India is never ready for a public health emergency of Kovid scale. No country. But the government’s displaced priorities have hit the country particularly hard. It is now low on the basics including oxygen tanks, ventilators, antiviral drugs and hospital beds, with hundreds of thousands of new infections being registered every day. Nearly 1% of India’s GDP, public health spending is very low. The country ranks 179th out of 189 in giving priority to health care in government budgets. It costs per capita to donor-based countries like Sierra Leone. The country’s medical facilities are inadequate, and hospitalization rates for the sick are among the lowest in the world: 3% to 4%, compared to an average of 8% to 9% in middle-income countries, and even higher elsewhere.
The country has never focused on its public health care infrastructure — it is constantly on the edge, having been successful in reducing infection numbers last year. But there is no such luck in the country right now.
Prime Minister Narendra Modi has encouraged growth by giving land and tax exemptions to private hospitals, creating a $ 133 billion health care market by 2022. Many Indians now rely on private medical facilities. The problem is that the financial burden ends up on the shoulders of households: India’s health costs are the highest in the world, and continue to rise.
Substantial sums of India’s health budget are spent on subsidies to private service providers to build medical infrastructure or further enhance its health care goals. Private hospitals were built to make money without committing to national outcomes such as mortality rate or disease reduction. Primary health infrastructure is also not on the political agenda. The government investment needed to influence change will have limited returns for short-term ambitious politicians. The Modi government will have to relinquish this responsibility. The latest in the country Financial Survey “Improved health infrastructure does not guarantee that a country can withstand a devastating pandemic like Kovid-19” because the next one is different.
As an example, the government probably refers to Brazil, which is posting tens of thousands of new cases per day and has the highest number of virus-related deaths in the world. Its population is similar to that of Uttar Pradesh and it spends 16 times more on health care than India does on a per capita basis. Yet its medical approach has sunk.
But that is why India should be concerned now. If India misses, its failure will many times be a disaster in Brazil.
More than a year after the outbreak, countless infected people in India have been denied the chance to recover because the government has not built a system to get the medical supplies they need. A country of about 1.4 billion people needs a system that supports their basic need: survival. It is ridiculous to think that a private health care system focused on profits could adequately be attended by almost 18% of the world’s population. A true health care tool makes people understand the risks, stay alert and receive care.
Instead, oxygen supply is only available for a few hours in overcrowded hospitals, antiviral drugs are hard to find, and intensive care units are close to capacity. Temporary measures will help India get out slowly, but it does not guarantee that things will stay that way. They didn’t when the country thought it had fought wonderfully from the virus.
India’s small public health care spending will not be guided by absolute, national level priorities. It varies state-wise and each gives a lot more funding than the center, which leads to unequal results for people in different regions. The differences have become political as federal and regional governments struggle over who is responsible for specific needs.
All this means that India has not been established to withstand the waves of commitment that follow like nowhere else in the world. Blame who or what you want, the reality is that one has to assess how ready India is for future growth. As the Modi administration did in its national address last week, much more needs to be done than demanding unity.
Alleged negligence — personally bureaucratic — was responsible for India’s latest Kovid wave. That’s true. That would be even more true if India did not: go back to the basics of building the country’s health care infrastructure. Being a ‘global pharmacy’ means you can’t heal your own people.
Anjani Trivedi is a Bloomberg opinion columnist covering industrial companies in Asia.