Overcoming structural constraints – analysis
In the course of history, bacteria and viruses have played a crucial role in changing the course of events, and have contributed significantly to the rise and fall of civilizations. This is not the first time that humanity has been threatened by an invisible enemy; From Spanish flu a century ago to the most recent global outbreaks of Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS), public health crises have shaken the foundations of societies and countries. However, the fact that we have been greatly surprised says a lot about our research and preparedness against biological threats, the priorities and the fragility of economic and financial systems.
As a percentage of GDP, India’s health budget has hovered below 1.5% for several years. Per capita public spending on health in India increased from ~ 621 per person in 2009-10 to ~ 1,657 in 2017-18, which is still too low. In comparison, the countries of the Organization for Economic Cooperation and Development spent, on average, 8.8% of GDP on health in 2017, the last year for which figures are available. Only a fraction of India’s health care budget goes to fighting communicable diseases.
This chronic underfunding is responsible for inadequate infrastructure. It is common knowledge that inpatient facilities in India are poor. However, some numbers may put the problem in perspective. According to an article published by Brookings India last month, we have just 0.55 beds per 1,000 people. Twelve states, with 70% of the population, are below the national average. These include states in central, northern and western India, where the maximum number of cases of coronavirus disease has been reported (Covid-19). When rural-urban and economic disparities are taken into account, the threat of a severe pandemic overwhelming the health system is real. Health spending for the current financial year is extremely inadequate. As a first step, budget allocations must be expanded.
The pandemic has accelerated the recent decline in various sectors of the economy. The International Labor Organization warned that more than 400 million Indians in the informal sector may fall into a vicious circle of poverty. This calls for long-term planning to support businesses through loan moratoriums, lower interest rates, increased state contributions to employee benefits, a transition to clean workplaces, and institutional support for their participation in the contactless economy. Agriculture must be supported through liberal and secure acquisitions, lower input costs and tolerance in agricultural loans and loan recoveries until the crisis breaks out. Goods and services tax and income tax administration should be geared towards lower rates and lighter compliance charges.
Social distancing and personal hygiene have become keywords as effective strategies to prevent the spread of the disease. In fact they are effective. Staying home means everyone has a home right where they are. Unfortunately, the large-scale internal exodus from cities to rural areas suggests otherwise. Almost half of our population cannot store food and essentials beyond a few days, after which they must withdraw or receive them. The postal department and select courier companies must be cordoned off to ensure door-to-door coverage where needed.
Health personnel is scarce. They are precious resources at any time, but even more now. They need adequate protective equipment, machinery, and medications to help Covid-19 patients. There is no evidence that India lacks the raw materials, know-how or the entrepreneurial spirit to close the gaps. However, access to capital, standardization and testing facilities, and lengthy procurement procedures remain limiting factors. A transparent emergency procurement policy must be implemented to cut red tape. Various promising designs of low cost fans have been made available and should be put into production.
Hundreds of physicians embedded in non-medical currents, such as the civil service, the military, and the pharmaceutical industry, must be organized to support front-line care providers. Thousands of recently retired doctors and nurses can be organized to help patients with other health problems. Pooled tests, where samples are pooled to run Covid-19 tests, must be implemented to identify and isolate high-risk groups. This can significantly compensate for the shortage of test kits.
None of the four members of the National Disaster Management Authority has experience in biological disasters. This institutional flaw must be rectified quickly, possibly expanding the body to include the director general of health services. It can also be considered a separate agency with adequate resources and expertise on Taiwan lines, where a flexible command structure, a comprehensive epidemic prevention strategy, big medical data, and proactive disclosure of public information, all through a clearinghouse. Central Epidemic Situation Command and other institutions and collaborations have made the country a model for the response to the coronavirus.
Providing authentic information and discrediting fake news need special attention in today’s online world. State governments have risen to the challenge and instituted practices sensitive to local requirements. Successful crisis management is likely to strengthen people’s faith in democratic institutions and good governance. Marginalized people become even more vulnerable in emergencies.
We must maintain the strength of our plural country to guarantee a unified response to the challenge, since the recognition of interdependence would allow us to take better advantage of our strengths. As learning from this crisis, we must implement far-reaching policies and programs to face such challenges in the future. It is everyone’s battle, and credit is due to all those who are making great and small sacrifices to achieve this collective goal.
Sachin Pilot is Deputy Chief Minister of Rajasthan
The opinions expressed are personal.