virus scare in America, the US President Donald Trump had to step in to assure people that there is no shortage of food supplies and urged them to resist from panic buying. 

In India, while Prime Minister Narendra Modi has urged the people not to resort to panic buying the Supreme Court directs all states to ensure that the disbursement of nutritional food to children and lactating mother is not affected as a result of the closure of schools, Kerala has launched a programme for delivering mid-day ration to school children at their homes. Meanwhile, reports of consumers stocking food and other essential items in panic have poured in from across the country. With Punjab closing down the weekly vegetable market called Apni mandi, and with some experts pointing to community transmission of corona virus expected to happen, which means self-quarantine will become the norm in the days to come, the scramble for buying and storing essential food commodities has only heightened. My own neighbours have already stocked their monthly household requirement of wheat atta, rice, sugar, edible oil, onion and potato.

Although there is no shortage of food globally as well as nationally, panic buying of food items at a time of crisis is nothing unusual. As far as wheat, rice, sugar and pulses are concerned, there are enough stocks available within the country. In fact, for wheat and rice, the godowns are already overflowing with the surplus over the required emergency buffer being several times more. Against the requirement of 214 lakh-tonnes of wheat and rice at the beginning of the year on Jan 1, 2020, Food Corporation of India (FCI) had 565.11-lakh tonnes, which means roughly two and a half times more than the essential requirement for public distribution. With the new wheat arrivals expected from the first week of April, India has certainly nothing to worry on the foodgrain front. In addition, India already has a buffer stock of 30-lakh tonnes of sugar, which the government is planning to raise to 40-lakh tonnes this fiscal. In the cases of pulses, the Ministry of Food and Consumer Affairs has been trying since December to offload 8.47-lakh tonnes from its buffer stock of pulses.

The abundance of food stocks within the country at a time when national borders are closing for movement of people and also expected to hit international trade is certainly a big sigh of relief. This reminds me of the global food crisis in 2007 when food prices had soared globally, and food riots had erupted in 37 countries, including countries like Egypt. While people went hungry, food companies had raked in huge profits with the food commodity prices soaring in the Chicago Mercantile Exchange, the world’s biggest commodity trading market. The UN Human Rights Council had attributed commodity futures trading to be the primary reason behind the global food crisis. Nearly 75 per cent of the blame for the unprecedented rise in food prices was directly linked to the exploitative commodity prices that prevailed.

India had escaped the global food crisis primarily because it had enough food stocks and also it had not linked its agriculture to the international futures market.

With public memory being short, the corona virus pandemic has perhaps come knocking at the right time. For past several years, mainline economists and policy makers have been seeking the reversal of the food procurement system that is primarily responsible for building the food reserves so essential for ensuring household food security. With all eyes on dismantling the network of regulated mandis under the Agricultural Produce Market Committee (APMC) Act, the government is keen to gradually withdraw from the open-ended procurement of wheat and rice. The Prime Minister Office has already written a letter to the Punjab government asking why the open-ended procurement under which whatever quantity of wheat and rice farmers bring to the mandis the government is under obligation to procure at the Minimum Support Price (MSP), is not curtailed.

The basic objective being to liberalise the agricultural markets which, in turn means not learning enough from what led to the global food crisis. Any tinkering with the food procurement system built so assiduously over the years is certainly fraught with unforeseen dangers. More so in a country which has the worst child mortality in the world, with over 8.80-lakh children succumbing to malnutrition and related ailments every year, termed by the UNICEF as – burden of death – clearly shows the problem is not with surplus food the country has but with its (mis)management. More so, at a time when the country ranks 102 among 117 countries in the Global Hunger Index.

Therefore, the policy makers need to listen again and again to what Dr M S Swaminathan had once said: “Future belongs to nations with grains and not guns.”India cannot afford to go back to the days of ‘ship-to-mouth’ existence when food would come directly from the ships to feed the hungry. #

India has enough food stocks to tide over CoronaVirus crisis. Deccan Herald. Mar 20, 2020

https://www.deccanherald.com/opinion/panorama/india-has-enough-food-stocks-to-tide-over-coronavirus-crisis-815502.html 

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