Ending the lockdown, reviving industries, migration of labourers to their places of work, emigration of workers abroad, future inward remittances and a vibrant economy are intrinsically linked to the better health of the Indian population. Hence, let public health assume a central role in any economic revival and post-pandemic plans
-Prof P R Kumaraswamy
Coronavirus is a challenge to our healthcare system
India’s eventual success in recovering from the catastrophe called Covid depends upon its ability to reform two key sectors, health and education. Though they are not attractive like the rest, they are critical for society’s physical and mental welfare and long-term survival. Let’s look at health now.
The Covid has exposed the limitations of the public health system in the country. While it is a once-in-a-century challenge, there were sufficient advanced warnings and lead time for preparing an effective response. If one takes January 2020, when the outbreak was first recognised in China, we had over 15 months before the second wave hit us this April. This should have been sufficient for developing an effective, inclusive and efficient healthcare response. This was not to be. When the dust settles down, they will have to do a complete audit of the problem, response and systemic deficiencies. Whether we like it or not, history is merciless in its verdicts.
Our public health system could not cope with the challenges of the pandemic; as the numbers rose, contact tracing was forgotten; when positives increased, only tests for symptomatic cases became mandatory; then post-Covid negative tests were removed to ease pressures; and when many reported shortage of vaccines, increasing the gaps between first and second doses became inevitable. These are the hallmarks of our work-in-progress mode. The Covid is truly socialists in the negative sense of the term; non-discriminatory in terms of caste, religion or social status.
Connections could not ensure beds, and the availability of beds could not ensure the patients were walking away alive.The primacy of the healthcare workers during the crisis could not be reemphasised. Under tiring circumstances, insufficient settings, inefficient logistics and overworked conditions, millions of doctors, nurses and other support staff continue to battle this crisis. Though the actual number may never be known, thousands of frontline workers have died or suffered irreparable physical and psychological damages. No amount of solatium will resurrect the dead or console the living. Yet despite the obvious dangers, millions have joined the fight..At the same time, it is essential to admit that the pandemic also contributed to the generation of immense black money, both individually and institutionally. The scarcity of supplies and surge in demand have been used by sections of the healthcare industry and professionals to made undue demands on the public; there were several cases of hospitals demanding two lakhs in cash before they could allot beds; yes, in cash when the RBI relations set the limit of two thousand rupees for cash transactions. The media is replete with reports of exorbitant ambulance charges, black-marketing of ventilators, hoarding of oxygen cylinders, shortage of essential medicines or even helpers demanding four figures just to pass messages from the quarantined patients and their anxious relatives outside. The crisis has made the unscrupulous more imaginative, industrious and greedy. The black money generated by the pandemic would be in the billions, not millions. Indeed,crisis response has made a mockery of cashless transactions in the healthcare industry.
It is essential to recognise that the lockdown—complete or partial—was a response to the health emergency. The opening of the economy will have to be linked to freezing, halting, and eventually reversing the situation. Anything else will be temporary, counterproductive and even catastrophic..So the business-as-usual approach will not work. We need to take a hard look at some of the omissions and commissions since January last year.
It is essential to recognise that the lockdown—complete or partial—was a response to the health emergency. The opening of the economy will have to be linked to freezing, halting, and eventually reversing the situation. Anything else will be temporary, counterproductive and even catastrophic..So the business-as-usual approach will not work. We need to take a hard look at some of the omissions and commissions since January last year
First, even the negative test reports done in India are not foolproof. Several Air India flights were cancelled because the passengers from India were found positive upon landing despite carrying negative reports. Even the External Affairs Minister S Jaishankar’s delegation to London was not diagnosed correctly. Either the tests were unscientific or manipulated, and neither give a good name to India. The information available in the public domain does not indicate anyone was taken to task for such lapses. Unless tests conducted within India are credible, the outside world will ban travels from India or make special and exclusive arrangements for ‘testing.’ Both would cause lasting damages to the country.
Healthy Indians are necessary to revive the economy
Two, public health requires apolitical, professional and above all, accountable leadership. This is impossible with most politicians and bureaucracy; if the former is worried about the next election, the latter is a generalist and unimaginative. Both are rarely held accountable for their omissions and commissions. Hence, Prime Minister Narendra Modi needs to explore the need for a health audit where individual citizens could raise his or her complaints and grievances against public and private healthcare providers. For too long, accountability has been absent in the healthcare system, and it is time to fix it. Since it concerns lives more than livelihood, the punishment must be a deterrent, not just proportionate.
Three, now we know that state elections and massive religious congregations were super spreaders that contributed to the deadly second wave. Hence, future elections need to be weighed against their possible impact on the pandemic. You cannot promote democracy with dead people.Four, controlling the pandemic is critical for economic growth. Within and outside the country, the movement of people will happen only when the pandemic is under control. Since the scientific community worldwide cannot control the pandemic or even visualise a timeframe for it, we need to make alternatives. The Indian health sector needs to prepare itself better; forecasting and prevention are key to fighting another wave or future pandemics. The vaccination process provides enormous data which could be used scientifically to identify, forecast, prevent diseases in the future,and prepare follow-up measures. Likewise, the lockdown has compelled the reluctant public to rely on e-commerce, and this should ease the pressure of frequently replenishing and managing ATMs or even printing more currency notes. The digital economy is one of the unlikely beneficiaries of the pandemic.
Five, India ideally needs a Healthcare Czar whose decisions are final and binding on the entire population. Guided by a scientific team, the Czar will implement the policies without exceptions or special treatment of any individual, community or state. Since this is not possible in a country of exceptionalism, we need to settle for the second-best. In his next cabinet reshuffle, Prime Minister Modi must place the Ministry of Public Health among his top three or four ministries. This should be reflected in the seniority of leadership and mandate, and the health minister must be part of the Cabinet Committee on Political Affairs, the high-power body within the cabinet..Six, there has to be a post-mortem of the pandemic response at all levels. A growing India should not hesitate to admit its errors and omissions. Only the strong admit mistakes, while the weak ones never go beyond justification and side-tracking. If necessary, India should not hesitate to learn from others’ experiences—both good and bad—or even ask for help from established professionals and institutions abroad. The egos are the enemies of greatness and progress..
The health of the people is critical for the health of the Indian economy. Ending the lockdown, reviving industries, migration of laborers to their places of work, emigration of workers abroad, future inward remittances and a vibrant economy are intrinsically linked to the better health of the Indian population. None of the economic activities are possible without healthy Indians. Hence, let public health assume a central role in any economic revival and post-pandemic plans.
(The writer teaches at Jawaharlal Nehru University, New Delhi)