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Imagine a post-Covid India in which the most important persons in the Union Cabinet are not the Ministers of Finance, Home or Defence but the Minister of Health & Family welfare. This leader, as the Prime Minister’s pick and the probable PM-in-waiting, refuses to spout the mythical healing powers of gau-mutra and strictly sticks to evidence-based medicine while recognising that traditional medicine is important and has its place in the Indian order of things. This Health Minister leads a vast team of doctors who are the pride of the Indian civil service, the most coveted positions and respected people in government and society.
This signal change at the top mirrors the change along the chain right down to the bottom, at the district where the Chief Medical Officer (along with an Education officer) is the most important and resourceful officer of the government in the district, and caries the same financial powers as the Collector and the District Magistrate. Primary and Secondary Health Care Centres under her are connected by technology to a dashboard and live data is generated and posted on the health, literally, of the people of India, minute-by-minute. No one complains that doctors are missing, the beds are dirty or that ambulances don’t work. Cases are referred with speed. There are district hospitals in the public sector or the charitable sector of the kind run by as AIIMS in New Delhi or CMC in Vellore. Five-star health is unfashionable; doctors forced to meet billing targets speak out; hospitals forcing them to do so are prosecuted. Health insurance premia fall dramatically and most treatment is by prefixed and regulated fees or at very nominal costs. There is still space for gold plated health treatment for the rich and the trendy but most people, including the rich themselves, feel that is quite unnecessary when public health care is so good.
This is a vision that will require political stamina and huge public spending, of the kind that can trigger a revival in the economy and build it for the future so that our growth takes on a whole new meaning.
This is the vision of an India that is built from the grass roots up and is ready to respond to challenges of a world that has been shattered by the Covid-19 pandemic. This is a vision that will require political stamina and huge public spending, of the kind that can trigger a revival in the economy and build it for the future so that our growth takes on a whole new meaning. If India has to move out of Covid to a place where it really heads towards becoming global power, then there is no escaping the reality that its maximum investments have to be in primary heath and primary education; not in bullet trains, smart cities or mega statues. Not many people know that Modi mooted the bullet train at a public meeting in Mumbai before he became the Prime Minister where he admitted as much openly that even he knew nobody would ride on that train. But it will help us show to the world in the same way, he said, China shows off Shanghai! This was always the road to doom. Covid-19 has brought that doomsday right in front of us.
Today, the picture is of India on its knees as the poor cannot hold out anymore with the lockout and the threat of Covid-19 won’t let us lift the lockout. You are doomed if you do and doomed if you don’t.
It is true that India is not the only nation in this conundrum but India stands apart among the large and faster growing economies that has inevitably unleashed the horror of hunger, helplessness and penury on a very large segment of its population. Suddenly, the bright spots of the Indian economy like the demographic dividend, largest reserve of scientifically trained manpower, global IT backend and the country with a new story of rising domestic consumerism have collapsed into the real picture of real India – tens of thousands walking back home with meager belongings, hit with police lathis, some weeping and many hungry.
The bright spots of the Indian economy like the demographic dividend, largest reserve of scientifically trained manpower, global IT backend and the country with a new story of rising domestic consumerism have collapsed into the real picture of real India – tens of thousands walking back home with meager belongings, hit with police lathis, some weeping and many hungry.
These constitute the “bottom of the pyramid”, that fancy term used to sell to those who can afford to buy only in small units, those who oiled the economy on less than fair wages and then spent some of those on sachets that made our FMCGs look good on the stock exchanges. Yet, when the time came, they were unsupported, shunned and literally put on the streets, and in their collapse they announced the collapse of the Indian economy that has had no means to ensure their food security, health security and their economic security. Where has seven per cent plus GDP growth got us then?
In fact, so shabby is the treatment of the poor that there is ample anecdotal evidence that many will not return to work the way they used to. An ASSOCHAM survey reported 36 per cent of its respondents saying “manpower availability” will a key challenge. Other challenges were managing costs (81%), weak demand (74%), weakening rupee (30%), availability of financing (45%) and supply chain uses (48%).
There are other prescriptions for revival of the economy, among them those from the likes of the builder Niranjan Hiranandani, the President of ASSOCHAM and National Real Estate Development Council (NAREDCO), who says that industry needs a “stimulus of over $200 billion with an ability to go up to $300 billion with $100 billion provided immediately, $100 billion in four months and the last $100 billion in eight months”. The esteemed Chamber, it might seem, has sliced out its cake into three neat mouthfuls and is ready to bite. What if the government pumps it all into healthcare, where, by its own account, the Community Health Centres run with a huge order of vacant posts.
So shabby is the treatment of the poor that there is ample anecdotal evidence that many will not return to work the way they used to.
As on 31 March, 2019, out of the sanctioned posts, 79.9% of Surgeons, 64% of obstetricians & gynecologists, 77.5% of physicians and 69.7% of pediatricians were vacant! If this is fixed, if the investments are prioritised, we will change the ugly numbers that tell us that even today, in so-called modern India, only 21% of mothers received full ante-natal care(16.7% in rural India and 31.1% in urban India), according to the latest National Family Health Survey (NFHS-4). Fixing this will reduce maternal mortality and child mortality, which will lead to a reduction in the fertility rate, which means parents can invest more in their children and enable them grow to become healthy contributors so that India can reap the real demographic dividend, not the dividend wrested from underpaid, undernourished and under-supported populations who must fend for themselves every time a crisis hits us.
It was 50 years ago that a landmark judgment in the US (Judge Grufein in the Pentagon Papers case) wrote: “The security of the nation is not at the ramparts alone”. The words come alive in an entirely different context today as health stands equated with the security and the future of India. Which way will the nation turn?
(The writer is a journalist and a faculty member at SPJIMR)