Coronavirus should force India to shore up rickety public health system
As the days go by and the number of COVID-19 cases go up, the cracks are already beginning to show in the rickety Indian healthcare system – suspected patients are being asked to remain in isolation wards that have no basic facilities, checking at airports and public transport terminals are inconsistent at best and chaotic at worst.
The raging coronavirus pandemic sooner or later, hopefully sooner, will come under control but it has exposed the woeful healthcare infrastructure India has built for itself. At this stage, the pandemic has not risen exponentially, going by official statistics but there is palpable fear, dread and a growing sense of panic that it might swamp this vast nation.
Apologists might argue that even developed countries like the United States, China and those in advanced Western Europe with their superior healthcare systems have not been spared by the C-virus, why should it be different in India.
They miss the point that despite advanced healthcare facilities if the developed nations are finding it strenuous to cope with the pandemic, what would be the situation in India if it sees a similar upsurge in COVID-19.
As the days go by and the number of COVID-19 cases go up, the cracks are already beginning to show in the rickety Indian healthcare system – suspected patients are being asked to remain in isolation wards that have no basic facilities, checking at airports and public transport terminals are inconsistent at best and chaotic at worst.
Media is replete with reports of how suspects told to be in quarantine are walking into a crowd, mixing with healthy population and then turning up at hospitals testing positive.
Except for Kerala, where from the beginning, there has been a semblance of professionalism in keeping the situation under control, the rest of the country has woefully fallen below expectation other than partial lockdowns and loads of advisories to people on how to conduct themselves.
The coronavirus, in short, has exposed years of healthcare neglect by the Indian establishment.
Governments right from Independence have never given the importance due to healthcare, and there have been Congress, the various factions of the Janata Dal besides the BJP which is currently in power.
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None has done anything of note to improve healthcare, notwithstanding reams of promises in political manifestos and gaseous loads of rhetoric in public platforms.
In November 2019, the Union Ministry of Health and Family Welfare released the National health profile where it conceded that the expenditure on health as a percentage of GDP was just 1.17 percent, lower than even what the poorest countries in the world spend, which is around 1.57 percent.
And, the situation in 2025? The spending on health will go up to 2.5 per cent, when the average for the rest of the world is expected to be six percent.
Overall, public expenditure in India (which includes health) is only about 13 per cent of its GDP while in comparison a country like France spends a whopping 57 per cent.
To begin with, the budget on healthcare is abysmally minimal. To make it worse, the holes in the Indian system (like corruption and mismanagement) leak even the little that is meant for healthcare.
The coronavirus is gender, race, religion, economic status agnostic making one human being as vulnerable as the other, be it a top government minister or a high-ranking global business leader.
But, in the normal course, especially in India, it is the poor who suffer the adverse side-effects of a largely dysfunctional public healthcare system. The tragedy in a Gorakhpur government hospital that witnessed the deaths of around 60 children in 2017 due to want of oxygen cylinders should have been enough for any government to act to prevent a similar recurrence.
Instead, doctor Kafeel Khan who heroically tried to get emergency oxygen was later hounded by the government.
Or, for that matter, the deaths of more than 100 children of encephalitis in Bihar’s Muzaffarpur in June last year. According to reports, the statistics of mother-child nutrition in Bihar is worse than at least 43 African countries. The government hospitals where the children were brought to were found woefully inadequate to treat the hapless children.
More recently, in January this year, at a government hospital in Kota, Rajasthan, some 109 children died due to poor infrastructure that included lack of medical personnel and unhygienic conditions.
These are but the proverbial tip of India’s ailing health iceberg.
When the news of each incident goes public, there is an outcry followed by a charade of mutual blame and soon they are ‘out of sight, out of mind’.
For the Indian poor, their reality is a constant coronavirus that accompanies them all their lives. The financially endowed middle-classes and the elite are insulated from the shenanigans of government hospitals and the gaping hole in rural healthcare.
Since the early 1990’s the private sector has taken care of their needs effectively relegating the government’s healthcare systems to the netherworld. As a colloquial Kannada saying in English wryly goes, “there are no askers, no tellers”.
The elite and the political class mostly don’t depend on India’s private sector hospitals.
For this class, the world is their oyster. Politicians of all hues – left, right and centre – routinely rush to New York, London or Singapore when their health is down.
The nationalist BJP’s top politicians, exuding patriotism, are no exception. After advising their followers to make do with “goumutra” (cow urine) and cow dung, the leaders visit top allopathic hospitals in all parts of the globe to luxuriate in the world of Western medicine.
Coronavirus has turned everything on its head. With international borders shut and travel abroad risky, it is the desi dilapidated public health system that the elite and the middle-class have to now depend on to control virus.
Having never had any reason to cast even a glance at the pathetic conditions of the government hospitals, some of them have to now experience what it means to be in a stinky isolation ward with inadequate water and dirty bathrooms.
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The private sector has played but a minimal role, if at all, in handling the pandemic, so even that consolation is not available.
Hopefully, COVID-19 by the time it loosens its hold would have knocked enough sense into civil society and the ruling class that a nation that neglects its public health infrastructure can be brought to its knees in no time. If a change in the establishment’s heart does occur, the poor may well end up having to thank the malevolent coronavirus.
