On the night of 23rd March, PM Modi decided to abruptly lock down 1.3 billion people. I wasn’t home; I was instead in a village 50 km away from home, and the news of the lockdown had me worried for a bit. I can’t even begin to imagine the plight of migrant workers and daily-wage labourers, whom I now see all over the news walking 700 km and carrying their children over their shoulders. The announcement carried a nostalgic thread of 2016 when the PM did the same thing with demonetisation. Known for his bold decisions, this was the boldest of them all.
Many have praised him for this move and rightly so. It is the only known solution that a country can take during such times. Everyone is in the pursuit of flattening the curve, and social distancing seems to be the most effective way. But can a country like India afford a lockdown announced in such a short notice? Or is it only delaying the outbreak?
The situation is unquestionable regarding our economy, which is already in shambles. The economic growth fell 4.7% in the last quarter, which is at its lowest in the last six years. This is expected to fall another 2.4% in the next quarter (Jan-March), and to make matters worse, we are likely to increase our borrowing plan for 2020-2021 to Rs 7.8 trillion, and making the central bank to directly buy these bonds, reports Al Jazeera. Furthermore, our fiscal deficit is mounting to 7.5%, which is more than Vietnam and Bangladesh with 4.4% and 4.8% respectively.
The floating population is the worst affected in such a situation. They are the informal workers of our country who roughly make about 80% of the total workforce, out of which 8.8 million of the households are scattered across congested urban slums with an average income of Rs 150 per day. According to a report by the World Health Organisation in 2016, India spent about Rs 4,500 per person on healthcare, six times less than what China spends. Our public health expenditure is about 1.2% to 1.6% of the total GDP between 2008-09 to 2019-2020, which is about $9.7 billion compared to $66.7 billion spent on defence from the total budget.
Budgetary allocation for the Department of Health and Research is so poor in our country, that 97% of this budget is directly allocated towards the Department of Health and Family Welfare. Governing establishments such as the Indian Council for Medical Research (ICMR) received only 3% (Rs 2,100 crores) of the medical budget in the 2020-2021 financial year. According to the National Health Profile of 2019, the per capita of the public health expenditure is Rs 1,657 in the 2018-2019 financial year, three times lower than Indonesia and even lower than Sri Lanka.
I think our government takes solace on the historical fact of our country’s inability to mobilise in times of uncertainty, like how we were able to eradicate smallpox. The concerning issue is our country is undergoing an ongoing war with an existing epidemic of tuberculosis for many years. The WHO estimates around 2.8 million people have been affected tuberculosis in India, and the numbers are only rising. Some 480,000 people die every year in India alone and more than 1,300 per day, which is more than reported deaths from HIV-AIDS from South Africa. Though TB is far less deadly than HIV and easily curable, Indian healthcare seems to be struggling tremendously.
Zarir Udwadia, a lead researcher, stated in his 2010 study that prescriptions given out by the small privatised sectors are inappropriate. These contribute towards strengthening the virus rather than killing it. Our fight against it is not over and diseases like COVID-19 take over. Is our healthcare system ready to take up the challenge?
First of all, we are in the context of this pandemic, our country has the lowest testing rate. With a capacity of testing about 8,000 per day, the government was only testing about 90, which has now slightly risen with broadening of the testing criteria of people without travel history only very recently. The case of the first corona related death was reported on 11th March of a 76-year-old man from Karnataka who was initially rejected by a private hospital. It was only after his death that the results of his tests came in.
The concern of the lack of facility provided by the central government was displayed by Chattisgarh Health Minister T.S Singh Deo when he wrote to Union Health Minister Harsha Vardhan, stating that there is only one centre in the State that is carrying out tests. he also asked for more testing kits in the State to be able to carry out the vast testing program. Meanwhile, Kerala exceptionally expanded its guidelines on testing over a wider population much earlier on.
Dr S.P Kalantri, a medical superintendent, told Vox that he expects 55% of the total population to be infected by COVID-19, that is around 300 to 500 millions of cases in the next four to five months, and around 1-2 million deaths from it in a year. Now, these are daunting numbers to hear and are directly reflective of how our health system is set up.
We have around 0.5 hospital bed for every 1,00 people according to the Organisation for Economic Cooperation and Development, while Italy has 3.2 and China has 4.3. According to the National Health Profile, a compilation of all the data that the Union Health Ministry has at his disposal reports that India has a total of 11,54,68 allopathic doctors that are registered, out of which, only 1,16,756 doctors are eligible to carry out current tests, that is one doctor every 10,926 person. The WHO has recommended a standard ratio of one doctor for every 1,000 people.
According to a 2016 report by Reuters,every country needs more than 50,00 critical-care specialists, while India possesses only 8,350 of them. We need to understand the condition of our healthcare system, where the private sector hold about 70% and only a smaller portion is controlled by the government. Only a small number of our population can afford better health facilities, every Indian state is in the stage of acquiring new beds, increasing the capacity of ICU’s, life-saving ventilators and so on.
Given the numbers from some of the biggest states in the country are quite alarming. Maharashtra, with more than 126 million population, has only 450 ventilators and 502 ICU beds in public hospitals. Chhattisgarh, with a population of 32 million, has only 150 ventilators and only 25 specialists know how to ventilate, while Assam has 200 ventilators out of which 36 are not functional. Telangana has only 1,000 of such ventilators. Even the Indian Railways is preparing 7,000 beds and 500 ventilators in its hospitals all across the country. There are 40,000 ventilators in the Indian inventory.
The government has recently come up with a Rs 15,000-crore financial package to meet the health expenditure in the country, but it falls Rs 5,000 crores short of the Central Vista of New Delhi Project. It is a project to develop and beautify all the prominent buildings in Lutyens Delhi. The financial package makes up less than 1% of the country’s GDP, while countries such as Britain, Spain and Germany have given up to 20% of their GDP.
I fail to understand how things will pan out in the coming days, and I don’t know how our country is going to react, given the vulnerable state of our healthcare system. An Atlantic article by Vidya Krishnan on the dire and frightening conditions of the Indian healthcare system for concludes with a quote by Ramanan Laximargan: “Imagine that you’re standing on the shore and you’re watching the tsunami come in,” he told the BBC. “If you are going to just stand there, and watch the tsunami, you are finished. If you can run as fast as you can, you have a better chance.” Krishnan adds, “India is not running fast enough.