Time now for India to convert Covid-19 as an opportunity to revamp country’s healthcare system Rajaram Panda Global impact of Pandemic The outbreak of the coronavirus pandemic in the Chinese city of Wuhan that spread across the world like wild fire continues to cause incalculable damage to the economies of all the countries. Not only it has dented the economies of most nations but has dramatically changed the way of normal human lives. Social distancing, manner of greetings, way of conducting political meetings, teaching methods in schools and colleges, conducting seminars and conferences virtually, and even holding virtual summits meeting between the heads of governments and many more have become the new normal. These are experiences never faced by human race in this century. The dramatic upturn in the style of human living required quick adjustment and cooperation of people to keep the spread of the virus in check as there has been no remedy available to bring this under control. While scientists world-over are grappling to find the right vaccine, there are no indication of an early success. Accompanied with this grave situation, the societal impact of the virus is equally troubling. The virus has not spared anyone, rich or poor, and those who are vulnerable have become easy victims. From the initial response, Taiwan, South Korea, Vietnam and New Zealand were success stories in containing the spread of the virus as timely measures prevented its spread. But the success was short-lived. Despite international travel restrictions and suspending airlines to undertake international flights to prevent human transmission, the virus did travel through invisible means and porous borders and infected peoples, thereby weakening the success stories that were seen as examples and models for others to follow. It also resulted in stigma and shame as people started avoiding those succumbed to the virus or even infected for fear of contracting the virus themselves. News of a son unwilling to lit the funeral fire of the father who died of the virus or a husband returning from another city where cases were high to his home but not allowed by his wife to enter home without undergoing state quarantine for 14 days makes disturbing reading. This demonstrates that the fear is real as no one has a solution to this pandemic. In Indian context: Effect on the economy The Indian economy has never been in a more precarious situation than now. In fact, Indian economic growth has been in a free fall for three years now. The GDP contracted a whopping 23.9 per cent in the April-June quarter, the first time in four decades. Fitch and Goldman Sachs predict a double digit collapse of India’s GDP growth for the whole year. With such a situation, Prime Minister Narendra Modi’s dream of creating a $5 trillion economy for the country by 2024 looks distant. The outlook is particularly sombre since pre-pandemic GDP levels are unlikely until the first quarter of 2022-23. Compounding this negative picture is the unemployment rate at unprecedented levels. Millions of businesses are on the verge of bankruptcy. After coming to power, Prime Minister Modi promised the youth of the country to create millions of jobs. He also promised to bring black money kept by many Indians in Swiss banks and deposit Rs. 15 lakh in every individual’s bank account. His demonitisaton announcement in 2017 was a disaster, hitting the poor the hardest. His stress on paper-less transaction never materialised as many poor people are used to cash in their daily lives. None of these mentioned measures were achieved. His promise to rein in corruption and clean up the system achieved moderate success. However critics complained that he at times overstepped the boundaries. Expanding the base of tax payers also achieved marginal success. In fact, the economy was struggling even before Pandemic hit the country because of above-mentioned overdrive. None of the major economic engines such as consumption, private investment or export look bright. With weak financial base, the government’s priorities shifted to re-build the Parliament and Central Vista incurring huge expenses. This decision could have been deferred till the country’s financial health would have improved. Major corruption is under control but retail corruption which actually determines ease of doing business on the ground remains unabated. The introduction of the GST ending the multiple rates and exemptions has not turned out to be a game-changing reform. Tax terrorism has created fears among honest tax payers. Tax officials are empowered with sweeping powers deterring investors. After supply chain disruptions as many Japanese, American and South Korean companies started relocating their production bases, India has not been able to attract many such companies to its shore. Complex rules and regulations are deterring potential investors who find other destinations such as Vietnam, Thailand and Malaysia more attractive. Investment in absolute terms might look decent but as a proportion to the GDP, not much has changed. Bureaucrats are unwilling to take decisions for fear of being blamed if decisions go wrong at a later stage, giving rise to inertia. With a comfortable majority, the