By Nageshwar Patnaik in Bhubaneswar, May 30, 2020: The ancient Sanskrit adage “Shariram adyam khalu dharma sadhanam” (a sound body is the veritable instrument of the pursuit of the ideal law of life) underlines the importance of health for one and all. In fact this adage is also the slogan of the New Delhi based All India Institute of Medical Sciences (AIIMS) – the premier public health institute in the country.

The ongoing COVID-19 crisis has brought the issue of health to the forefront. It also exposed too many chinks in the public healthcare infrastructure armour. On the other hand, the private health facilities and practitioners quietly sit on the sidelines at a time when the pandemic has already killed more than 4700 people across the country. Total number of coronavirus cases in the country as on Friday stood at 1,65,799 including 89,987 active cases, 71,105 cured or discharged or migrated.

In fact, India has overtaken China in terms of deaths related to Coronavirus and is now placed ninth in the world in the list of the most-affected nations. Meanwhile, the Centre is in talks with state governments on the possibility of extending the lockdown for fifth time as coronavirus cases in India have crossed 1.65 lakh-mark.

Ironically, public healthcare systems around the world are crumbling under the pressure exerted by the pandemic. India is no exception, but what has aggravated is the quiet withdrawal of private healthcare providers in taking on the deadly virus. This has turned out to a worst-ever tragedy, where the private players provide 70% of the healthcare. Barring few, private healthcare either shutters down or refuses care to Covid-19 patients.

Interestingly, the governments, which have been strongly espousing the cause of free market economies across the globe are now forced to have a relook at massive investments in public healthcare. Prime Minister Narendra Modi must take a cue from the changing scenario and initiate a major healthcare reform by hiking budgetary allocation for this crucial sector. The country’s expenditure on healthcare is one of the lowest in the world, even as our economy has grown robustly in the post-liberalisation period.

Investment in healthcare has consistently hovered around one per cent of the Gross Domestic Product (GDP). In the 2020-21 Budget, it was 1.02% of overall expenditure. Sadly, the funds allocated to the National Health Mission (NHM) were slashed.

National Health Policy 2017 promises to increase public health spending to 2.5 per cent of GDP in a time-bound manner and guarantees health care services to all Indian citizens, specifically to the underprivileged. But there has been decreased allocation despite a GDP growth of 6.8% in 2018-19 and 4.5% in 2019-20.

The pandemic has now hit an already tottering economy, with projections of India’s GDP growth reduced to zero in 2020-21. It will be tough for Narendra Modi led government to increase investments on health in the wake of a battered economy hit by an unprecedented crisis.

The pandemic has made it amply clear that the primary health care of the country, both in rural and urban areas is abysmal and requires special focus. The Health Survey and Development Committee, popularly known as the Bhore Committee, is now 45 years old. And yet, its relevance is not lost even today. The Committee spoke about the importance of health care ‘at the doorstep of the individual irrespective of their ability to pay’.

The country has not been able to achieve this nor will it be able to succeed if it makes combating COVID-19 yet another vertical programme, focused on disease outbreaks without investments in the social determinants of health, which are mostly responsible for health inequities – the unfair and avoidable differences in health status seen within and between countries.

Modi government has stressed on privatization apparently due to fiscal distress. The National Health Policy 2017 recommends changing the role of the government from healthcare provider to strategic purchaser. NITI Aayog had already set rolling out plans to outsource some district hospitals to private players in December 2019. The draft proposal allows private contractors, called ‘concessionaires’, to set up medical colleges attached to these district hospitals.

Indeed, about half of the beds in these hospitals, categorized as “markets beds”, would be open to “appropriate charges” by the concessionaire. A similar proposal in 2017 was floated to promote public private participation (PPPs) in treating non-communicable diseases at district hospitals.

The concessionaire will be allowed to bid for a 30-year lease of reasonably well-functioning’ district hospitals with fair patient load. There is no justification for outsourcing a reasonably well-functioning hospital. Experts fear that the post-corona health policy and planning landscape will only bolster the government’s resolve towards privatization though at the time of pandemics like Covid-19, public health facilities come to the rescue of the nation.

In the last two months, India has borrowed close to $7.4 billion from international lending agencies to combat Covid-19. Global finance institutions by and large favor private partners for their project implementation as they consider them more efficient and open to work.

Most government hospitals in India have procured high-end equipment, but they have invested close to nothing in attracting human resources particularly, the allied staff such as the nurses, paramedics and sanitary workers. Most of them are hired on contractual basis and have no protection from occupational hazards.

No one will contest the need for a robust public health system. This will automatically lower the cost of private healthcare. Modi must see the writing on the wall and ensure a healthy competition between the public and private sectors. This will be only possible, if the government sticks to its National Health Policy 2017 target of earmarking 2.5 per cent of GDP for boosting the public health care system.

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