In the course of history, bacteria and viruses have played a crucial part in changing the course of events, and contributed significantly to the rise and fall of civilisations. This is the not the first time humanity has been threatened by an invisible enemy; from the Spanish flu a century ago to the more recent global outbreaks of the Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS), public health crises have shaken the very foundation of societies and countries. Yet, the fact that we were caught largely unawares says a lot about our research and preparedness against biological threats, 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 now. India’s per capita public expenditure on health has increased from ~621 per person in 2009-10 to ~1,657 in 2017-18, which is still far too low. By comparison, the Organisation for Economic Cooperation and Development countries spent, on an average, 8.8% of GDP on health in 2017, the latest year for which figures are available. Only a fraction of India’s health care budget goes towards battling communicable diseases.
This chronic underfunding is responsible for inadequate infrastructure. It is common knowledge that in-patient facilities in India are poor. However, some numbers can place the problem in perspective. According to a paper 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 the coronavirus disease cases (Covid-19) have been reported. When rural-urban and economic disparities are taken into account, the threat of any serious pandemic overwhelming the health care system is real. The health outlay for the current financial year is grossly inadequate. As a first step, budget allocations need to be scaled up.
The pandemic has accelerated the recent decline of various sectors of the economy. The International Labour Organization has warned that over 400 million Indians in the informal sector may fall into a vicious cycle of poverty. This demands long-term planning to support businesses through loan moratoriums, lower interest rates, greater State contributions for employee benefits, a transition to no-contagion workplaces, and institutional support for their participation in the no-touch economy. Agriculture must be supported through liberal and assured procurement, lower input costs and forbearance in agricultural lending and loan recoveries till the crisis blows over. The Goods and Services Tax and income tax administration must be steered towards lower rates and lighter burdens of compliance.
Social distancing and personal hygiene have become watchwords as effective strategies to prevent the spread of the disease. They are indeed effective. Staying at home assumes that everybody has a home right where they are. Sadly, the large-scale internal exodus from cities to rural areas suggests otherwise. Nearly half our population cannot store food and essentials beyond a few days, after which they must step out or have these delivered to them. The postal department and select courier companies should be roped in to ensure door-to-door coverage wherever needed.
Health care personnel are scarce. They are precious resources at any time, but even more so now. They need appropriate protective gear, machinery and medicines to help Covid-19 patients. There is no evidence that India lacks the raw materials, the technical know-how or the entrepreneurial spirit to plug the gaps. However, access to capital, standardisation and testing facilities, and protracted procurement procedures remain limiting factors. A transparent emergency procurement policy must be implemented to cut red-tape. Several promising low-cost ventilator designs have become available and should be taken into production.
Hundreds of doctors embedded in non-medical streams, such as the civil service, armed forces, and the pharmaceutical industry must be marshalled to support the frontline care providers. Thousands of recently-retired doctors and nurses can be marshalled to support patients with other health concerns. Pooled testing, where samples are pooled to run Covid-19 tests, should be implemented to identify and isolate high-risk clusters. This can significantly make up for the short supply of testing kits.
None of the National Disaster Management Authority’s four members has experience in biological disasters. This institutional defect should be rectified quickly, possibly by expanding the body to include the director- general of health services. A separate body with adequate resources and expertise can also be considered on the lines of Taiwan, where a flexible command structure, a comprehensive epidemic prevention strategy, medical big data, and proactive public information disclosure, all through a central epidemic situation command centre and other institutions and collaborations, have made the country a model for coronavirus response.
The provision of authentic information and the debunking of fake news need special attention in today’s networked world. State governments have risen to the challenge and instituted practices sensitive to local requirements. Successful handling of the crisis is likely to strengthen people’s faith in democratic institutions and good governance. Marginalised people become even more vulnerable in emergencies.
We must maintain the robustness of our plural country to ensure a unified response to the challenge, for acknowledgement of interdependence would enable us to better leverage our strengths. As a learning from this crisis, we must implement long-range policies and programmes to meet such challenges in the future. It is everybody’s battle, and credit is due to all those who are making great and small sacrifices to achieve this collective goal.
via Overcoming structural constraints – analysis – Hindustan Times
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