NITI Aayog’s role in Covid crisis

In a government hospital in Meerut in Uttar Pradesh, an Indian Express report informed, many patients bring their own folding cots; others lie on the floor on bed sheets. And such are the conditions in the two government hospitals in Patna that The Print reported that patients prefer to be treated at home, and God forbid, are even willing to die at home.

Both these reports sum up the crumbling rural healthcare infrastructure. They also provide a glimpse of the enormity of the crisis at hand, given the worrisome inroads the virus is making into the rural areas. The more you travel in the interior, the more you realise how decrepit the rural healthcare infra is. To give you an idea, in an Assembly constituency in Abohar district in Punjab, only one hospital caters to 68 villages. This hospital has no oxygen beds. Imagine the situation elsewhere in the country.

Even before the brutal second wave hit the urban areas with deadly ferocity, much of the rural health infrastructure was already in ruins. We ignored it because it didn’t affect us. Several studies have meanwhile shown how a rural family, when even one of its members falls ill, easily slips below the poverty line. They often have to take loans to repay the medical bills. With nearly 74 per cent of the population in rural areas banking on private clinics for medical treatment, health care has become dreadfully unaffordable, adding to the huge economic distress the rural population is already reeling under.

As city hospitals run out of oxygen, medicines and beds, with harried friends and relatives appealing desperately for help on social media, there is belated realisation that public health infrastructure in the cities is on the brink of a collapse. Most hospitals had run out of beds, and disturbing visuals of many patients being taken by their relatives from one hospital to another to get admission, has certainly shaken up the urban middle class. The tragedy is lit large. Unlike the pandemic last year, when the death toll were only a number, the second wave has provided a face to these figures.

People now realise that many lives could have been saved if timely medical help, including hospital admission, were possible. But let’s be very clear. Before we blame the system, isn’t it a fact that we remained a mute spectator when the public health infra was being privatised?

Didn’t we fail to question the mainline economists and economic journalists when successive governments drastically cut public sector investments in health, education and agriculture to reduce the budgetary fiscal deficit? We kept quiet because somewhere at the back of our mind we thought Mujhe Kya (how does it affect me). As long as you could afford the private hospitals you thought you had nothing to worry.

***

I am not sure whether the dance of death around us will wake us up from deep slumber. But as someone wrote on Twitter: “Can’t even say Covid-19 caught us with pants down, it came by invitation ... after the pants were sold in a Fire Sale.” He was referring to a Down to Earth (Aug 15, 2017) report titled: ‘Government hospitals on sale’ which clearly stated how the government was handing over public health infra in cities, town and villages to the private sector.

Niti Aayog had then suggested privatisation of the district hospitals on public private partnership (PPP) mode. And don’t forget, how many corporate big wigs, media personalities and even policy makers had applauded when medical tourism by top private hospitals was being encouraged.

Last year, in 2020, Niti Aayog had again come out with a 250-page policy document: ‘Schemes to link new and/or existing private medical colleges with functional district hospitals through PPP’. It spelled out a roadmap on how to privatise the public sector health infrastructure drawing from the ‘best practices’ abroad.

That’s the problem. Our mainline economists are always quick to cut and paste the ‘best practices’ (read, from the private sector) of western countries. Without trying to find out first-hand what the real needs of the country are, they look abroad. This gels very well with the dominant economic thinking that calls for cutting down on social sector spending – including health, education, food and agriculture. Just because the World Bank/IMF have advocated for stiff austerity measures, does it mean that we have to blindly follow what international bodies tell us? Why do we have to go by the dictates of the credit rating agencies, which encourage privatisation of profits and socialisation of costs?

In a country where the public sector investments in health is too low at present, only 0.95 per cent of the GDP (15th Finance Commission has promised, and that too in the midst of pandemic last year, to raise it to 2.5 per cent by 2024,) I thought mainline economists would demand a substantial increase in public health spending. After all, if after the reports submitted by 14 of the successive Finance Commissions, if public sector investments in health is less than 1 per cent of GDP, isn’t it time to question the economic rationale behind it? The question that also needs to be asked is how has China been able to invest 5 per cent of its GDP on public health? How have the other emerging economies, Brazil and South Africa, invested 9.2 per cent and 8.1 per cent of their GDP on public health, respectively?

The second wave has exposed the chinks. This calls for a larger public debate on what kind of economic policies are best suited for a country like India. Hope the catastrophic second wave will make us rethink, force policy makers to take a relook at the economic policies that are required to meet the challenges of an Atmanirbhar Bharat.

(Devinder Sharma is an award-winning journalist, writer and food and trade policy analyst. Views are personal)