In an era dominated by information technology and the razzmatazz of a freewheeling existence, the health sector was considered pretty much passé. Now we know better.
With COVID-19 looming large over the country’s hapless denizens, the wisdom of investing a mere 1.15 percent of GDP in public health expenditure could come back to haunt the republic. The level of destruction that the coronavirus is going to inflict on India is still unclear, but suffice it is to say that real danger looms ahead. The record in public policy does not encourage optimism, and the government has reacted too slowly to the dangers inherent in the pandemic. To be sure, so has the rest of the world, including the USA, but each country’s case is different. If the Indian Council of Medical Research’s (ICMR) COVID-19 testing is any indication, there is a lot of ground that needs to be covered. On the basis of about 15,000 to 17,000 tests this week, the Council has concluded that community transmission has not occurred! The sample size is tiny, given the country’s huge population, and it will not take us too long to figure out whether it has reached the community transmission stage; if it has, then good luck to all of us.
That India’s healthcare system is appalling, despite the undiluted commitment of its frontline and overworked medical staff battling all odds, is hardly saying anything new. What may appear to be shocking is that in the wake of the Wuhan outbreak, the government failed to sufficiently invest in COVID testing kits and protective gear for medical personnel. There was ample time to do so, but somehow the government lost an opportunity. Prime Minister Narendra Modi has sounded the alarm bugle and as the Sunday evening utensil-beating revealed, the people have become alive to the imminent danger that the pandemic poses. However, there is ample evidence that tells us that India’s carefree society is entirely capable of thumbing its nose at what the world considers standard health practices. The tamashas on Sunday evening – from Kolkata to Mumbai – demonstrated that the more things change, the more they remain the same. Add to it factors that can welcome the coronavirus pandemic with open arms: Huge city slums with poor or no sanitation, a vast semi-literate population and the world’s largest incidence of malnutrition. Put together, it is a deadly, unbeatable combination.
An opportunity to cleanse the system
Having said it, this is also India’s grand opportunity to cleanse the system. The Modi government, aware of the pitfalls, needs to move. It is time to ramp up India’s public health expenditure by doubling spending to 2.5 percent of GDP. By global standards, it is still small, but it is at least a start. Comparisons are odious, but compare we must, especially in times of crisis. In 2017, the US spent 17 percent of its GDP on health consumption, whereas the next highest comparable country, Switzerland, devoted 12 percent of its GDP on health. Health spending per person in the US was $10,224 in 2017, which was 28 percent higher than Switzerland, the next highest per capita spender, according to OECD figures. Even Nepal spends 6.29 percent. India rightly aspires to be a global power, but if those lofty standards are to be applied on the ground here, she needs massive capacity building in the health sector. What is needed is more hospitals, doctors, primary healthcare, emergency facilities, diagnostic equipment, protective gear, and medical and nursing schools.
Other indicators, too, are far from heartening. India has just 0.5 hospital beds for every 1,000 people living when the World Health Organisation (WHO) recommends at least five. India averages 0.8 doctors for every 1,000 citizens; even Italy, which has been badly hit by the coronavirus outbreak, has five times as many doctors per capita.
There is also the dire need for a change in the relationship between patients and the medical staff. In situations like the coronavirus pandemic, caregivers and care seekers need to not just cooperate fully but also do so gently.
There is ample reason to fear that if the coronavirus disperses rapidly through a country as densely populated as India — it may already have done so — it could overwhelm the country’s medical infrastructure.
Yet, what counts in India’s favour is the country’s innate resilience, particularly when confronted with a crisis. Some compelling examples from the past suggest that the country has an ability to mitigate dire health challenges even though it displays a lax attitude toward addressing routine public health needs.
Innate resilience
When the HIV crisis hit the world in the late 1980s, pundits predicted the virus would severely impact India. Yet the National AIDS Control Organisation managed to prevent a national epidemic, with infection rates showing a substantial drop in the late 1990s after an initial spike. Two things happened: One, the government provided free antiretroviral drugs to the afflicted population. Two, it also made significant outreach efforts to vulnerable sections of the population. India’s relative success in reducing new infections showed that it was able to adopt a crisis plan despite its archaic laws and below-par health care system. Then, in 1994, there was an outbreak of the pneumonic plague in Gujarat’s Surat. After a somewhat sluggish response, the government managed to control the plague before it assumed epidemic proportions. Surat’s officials improved trash collection and street cleaning, and put in place strict standards of hygiene in restaurants. Then again, recently when confronted with the deadly Nipah virus, for which there is no known cure, Indian health authorities acted promptly. They sent a virus sample for testing to the National Institute of Virology in Pune. They also waived the costs of the tests and promptly imported anti-viral drugs from Australia. The National Centre for Disease Control coordinated efforts with local, state, and national health authorities, eventually containing a potentially deadlier outbreak.
Prime Minister Modi is aware that routine access to health care for the vast majority of India’s citizenry remains abysmal. A mere 44 percent of the population has some form of health insurance. Hence the government’s ambitious Ayushman Bharat Programme, but it is going to take some more time for it to iron out its teething troubles. While the poor suffer, the country’s rich can afford elite hospitals that are often world-class. Little surprise then that India is now a hub of global medical tourism.
Ranjit Bhushan is an independent journalist and former Nehru Fellow at Jamia Millia University. In a career spanning more than three decades, he has worked with Outlook, The Times of India, The Indian Express, the Press Trust of India, Associated Press, Financial Chronicle, and DNA.
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