Public Health Sector: Where is the Central government?

Given the rising cases and deaths due to the Coronavirus outbreak, it is now clear that the world’s largest democracy is in contest with the world’s so called greatest democracy. If the graph continues to rise as it does today, estimates are that India will take over the United States by October.

The pandemic has lay bare our nations’ deeply problematic approach towards public health. According to the latest National Health Profile (NHP), India spends a little over 1 per cent of its GDP on public health despite an increase in health expenditure. India spent only 1.28 per cent of its GDP (2017-18) as public expenditure on health. The figure was 1.02 per cent of the GDP in 2016-17.

Developed nations spend far higher: the US (16.9%), Germany (11.2%), France (11.2%) and Japan (10.9%). India spends the least among BRICS countries: Brazil (9.2%), South Africa (8.1%), Russia (5.3%), and China (5%). This was not always the case. In the First Five-Year Plan, 3.4% of the total plan investment was for health outlays. This rose to 6.5% by the Eleventh Five-Year Plan.

Then came the age of neo-liberalism when the government pursued infrastructure growth and foreign investment. It led to defocusing public health and education with the belief that since these are essentials, the states will be able to manage them. That did not happen. The private sector stepped in and we compromised our core human development indices.

By not delivering effective health care to 80 crore people or two-thirds of our nation on the public distribution system, our public health care system has pushed them towards the private system which is unaffordable. Thus the nation health system abandons them.

Bureaucrats opine that the greatest fallout of such flawed policies is the trust deficit in the national public health care system. Even if we were to rebuild it now, it would take us over half a century to regain what we lost in the past quarter century.

The Coronavirus outbreak gives us an opportunity to leap across the huge trust deficit. It can still start with the government owning up every COVID-19 case, right from testing to treatment. It was good that finally the Supreme Court stepped into capping the price of tests. It did leave the private testing laboratories at a disadvantage but those costs are for the government to pay. In fact, all testing should be free and the government should pay for them.

Australia has recently discovered a much shorter 20 minute COVID-19 test. The test can be conducted at any laboratory. A quicker test and results would mean early treatment, avoidance of hospitalization, reduced morbidity. Has the Central government even approached the Australian government for the technology?

The Central government announced a PM Cares Fund. By mid-May it had collected around Rs 10,000 from corporates. Where is that money? What is it being used for? The Centre announced the nation will get 50,000 Ventilators by July 1. They have still not arrived. Where are the Ventilators?

It is the same for treatment. The Punjab government deserves appreciation for capping the per day price of treatment in private hospitals. When Kerala, TamilNadu, Maharashtra tried to cap the rates there was resistance from the private health sector. Punjab managed to find a balance.

The fervent hope is that in all states the governments and private sector will arrive at a consensus on rates. Wherever the private sector feels short-charged, the government will step in and support. Our appeal is to go further and make treatment free in all hospitals public or private.

Why is the centre not initiating this exercise? The fact is that the Central government’s approach to the whole Coronavirus crises has been flawed and extremely inadequate to what is needed on the ground.

Recently a frontline contractual doctor died from COVID-19 and the government merely declared since he was on contract, he does not get benefits. This sends a extremely disturbing signal to the medical fraternity, many of whom are contractual. At this point the nation needs all hands and cannot afford to discriminate.

On a positive note: recently, moving beyond his brief, a Member of Parliament from Rural Bengaluru led from the front and participated in the cremation efforts of a COVID-19 patient. These are the examples that our representatives should establish and signal to the nation that we stand together against the pandemic. Coronavirus is a catastrophe but also an opportunity, provided the government has a will.