government could have undertaken bolder reforms, thereby substantially improving the country’s growth prospects. Unless the government takes bold reform measures, the clean-up operations that eliminated corruption to a large extend would be meaningless. Tapping opportunities If this is in brief the new situation, let me explain how the post-Covid 19 situation could be turned into an opportunity. The pandemic proved that India’s healthcare system is poor and thus the pandemic presents a unique opportunity to the government to transform the country’s existing healthcare system. The focus ought to be shifted and prioritised through infrastructure, investment and manpower. This is a gigantic task before the government to undertake radical reforms in order to address not only the healthcare system with a view to save lives and not allow the common people to slip into penury but also with the larger long-term aim to boost economic growth. India boasts of pioneering in pharmaceutical industry. It also boasts of qualified doctors and paramedical staff, who may have excelled in overseas nations that offer better facilities compared to their host country but paint a dismal picture back at home. India also could boast of promoting medical tourism and service overseas patients but falls short of alleviating the pains of its own citizens. Why is this so? The weakness of India’s healthcare system stems from the fact that the government, including the Centre and states, spends a mere 1.13 per cent of the GDP on health. The CEO of Niti Aayog Amitabh Kant in an opinion piece in the Economic Times dated 11 September 2020 informs us that almost 62 per cent of healthcare spending is met through out-of-pocket expenditure by households. He also mentions that as much as 98 per cent of healthcare facilities in India are provided by those who employ fewer than 10 people, which has resulted in a highly complex and fragmented delivery of healthcare services. Maintaining manual health records on a national basis despite that India boasts of its expertise on information technology results in market failures and governance. Now is the opportunity for India to reprioritise and create a vibrant, dynamic and progressive healthcare system by the much-needed reforms. India could learn some lessions from other countries that have strong primary healthcare systems and have better health outcomes, lower inequality and low cost of care. Kant observes: “The creation of 150,000 health and wellness centres by 2022 by transforming existing sub-centres and primary health centres under the Ayushman Bharat Scheme is a major move in this direction.” Despite the massive upgrading testing, cases continue to rise. On 22 August India had three million cases but within a fortnight it crossed to four million marks, surpassing Brazil to record the second highest number of cases in the world. By 13 September it crossed 4.7 million with 78,727 deaths and the numbers are rising every day. Despite emergency measures and quick-fix responses and augmenting bed in the hospitals, many are unable to receive timely treatment. The present healthcare system is fragmented with focus on disease-centric programs rather than integration of programs. Exploiting the new situation as an opportunity, India needs now to design integrated and comprehensive ways of delivering primary healthcare. India urgently needs this critical paradigm shift to expand healthcare base to a larger section of the population at affordable costs. Instead of giving away doles as temporary measures, the government could consider on long-term measures. Even today, a larger number of people die because of tuberculosis. With a population of 1.3 billion, the Covid-19 fatality could look small in percentage terms but this does not justify the lacunae in the existing healthcare delivery system. India boasts of qualified doctors who have rendered admirable services in foreign countries but is unable to welcome them back to serve its own people by providing better facilities and attractive remuneration packages. Hospitals in districts and sub-districts are either understaffed or lack advanced medical equipments. Strengthening these health outlets and enabling these to provide high quality referral cases is the need of the hour. Health insurance system also needs reforms. Potential buyers are deterred by tough terms and conditions and imposition of many exclusion clauses by insurance companies. There are a number of cases where claims are denied. Here India needs to learn from the best practices followed by Japan. While the affluent can afford to pay and avail treatment in private hospitals with 5-star facilities, the common men does not have that luxury. While central government servants, including those retired, and their families are covered under the Central Government Health Services (CGHS), and some private companies defray healthcare cost of their employees, millions others are deprived of such facility. It is time now that the government seize the present difficult situation and convert as an opportunity by revamping the country’s healthcare system. Dr. Rajaram Panda was formerly Senior Fellow, IDSA, New Delhi.
By Rajaram Panda
- 2020/09/1404:32 PM