Corona has taken a heavy toll on the health systems of various lower and middle-income countries including India. Meanwhile, Kashmir suffers from a double burden of ‘healthcare fragility’ and ‘unaccountability’. Interestingly, for the first time, discrimination has not occurred among the rich and the poor, bureaucrat and commoner, male and female, srinagarite and non-srinagarite. Nevertheless, it has exposed the fragility of our health care governance and the collapsing nature of our health system. Understanding this tragedy requires a timely retrospection: who is responsible for this crisis inflicted by corona pandemic?
Where have we failed?
From a regulatory point of view, health sector has always suffered ‘neglect’. It is often suggested that our health system has no ‘guardian’. The authorities are often criticized to maintain the status quo in health sector thereby evading ownership and accountability. Even though the public health services sector is running as it is, lack of proper management has unveiled serious ramifications. The promise for free healthcare has remained as it was – unfulfilled. The whole sector has been gifted to private industry by our own hands which has resulted in catastrophic expenditure on common populace. Yet, people choose to bear this expenditure because the trust on public hospitals has long eroded. Corruption, bribery, informal payments and mismanagement have become socially acceptable in delivery of health services. While the prevalence of absenteeism is high among the health care providers, at the same time, prevalence of dual practice is also high. What remains are the miseries and sufferings of common man.
In almost 73 years of independence, we are polarized into his, her, theirs and ours. A multi-faceted version of this division has resulted in inequalities, inequities and victim-blaming. Our education system creates thousands of semi-educated individuals every year. We have privatized education without considering the demand side requirements. Moreover, we amplified its ramifications with private tuitions making it a matter of show-off and class. We induced the class system in society, yet we don’t seize to criticize it. We failed to create an enabling environment for professionalism. Rather, we resorted to rule-bending. As a result, education may have changed from percentage to grades but it is deemed strangled. Instead of making judicious use of our resources, we have not stopped complaining about the limited resources we have, and yet loot them every day.
Urbanization has taken a heavy toll on our cities making them inhabitable. Now, we are after waterbodies and swamps. Our roads require replenishing every year yet they are damaged and shabby. Our footpaths are for two wheelers and our roads are parking lots. Road traffic accidents show an increasing trend. Our drainage systems are dysfunctional because they are blocked by polythene. It is often banned but that has only increased its value in the black market. Our roads and bridges take decades to complete. We have introduced a culture of oppression instead of democracy and equality. We have tarnished and eroded the trust within families. Our family courts have millions of property cases pending. Domestic violence is at peak and elderly abuse is socially acceptable. Our marriages are a mere show-off of social capital, individuals influence and position in the society. Money and muscle have become our social status while responsibility and responsiveness have expired.
The way forward
We make the society; thus, we are responsible for our state of affairs. Radical interventions rather reforms are warranted at the grassroots level. We have long passed the time of ‘promising’ and public speaking. Practicality and action are needed in the times to come. Primary education requires strengthening with a robust and dynamic curriculum where feedback must be taken from the students at the end of the year and relevant modifications made. Social audit has become an imperative in the education system. Our education system requires strong integration of humanities, health education, law and career-oriented subjects. A bottoms-up approach is required rather than carrot-stick autocratic approach. Students need to go ahead with their choice rather than what is available. Vocational trainings and community service should be made mandatory after the age of sixteen, so that students, while pursuing higher education, can also support livelihood. Problem solving approaches of education are warranted in colleges. Field works need to be made mandatory for students thereby promoting experiential learning. These interventions if carefully administered will generate leaders and agents of change rather than battalions of unemployed youth.
Public healthcare system deserves utmost priority and support of the communities. Mohalla welfare committees and trusts could take it into their hands to induce a community based socially responsible model of health care delivery where the community people volunteer on rotational basis. Scarcity of funds in hospitals could also be overcome by efforts of the community members. We have examples where we have spent millions on religious places, the same individual donations could also be spent on hospitals through a community based regulatory mechanism thereby making the end-users accountable. Community based health insurance is warranted in Mohallas. These social security nets will not only aid individuals in times of turmoil but will also insure their better future. At the same time, preventive component of public health deserves utmost priority. Health education coupled with behavioural change messages integrated in schools, colleges, offices, and at any place where gatherings occurs will bear outstanding results. However, at the same time, this requires unequivocal support from the governance actors as well. Nevertheless we have to start somewhere and end our complaining nature. We can only achieve prosperity, if we choose to work on it.
Ateeb Ahmad Parray, Fellow Researcher, Center of Excellence for Gender, Sexual and Reproductive Health and Rights