Banging plates will not defeat coronavirus – we must build a quality public-health system to do that

The news of coronavirus has been on all our minds since Narendra Modi’s televised address on Thursday. The janata curfew or people’s curfew that he suggested for Sunday was near-total through India, and at 5 pm, many came out to beat thalis and clap their hands to express gratitude to doctors , nurses and others who are at the forefront of fighting the pandemic.

In his speech, Modi urged Indians to refrain from panic buying, assured them of continued supply of essential goods and asked them to look out for those less fortunate then themselves. He did not detail a plan of action regarding public health strategies or measures the administration has taken to combat the virus. Nor did he address the question of what the Union government plans to do to alleviate the economic suffering of all Indians besides stating a task force was being formed.

The analogies and words used by the prime minister resonated with India’s growing upwardly mobile middle class. Commentators and journalists across the spectrum saw the speech as “masterful” and the need of the hour. This is the class that, as sociologist Sanjay Srivastava, noted in an interview with Ankur Datta in Seminar, has been most swayed by the changing idea of victimhood.

“Historically, under the post-colonial state, the ordinary person was the poor farmer, the slum dweller and so on,” Srivastava noted. But now, the ordinary person is a considered to be a middle-class person and “the new ordinary people, the middle class, are saying, ‘we are also victims.’”

The disruptions of liberalisation

This change in thinking, Srivastava explains, occurred with the transition from the Nehruvian state to the “liberalisation” of the economy. This is why partly we see the huge resistance as well critique of schemes such as the Mahatma Gandhi Employment Guarantee Act, which guarantees rural families a minimum of 100 days of work a year. The idea of entitlements for the poor are seen as waste. Scarce resources, it is felt, should not go to “non-productive” activities but rather to industry and business, which will grow and prosper. The fact that a healthy and educated work-force is the need of the hour falls on deaf ears.

India spends a shockingly low percentage of GDP – 1.28% – on health. Bangladesh and Sri Lanka spend a larger proportion. Public health policy makers and activists have for the last few decades or more been campaigning for an increase to at least 3% of GDP spending on health. In 2006, a children-led campaign called “Nine is Mine” launched a campaign calling for 6% of GDP to be committed to education and 3% to health.

Though successive governments promised to do so and political parties even committed to this spending in their election manifestos but it was never put into action. Health and education are not seen as issues that can win elections.

Health as a right

To further complicate matters, health in India is a state subject. That is part of the reason some states perform better and are quicker in responding to the pandemic than others. In addition, the right to health is not a fundamental right, even though, as the Economic Times reported in September, “a high-level group on health sector constituted by the Fifteenth Finance Commission has recommended that Right to Health be declared a fundamental right on the 75th Independence Day in 2022 and the Constitution be amended to shift the subject of health from the state list to the concurrent list.”

I am not advocating that health should be shifted from the state list but we need to perhaps re-look at how health services in our country can be at least standardised and optimised so that poorer and less advanced states are not left out or under-serviced, without any kind of resource in times of emergency.

The idea of affordable, quality and accessible health and education for all as a public good and as a right is one we have abandoned before attempting to implement – with resources as well as intent. It is clear how unprepared we are for any large disease outbreak. Our public health infrastructure is woefully inadequate and crumbling, stretched at the best of times. Today with the coronavirus pandemic looming it is strained to breaking point.

As Caravan pointed out: “India has a total of 11,54,686 registered allopathic doctors. Of this, the government sector...has 1,16,756 doctors. That amounts to one government doctor for every 10,926 person. The World Health Organisation recommends a doctor-to-patient ratio of one doctor for 1,000 patients. A 2016 Reuters report noted that India needed more than 50,000 critical-care specialists, but has just 8,350.”

A new model

The Indian state’s preferred model of development especially since liberalisation has been one of privatisation or at best the private public partnership model for all essential services. The middle classes in India have barricaded themselves over the years in gated colonies and enclaves, going to private schools and universities as well as using private health care facilities. Today, we face a situation where the disease carriers are largely the well-off who are spreading to the less advantaged.

Our knee-jerk reaction is to further barricade ourselves and look with deeper suspicion at the poor who work as cleaners, domestic workers, delivery and couriers, and the vast army of service staff who clean, guard and ensure our comfortable lives. Yet we are the contagion carriers who will infect them. We have no facilities built for quarantine that are clean and hygienic. This in turn means that many are trying to escape and spreading the infection further.

This is the time we the middle class must demand from our government that it prioritises the process of building basic, affordable, quality health infrastructure for all and not only those who can afford it. Ringing bells from a balcony will not save us from what lies ahead – what will save us is the realisation that healthcare cannot be left to the whims of a rapacious private sector but rather is a public good and the government’s job.

The current model of healthcare depending largely on private health care facilities and medical insurance will not work in our country. With no basic and almost non-existent public health facilities, testing centers, infrastructure or trained staff, this system is rendered useless when it is needed the most. Perhaps if we begin the process of demanding this change from our government today, the next time a pandemic hits our shores, we may not feel so helpless, alone and afraid.

Radha Khan is an independent consultant working in the field of gender, governance and social inclusion.