Fixing The Health Of Health Infrastructure

Nations who forgive and forget easily are condemned to repeat and relive the misery. The second corona wave has led to a relentless outbreak of criticism of the Government’s response. Or, rather a complete lack of it. The narrative one hears is a disturbing saga of prolonged inaction and wrong decisions culminating into a complete abdication by the Government. One fretted over the Obsession of the Leadership with managing perceptions through a co-opted media than to man up and face the real issues. One worried about a complete emasculation of Institutions be it Election Commission or Bureaucracy-too scared and too career-driven to hold the mirror when it mattered the most. Hearts warmed on the hearing the sporadic tale of human goodness only to slide into cynicism on hearing sordid stories of greed-fueled profiteering.

In the din of it all, the lurking fear is that the larger lessons should not get forgotten. As is the national habit, whatever our proclivity, we will find suitable scapegoats - Modi, State Governments, Bureaucracy or System. We will vent and fume, feel violated for a few days, only to conveniently forget, even forgive and eventually move on to our pursuits- IPL final is yet to be played? Where are the next elections? Would be interesting to watch post-Covid, no? How is Salman’s new movie doing? On the comfortable cushion of short memory, Life would move on.

Whereas what really matters is a systemic course correction and that will come only if right and hard questions are asked from our Government. In the end, it will be about the boring job of attending to the nuts and bolts of a broken health system and finding resources to build it right. To avoid repetition of the human catastrophe we are presently at loathe to witness, it has to take priority over the toxic din which parades as a discourse in our country.

With health-spend as a percentage of the GDP at miserly 3.5%, to say health infrastructure is inadequate is to state the obvious. Forget odious comparison with the mighty USA with whooping 16% and the UK with 10%, even lowly Afghanistan with 9% and Nepal with 5% spend more of money on the health and well-being of their citizens. No amount of chest-thumping on Pakistan or Ram Mandir can gloss over the depressing fact that 19 cr (14%) of our population is still undernourished and over 51% of women of reproductive age (15-49) are anemic. These are not just clever numbers to win an argument, their larger Implication is that for times to come, a large part of our population will continue to have low immunity and thus remain a regular host to common diseases like TB, diarrhea, pneumonia, dengue, malaria and all other viruses which get unleashed in future.

A robust system of oversight of the local community on the health resources so that they are developed, deployed and used equitably needs to be configured. It is too important to be left to the ensconced bureaucracy in Delhi with no skin in the game and thus facing no consequences even in the extreme events of a human disaster like of the one we are seeing now. Questions need to be asked as to when the CORONA wave was creeping into the lungs of the nation, why no one raised the red flag. Not a single dissenting voice. Not a single person to throw up his arms in the air and put in his papers. Was it incompetence? Or worse still apathy? Today, it appears as if these so-called health experts in one Covid committee, task forces, and what have you are kept only for PR bytes on the TV.

Call it the health professionals and in the future, they have to be un-shackled from the pulls and pressures the politicians and their kowtowing mandarins. A robust system has to be put in place where the voice of science is by default heard and respected above the diversions like elections or the sacred Kumbh.

For a country of the size of India, even a back of envelope calculation shows that the scale of the problem is not insurmountable. For 741 districts, around 200 odd already have district hospitals with sufficient land and building to only require expansion and upgrading of the existing facilities where around Rs100 cr per facility leading to an expenditure of Rs20,000 crore would suffice. For the remaining 541 districts with Rs 75 lac per bed Industry-standard thumb-rule, it will require another 2 lac crore. So, in Rs 2.2 lac crore you can create an infrastructure to provide medical coverage to the entire population and that is only 1.5% of our 150 lac crore GDP. Spread over the next 5 years on mission mode, it means a commitment of only 0.3% of the GDP per year additional provision for taking the first step to create the health infrastructure to bridge the serious demand-supply gap which exists today. Many of these larger hospitals will also serve as medical, nursing, and technical colleges as well to strengthen the trained manpower across the country especially in the smaller district towns. A timeframe of 5 years is also sufficient for the device and even improve upon the regime where free treatment to the poorest is blended judiciously with payment cum medical insurance backed system for which there is the world over models to take the best practices from.

In today’s environment where fear of life is paramount and health is back on the radar of a scared nation, a small “Health Infra Building” cess on GST or on corporate tax for the next 5 years is an easy sell. Additionally, with a combination of innovative fund-raising tools such as  Long- term tax-free health bonds and low-interest international funding, it is a do-able proposition. Leave aside the human tragedy, the toll poor health extracts on the GDP itself far exceeds a petty 0.3% additional spend. Anyhow spending 0.3% of the GDP to bolster up the health of its citizen is not too much to ask from the Government?

Post the Second World War, Nations like Germany and Japan have risen from the ashes in a matter of a few years. We are a hundred times better placed to be than to be despondent. Same Germany has 8 and Japan has 13 functioning hospital beds to a population of 1,000 people as against meager 1.3 beds for India. Even Sri Lanka with 4.2 beds is much better off. All this has shown in the battle against Covid. It has to be kept in mind that no country has ever become poorer by spending on its health infrastructure, rather in the long run, the reverse of it is always true.

After all, be it human life or the life of a nation, in the end, it is always a matter of resolve. The government is presently on the back foot and people are angry. The only hope for the nation from now on is that the government finds the lost courage and wisdom to step forward and show its progressive face.

 (The writer is a former IPS officer of the West Bengal cadre)