Imagine apost-Covid India in which the most important persons in the Union Cabinet arenot the Ministers of Finance, Home or Defence but the Minister of Health &Family welfare. This leader, as the Prime Minister’s pick and the probablePM-in-waiting, refuses to spout the mythical healing powers of gau-mutra andstrictly sticks to evidence-based medicine while recognising that traditionalmedicine is important and has its place in the Indian order of things. This Health Minister leads a vast team ofdoctors who are the pride of the Indian civil service, the most covetedpositions and respected people in government and society.
This signalchange at the top mirrors the change along the chain right down to the bottom,at the district where the Chief Medical Officer (along with an Educationofficer) is the most important and resourceful officer of the government in thedistrict, and caries the same financial powers as the Collector and theDistrict Magistrate. Primary and Secondary Health Care Centres under her areconnected by technology to a dashboard and live data is generated and posted onthe health, literally, of the people of India, minute-by-minute. No onecomplains that doctors are missing, the beds are dirty or that ambulances don’twork. Cases are referred with speed. There are district hospitals in the publicsector or the charitable sector of the kind run by as AIIMS in New Delhi or CMCin Vellore. Five-star health is unfashionable; doctors forced to meet billingtargets speak out; hospitals forcing them to do so are prosecuted. Healthinsurance premia fall dramatically and most treatment is by prefixed andregulated fees or at very nominal costs. There is still space for gold plated health treatment for the rich andthe trendy but most people, including the rich themselves, feel that is quiteunnecessary when public health care is so good.
This is thevision of an India that is built from the grass roots up and is ready torespond to challenges of a world that has been shattered by the Covid-19pandemic. This is a vision that will require political stamina and huge publicspending, of the kind that can trigger a revival in the economy and build itfor the future so that our growth takes on a whole new meaning. If India has tomove out of Covid to a place where it really heads towards becoming global power,then there is no escaping the reality that its maximum investments have to bein primary heath and primary education; not in bullet trains, smart cities ormega statues. Not many people know that Modi mooted the bullet train at apublic meeting in Mumbai before he became the Prime Minister where he admittedas much openly that even he knew nobody would ride on that train. But it willhelp us show to the world in the same way, he said, China shows off Shanghai!This was always the road to doom. Covid-19 has brought that doomsday right infront of us.
Today, thepicture is of India on its knees as the poor cannot hold out anymore with thelockout and the threat of Covid-19 won’t let us lift the lockout. You aredoomed if you do and doomed if you don’t.
It is true that India is not the only nation in this conundrum but India stands apart among the large and faster growing economies that has inevitably unleashed the horror of hunger, helplessness and penury on a very large segment of its population. Suddenly, the bright spots of the Indian economy like the demographic dividend, largest reserve of scientifically trained manpower, global IT backend and the country with a new story of rising domestic consumerism have collapsed into the real picture of real India – tens of thousands walking back home with meager belongings, hit with police lathis, some weeping and many hungry. These constitute the “bottom of the pyramid”, that fancy term used to sell to those who can afford to buy only in small units, those who oiled the economy on less than fair wages and then spent some of those on sachets that made our FMCGs look good on the stock exchanges. Yet, when the time came, they were unsupported, shunned and literally put on the streets, and in their collapse they announced the collapse of the Indian economy that has had no means to ensure their food security, health security and their economic security. Where has seven per cent plus GDP growth got us then?
In fact, soshabby is the treatment of the poor that there is ample anecdotal evidence thatmany will not return to work the way they used to. An ASSOCHAM survey reported36 per cent of its respondents saying “manpower availability” will a keychallenge. Other challenges were managing costs (81%), weak demand (74%),weakening rupee (30%), availability of financing (45%) and supply chain uses(48%).
There areother prescriptions for revival of the economy, among them those from the likesof the builder Niranjan Hiranandani, the President of ASSOCHAM and National Real Estate DevelopmentCouncil (NAREDCO), who says that industry needs a “stimulus of over $200billion with an ability to go up to $300 billion with $100 billion providedimmediately, $100 billion in four months and the last $100 billion in eightmonths”. The esteemed Chamber, it might seem, has sliced out its cake intothree neat mouthfuls and is ready to bite. What if the government pumps it allinto healthcare, where, by its own account, the Community Health Centres run with a huge order ofvacant posts. As on 31 March, 2019, out of the sanctioned posts, 79.9% ofSurgeons, 64% of obstetricians & gynecologists, 77.5% of physicians and69.7% of pediatricians were vacant! Ifthis is fixed, if the investments are prioritised, we will change the uglynumbers that tell us that even today, in so-called modern India, only 21% of mothers received full ante-natalcare(16.7% in rural India and 31.1% in urban India), according to the latestNational Family Health Survey (NFHS-4). Fixing this will reduce maternal mortalityand child mortality, which will lead to a reduction in the fertility rate,which means parents can invest more in their children and enable them grow tobecome healthy contributors so that India can reap the real demographicdividend, not the dividend wrested from underpaid, undernourished andunder-supported populations who must fend for themselves every time a crisishits us.
It was 50years ago that a landmark judgment in the US (Judge Grufein in the PentagonPapers case) wrote: “The security of the nation is not at the ramparts alone”.The words come alive in an entirely different context today as health standsequated with the security and the future of India. Which way will the nationturn?
(The writer is a journalist and a faculty member at SPJIMR) (Through The Billion Press) (e-mail: editor@thebillionpress.org)