IMA lists 382 doctors who died due to COVID-19. That is a grossly understated number

On September 25, Union Health Minister, Harsh Vardhan told Parliament that the government did not have complete data on the number of healthcare staff, including doctors, nurses, support staff and government-accredited social health activists or ASHA workers, who had passed away due to the raging pandemic, now into its seventh month.

His deputy Ashwini Choubey cited health being a state subject and outside the ambit of the central government, for non-availability of this crucial piece of data.

The IMA list

In response, an angry Indian Medical Association (IMA) issued a list of 382 doctors who have perished due to COVID-19. It slammed the Centre, saying its admission amounts to “abdication of duty and abandonment of the national heroes who have stood up for our people”.

COVID-19 has claimed the lives of more doctors and health workers in India than anywhere else in the world. Sadly, despite paying lip service and singing hosanas for the country’s COVID warriors, the government has no numbers of the medics who have laid down their lives in the line of duty.

There is barely an acknowledgement for the yeoman services rendered by an embattled health services fraternity during the biggest pandemic of the last 100 years.

In its list, 63 doctors come from Tamil Nadu alone, the IMA said. “No nation has lost as many doctors and healthcare workers like India. Doctors suffer four times the mortality of ordinary citizens and private practitioners suffer eight times mortality on the same scale,” the IMA said, adding that “To feign that this information doesn’t merit the attention of the nation is abominable.”

Preliminary investigations, however, reveal that even this IMA figure is vastly underrated. This list of 382 includes only those medics who have perished in designated COVID hospitals. There is no inventory of casualties of doctors, health volunteers, nurses and ASHA workers in other medical facilities throughout the length and breadth of the land.

Consider this snapshot:

**This IMA list does not include the six Central Government Health Scheme (CGHS) doctors who have died in Delhi alone.

** A government report in August-end said that more than 87,000 healthcare workers have been infected with Covid-19, with just six states – Maharashtra, Karnataka, Tamil Nadu, Delhi, West Bengal and Gujarat, accounting for 86 percent of the 573 deaths due to COVID infection.

**The central government has admitted in Parliament that the kin of 155 healthcare staff, including 64 doctors, had sought relief under the PM Garib Kalyan Insurance Package, which provides help in case of death of healthcare providers.

**Kin of 32 nurses, 14 ASHA workers and 45 others, presumably drivers and cremation staff, also applied for insurance, the Health Minister admitted.

** UP accounts for maximum deaths of eight doctors. In addition, there were six nurses in Gujarat and three ASHA workers in Telangana on this casualty list, while Maharashtra accounted for half of the 45 dead in the `others’ category, Harsh Vardhan said.

Points out Ramanan Laxminarayan, economist and epidemiologist, who is founder and director of the Center for Disease Dynamics, Economics & Policy in Washington D.C: ``Given that India’s system for recording deaths is weak and that many people who have likely died of Covid-19, but without a COVID test are not counted as such, there is likely to be an undercount regardless of profession. In other countries, the proportion of deaths in medical personnel has been in the order of 2 percent, which is high. By that metric, one would expect more than 1,000 deaths in medical providers. This includes doctors, but also nurses and other medical staff.”

Root of the problem

He is right. A significant part of this apathy towards health workers, including doctors, stems from the fact that India’s investment in public health is one of the lowest in the world. The total per capita government spending on healthcare has nearly doubled from Rs 1,008 per person in FY15 to Rs 1,944 in FY20. The total expenditure by the Centre and states for FY20 was Rs 2.6 lakh crore, or 1.29 percent of GDP, including establishment expenditure comprising salaries, gross budgetary support to various institutions and hospitals and transfers to states under centrally sponsored schemes such as Ayushman Bharat. Of the total public expenditure, the Centre’s share is 25 percent. Over the last five years, the total public expenditure on health has risen at 15 percent compound annual growth rate (CAGR), much of this due to pay hikes.

India’s total healthcare spending (out-of-pocket and public), at 3.6 percent of GDP, as per the Organization for Economic Cooperation and Development (OECD), is a study in contrast, not a comparison, with some of the developed and developing countries. The average for OECD countries in 2018 was 8.8 percent of GDP. Developed nations—the US (16.9 percent), Germany (11.2 percent), France (11.2 percent) and Japan (10.9 percent)—spend even more.

India spends the least among BRICS countries: Brazil spends the most (9.2 percent), followed by South Africa (8.1 percent), Russia (5.3 percent), China (5 percent).

Healthcare professionals say this lack of funding has led to shortages in personal protective equipment (PPE) and other anti-COVID gear, leaving health volunteers, including doctors, vulnerable to infection, which in turn has led to so many deaths.

Pre-COVID-19, there was already a shortage of 600,000 doctors and two million nurses in India, and healthcare professionals have been working for several months without a break. An insurance scheme set up for the families of the deceased has been hit by bureaucratic red tape, while healthcare professionals across India have held regular strikes over unpaid wages.

Far from being compensated, doctors and nurses in many parts of the country — like some working to fight Corona in Mumbai’s civic body run-hospitals ----- have taken 30-50 percent pay cuts, while the government adjusts expenditure against failing revenue. Jarmansingh Padvi, president of Maharashtra Association of Gazetted Medical Officers has lodged an official protest against this policy. In Kolkata, 500 nurses from Manipur walked out of their hospitals when they were forced to work without salaries.

Shocking state of affairs

The case of ASHA volunteers reveals how deep the rot runs. Among the million-strong army of women health workers on COVID-19 frontline duties, their jobs scarcely get a mention. Despite no formal training to spot signs of the infection, no provision of safety gear, including masks and hand sanitisers, and a stipend of Rs 1,000 for conducting surveys to be used by the Union health ministry to gauge the pandemic situation, the band of volunteers carry on stoically.

Between April and June, at least five ASHA community health workers died in Bihar along with two auxiliary mid-wives’ workers, according to a report by the state’s health department.

In March this year, more than 15 ASHA workers passed away without their families receiving any ex-gratia allowance from the government, AR Sindhu, general secretary of the All India Federation of the Aanganwadi workers (nutrition providers) and helpers, told journalists in an interview this month.

Unsurprisingly, ASHA workers are demanding higher remuneration and compensation for the backbreaking work they do. Sadly, all of it has fallen on deaf ears. In March, the government introduced a welfare scheme, which provided COVID-19-related death insurance to health care workers. However, the scheme did not include ASHA members because they are termed peace-rated workers, said Sindhu. ASHA workers in many states recently staged a protest demanding safety and health for all.

Clearly, all the drum beating about health services is just another gig. Little surprise then that of the health minister’s statement laid on the floor of Parliament this week, the reference to the `good work’ by doctors occurs only on its 19th paragraph.

Ranjit Bhushan is a senior journalist based in Delhi.