Never in the history of India has a lockdown of this magnitude and scale been envisaged or implemented. And never in the history of India has the entire population faced such a strain; neither has the economy nor the healthcare system faced such a crisis. The virus is spreading rapidly; the hospitals are steadily getting stressed and would find it tough when the number of cases goes up. According to WHO’s World Health Report 2000 that compared country performances, the healthcare systems of France, Italy, Spain and the US ranked 1st, 2nd, 7th and 37th respectively; India ranked 112th. After this crisis, many countries will take a hard look at their healthcare systems and three issues in particular.
Firstly, the importance of an adequate ratio of doctors to patients must be addressed. According to the World Bank, Spain and Italy have 4.1 physicians per 1,000 people, while India, it is just 0.8 per 1,000. The number of hospital beds available is also low in India, with only 1 bed for 879 people. The ratio is likely to be worse considering the actual usable beds. This is a wake-up call for the healthcare system of the soon-to-be most populous country in the world. We must look outward for inspiration. Cuba boasts a ratio of 8.2 physicians per 1,000 people.
It is a commendable achievement to not only invest in the healthcare system but also to export healthcare ‘soldiers’ to nations in need. Similarly, India must invest in its doctors. We must take a hard look at the state of medical education in our country. It must be made affordable and accessible to all. Consequently the cost of accessing healthcare would also fall. Secondly, the crisis highlights the need for a Make in India impetus to medical healthcare. Doctors face both a lack of administrative support and limited personal protection equipment (PPE). Without these basic requirements the system would collapse.
The lockdown has also resulted in the disruption of the supply chain and to an extent, a disruption in the transportation and production of essential goods such as nebulisers, ventilators and PPE, especially face masks. Importantly, the crisis has shown the excessive dependence of even the most developed countries on import of medical equipment. So India must pursue the indigenous development of medical equipment, both in terms of capacity and capability. Unfortunately we are even importing PPEs though state-of-the-art technology is not needed to produce them. Due emphasis must be given to diagnostic equipment that currently amounts to a third of the $8 billion market share of medical equipment in India. Our nation is also heavily dependent on imports as it imports 50% of its medical equipment. Notably imports from China have seen a double-digit growth since 2017.
Thirdly, focus must be placed on production of high-tech equipment suited for Indian conditions at low costs. Entrepreneurs in the medical field must be promoted and the monopoly of state utilities must be broken. The monopoly of HLL Lifecare has proved a disaster and must serve as a lesson. Aravind Eye Hospitals is a worthy example. Innovation and dedication to a greater cause has resulted in a Rs75,000 operation to be performed for a mere Rs750, a 99% cost reduction. Aurolab has produced a lens for a mere Rs 80, 1/10th of the global market cost. Now they are exporting these lenses. Such efforts must be given a substantial push. Funding research in development of medical devices will provide cheaper and efficient alternatives. Within a few months of the Covid-19 pandemic in India, cheaper, novel alternatives for testing were developed. Recently the DRDO also developed a special sealant for biosuits due to the lack of seam sealing tape. It is an example of what is possible if support and funding is provided.
A policy change forced by a crisis has often helped in India. Take for example the agricultural and milk revolution in the 1970s or the economic liberalisation in 1991. These were responses to crises to which the state was forced to react. It’s 2020 and there is again a need for a policy change. The corona crisis has affected the lives of all Indians and there is an opportunity to enact changes if the ruling party of the day chooses to do so. The question whether the government is doing enough also arises. According to the Overseas Development Institute, India has the strongest measures, but at the same time has also spent the least on fiscal stimulus as a percentage of GDP. Western nations have provided a substantial economic stimulus. However in India despite a financial crisis brewing for the past five years the government has not shown a sense of urgency. Meanwhile we have helped big businesses by doling out tax reductions while also refusing to help MSMEs, which generate a lot of employment.
In these circumstances, unemployment has also been a constant concern. With the expected onset of stagflation, unemployment is likely to rise further. The US, within a few weeks, reported over 6 million unemployment claims. The situation in India is likely to be worse considering the lack of data and formalisation of employment. Keeping this in mind I intend to introduce ‘The Indian Unemployment Insurance and Benefits Bill 2020’. The Bill would ensure employers provide 70% of the daily average wage for a period of 90 days. A widow who is the guardian of a minor would be entitled for this benefit for a period of 120 days. Further it shall ensure employers provide medical insurance to the employee and his or her first degree family upto Rs1 lakh for secondary and tertiary care and 50% of primary care costs for a period of 120 days. These would be in addition to existing benefits. This would consequently ensure unemployment insurance is made a statutory right for every employee, white or blue collar.
I hope the government will take note of these measures and fully support our healthcare soldiers. We must make our contribution by practising social distancing and adhering to the lockdown. (Noel Therattil contributed to the article)
Lavu Sri Krishna Devarayalu
YSRC MP from Narasaraopet, Andhra Pradesh Email: firstname.lastname@example.org