Healthy stimulus

Govt should increase expenditure on health care

The Centre and the governments of Delhi and Maharashtra took great pride in the mammoth temporary facilities that were set up to cope with the surging rates of Covid-19 infections. But this satisfaction is misplaced, because these facilities underscored like nothing else the appalling inadequacy of public health care in India. The pandemic has also brought into sharp focus the culpable reluctance of private-sector hospitals, most of which have come up on local government concessions, to step up to the plate during this unique crisis. In urban areas, it was possible for state administrations to armtwist private hospitals to divert facilities for Covid-19 treatment. In rural areas outside the ambit of local administration, private hospitals simply turned away infected patients even as public-health institutions lacked the necessary basic facilities (intensive care units, or ICUS, with ventilators, for example) to treat them. Clearly, the belief that an expanded private health care system can substitute for its failing public counterpart has proven tragically untenable. The manifest inability of government hospitals to cope with the surging numbers of Covid-19 infections has encouraged state administrations to promote behavioural interventions (social distancing, arbitrary lockdowns, the use of masks, etc) to keep demand down, none of which has proved noticeably successful in controlling the spread of the virus. Instead, the message that the Centre and state governments need to heed is a blunt one: To augment and improve the public health delivery system on a mission-critical basis.

The very visible failure of public health delivery in Delhi and the country’s financial capital masks the far bigger health care infrastructure crisis that obtains in the states. Many states fall well below the already dismal national average of less than one government hospital bed (0.55) per 1,000 people, such as Bihar, Jharkhand, Chhattisgarh, and Uttar Pradesh. This is not surprising, given their relatively backward economies. But prosperous states such as Gujarat, Haryana, Andhra Pradesh, and Maharashtra also fall below the national average. The fact that just 5 to 8 per cent of the 713,986 government hospital beds qualify as those with ICU facilities only serves to highlight the level of the crisis in the Indian public health system. A National Health Mission launched in 2013 and the Ayushman Bharat public health insurance scheme, launched in 2018, which claims to be the largest of its kind in the world, have gone some way towards improving the poor Indian’s access to health care.

But the progress has been painfully slow. For instance, under the National Health Mission, which was launched to augment state health care facilities, only 24,000-odd facilities (from primary health care centres to district hospitals) were completed till 2019, and another roughly 35,000 renovated and upgraded. Even without a health crisis this is woefully inadequate but the pandemic offers the government a unique opportunity to focus on public health care delivery in a major way. Doing so can have a multiplier effect for an ailing economy. India has persistently had one of the world’s lowest spends on health care both as a percentage of GDP and on a per capita basis. Even doubling this expenditure to build primary and tertiary health care facilities, especially in backward areas, would serve multiple goals. A public health care expansion programme would create jobs in construction and service delivery, increase demand for equipment manufacture, and expand the market for health care-related jobs, presenting the government with the opportunity for a genuinely healthy stimulus.