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Friday, September 25, 2020

Now is the time for new, transformative decisions and interventions to transform health services in India

The lockdown was expected to slow the spread of virus and for getting health services ready to respond effectively. However, when lockdown was removed, it became clear that preparedness was not sufficient.

Written by Chandrakant Lahariya | New Delhi | September 9, 2020 8:16:38 pm
pune city news, pune municipal corporation, pune civic body budget shortage, pune budget crisisAt a Covid-19 testing centre in Pune. (Express Photo: Arul Horizon)

Seven months since the first case of the coronavirus disease in the country, India has achieved many dubious firsts or seconds. India is first in daily new cases, which are more than the cumulative number of cases reported by China in the entire pandemic. India has the second highest number of cumulative cases as well as active cases in the world. Projections are that India could be first on these parameters sometime in October.

India’s pandemic response has evolved. People happily faced the hardship during the 68-day long lockdown, considered as one of the most stringent lockdowns in the world, hoping that things would change on the other side of it. The lockdown was expected to slow the spread of virus and for getting health services ready to respond effectively. However, when lockdown was removed, it became clear that preparedness was not sufficient. Many states and districts continued on varied versions of the lockdowns till in the end of August the Union government directed that states should not lockdown without concurrence of the Union government. In early September, epidemiologists and experts agreed that the pandemic is unlikely to get over before late 2021, even with safe and effective vaccines. The virus would stay with humanity for even longer, maybe forever.

The long and stringent lockdown, which affected all essential services, resulted in economic and financial difficulty for all citizens, the worst affected are those in informal sector, the poor and the marginalised. The trade-off between economic hardship and saving lives is already being argued and will be argued for long. However, what is real are the first quarter growth figures for the ongoing financial year 2020-21 and there is nearly a 24 per cent contraction, the highest decline for any quarter in the last 24 years. Experts always knew and the world has witnessed the adverse economic impact of major health events. In 2014, during the Ebola pandemic in three African countries, their economies had shrunk by nearly 10-12 per cent with long term consequences.

Pandemic is a health event at a larger scale with a big impact. The poor health condition of people affects the economy of a nation and adversely affects growth. It is time that all those who are hawkish on economic growth understand that investment in health is an investment in the economy as well. Healthier people are assets of society in the form of human capital — they are more productive at the workplace, less absent due to sicknesses and contribute to development. There are estimates from reputed institutes that every dollar invested on health workforce yields a ten-fold return. It is unarguably an intelligent investment.

Outbreaks, epidemics and pandemics have always been a reality. We have been hearing that COVID-19 is not the first pandemic, nor it is going to be the last pandemic. However, a better functioning health system is more effective in tackling the challenge and the human and economic impact is mitigated. India’s investment on health has traditionally remained low, the country spends around 1.2 per cent of GDP on health, which is amongst the lowest in the world. (It has increased by 0.2 per cent since FY 2001-02). All the proposals to increase the funding have not fructified. The latest National Health Policy (NHP) 2017 proposes to increase government spending on health to 2.5 per cent of GDP by 2025. Health is a state subject in India. The NHP has also proposed to increase state government spending from the current level of 5 per cent to 8 per cent of the state budgets by 2020. The state government spending on health as proportion of budget had also increased marginally from 4.5 per cent to 5 per cent from FY 2001-02 to 2015-16. Clearly, these intentions have not been translated into an increase in the financial allocation for the health sector.

There is another opportunity. The Fifteenth Finance Commission has a high-level group on health which has submitted a report and proposed to increase government allocation on health to 2.1 per cent of GDP. The health expert group of the FFC had drafted and submitted the report before the pandemic. The expert group is revisiting those recommendations in wake of the pandemic.

COVID-19 is likely to be around for some time. In pandemics, everyone faces hardship. People lose work and income, jobs are reduced, children miss school and learning. There are mental health challenges. The burden is disproportionately higher on the poor and the marginalised.

The pandemic is still growing in India and more is needed to bend the curve. The impact of poor health was never so visible as it is now. The response is guided by the high-level policy makers including the prime minister and the chief ministers. Even after this, if all that happens to the health sector is minor and incremental change, that would be pity. Every opportunity should be explored and fully utilised to improve health services. For example, the FFC may consider having provisions and incentives for those states who would increase their investment on health and primary healthcare.

The challenges of a government health system have been recognised in the situation analysis document of India’s NHP 2017. The question is if we know the problems, why does the cumulative wisdom of elected representatives, executive, policy makers, subject experts and civil society members fails to find a solution which works? If our neighbours (Thailand, Bangladesh, Sri Lanka) can have better health services at similar or lower economic development, then why not India? If India keeps doing what it was doing in the health sector before the COVID-19 pandemic, it will have the same outcomes as earlier. It is time for new, transformative, game-changing decisions and interventions to transform health services in India. If this is not done now, we don’t know when will it be pressing time.

A stronger and well-functioning government healthcare system and improved provision of services would be a fitting and appropriate response to compensate for all the hardship people have already faced and continue to face. It is not only doable but is the right action.

(The writer is an epidemiologist and a public health specialist. Views are personal)

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