I have been in healthcare and I always felt so happy being in the healthcare sector for a quarter of a century (despite not being a clinician), as it provides so many opportunities to serve people in need. Also, sometimes, being able to save lives too, by helping in organizing the right care at the right time. There cannot be a bigger satisfaction in life than to see a smile on the face of a person who came in distress. Hence, for me, healthcare is the most satisfying and rewarding sector to be in. However, the last week has been terrible, where I have seen people losing lives, desperately searching for a bed, oxygen and even medicines, even though India was known as the ‘Pharmacy of the East’. India’s present crisis has forced one to ask some crucial questions.
Did Covid-19 stress healthcare unduly? Undoubtedly, Yes! But, was there a ‘healthcare system’ in place, and did we have a plan? NOT AT ALL! We need to go back in time to understand the origin of the problem and find a solution so that in the future, we don’t have to lose our near and dear ones.
Constitution and Health: Article 21 of the Constitution of India states that “No person shall be deprived of his life or personal liberty except according to procedure established by law”. ‘Life’ in Article 21 of the Constitution is not merely the physical act of ‘breathing’. The constitution broadened the ambit to include the right to live with human dignity, right to livelihood, right to health, right to pollution-free air, etc. - the idea behind being that the state shall provide for the basic minimum necessities critical to the ‘right to live'. But today, the very act of breathing is non-existent for want of oxygen.
The numerous calls on the phone, the flash of news in print and TV is agog with the horrid stories of struggle to save lives, and deaths due to lack of infrastructure. Despite the guarantee in the constitution, what brought us here? It is time to look back and introspect.
Constitution and national health policies should have been the guiding philosophy for leaders and planners. But did we even read them? Leave alone understanding or implementing it. In the past seven decades, we could not even build an infrastructure that can care about the health of our people?
I was involved in drafting the National Health Policy (NHP) 2017, and it has been four years since NHP 2017, but have we really understood the thinking behind the NHP and tried its stock-taking? How many times has the Central Council of Health and Family Welfare met to discuss Covid? What is the commitment of the people in the government and administration in implementing the policy and the mandate of the constitution? Should we not question it and fix the accountability? Also, it is time to make health a concurrent subject, if not a central subject.
The deadly combination of uneducated leaders, greedy corporates, ignorant public, and the contemptuous disregard for science has wreaked havoc. Our priorities are misaligned and actions ill-intentioned.
Reckless and unaccountable bureaucracy has been the biggest impediment. I recall, during my tenure as advisor to the Union Health Minister, the PM-JAY was launched. A lot of other projects and ideas were also approved that would have come in handy in handling this pandemic. For instance, the Healthcare Information Exchange, national registries, expansion of AMRUT & Jan Aushadhi stores on a franchisee model, building more hospitals and expanding our network of health and wellness centres, health helpline, etc.
Some projects were scuttled, despite the availability of funds by an IIT-trained bureaucrat. Trying to reform MCI is a clear example of the rampant corruption in the healthcare system, and at the top of it, we are planning to give gold, silver, and bronze accreditation through the Quality Council of India (QCI) for healthcare? It is a classic case of shoddy implementation of well-intentioned policies.
AIIMS Delhi is another culprit. Senior doctors at AIIMS get connected to powers in Delhi and occupy key positions and I don’t have to mention the names. Every top Covid management position is held by doctors from AIIMS. What did we expect from such people who got positions as a political quid pro quo? Why could they not pick people from different parts of the country and not only from AIIMS?
Last week, the judiciary made bizarre statements like; ‘Beg, Borrow and Steal’ to ‘Will hang those who come in the way’. Were they sleeping all this while? When the judiciary makes a call to ‘steal’, it is an indication of how broken the system is!
We Indians are religious people and believe that since we pray religiously, God will take care of us. In fact, we have rather started to believe, ‘Worship is Work’. We have forgotten that we need to work to get results. Another problem is that we celebrate victory too soon. A vast country like India cannot be run on hope, optimism and optics. We need swift and ground-level actions based on multiple scenario planning models for every state based on the demographics, economic and educational factors.
Now that we know where we have reached, we need to take definite actions. In Outlook, an article in March of 2020 called for forecasting multiple scenarios and making preparations for the same in light of Covid. Why did we not do it? Why do we not hold people in the government accountable? Shouldn’t the Health Minister resign for the number of deaths and disband the current Covid management task force which has been in place for one year. Let them give the opportunity to a new team. The message will go loud and clear that you cannot stay in your seat if you don’t deliver outcomes.
Also, our model of relying on big business houses for everything is faulty. Even in the case of oxygen, we have a few players who account for about 90 percent of the oxygen generation. District-level systems are also not in place for this critical resource. Why hospital clusters can’t be encouraged to generate as per need? Oxygen rates have gone up by 40 percent in the past few weeks, so will removing GST be enough?
Now, the administration is scrambling to get its act together. But the accountability must be fixed. Delhi-based experts participating in high-level meetings through video conferencing should be dispatched to the epicenters of the pandemic and should be attending meetings from there.
Also, as a rule, public leaders and bureaucrats should be mandated to use only public healthcare and without any preferential treatment, though free, and that is when the healthcare system will start falling in place.
Finally, the buck stops at us, the voters. We should ask who are we voting for and why. We have chosen leaders for considerations of caste, religion, money etc. and so, we are being served what we ordered. I cannot blame the elected beyond a point. Second, we have put our leaders on such a high pedestal that we cannot accept that they can fail, and we have not put our heads to check if they delivered what they promised, and the media has failed to deliver the ‘truth’. In all, Covid has shaken people’s trust in the people they elected. But Indian’s never wake up before being pushed to the wall. Now that we have been, India will awake, rise and shake up things. That will shape the New India.
(Prof. Rajendra Pratap Gupta is a leading policymaker and author of the book ‘Healthcare Reforms in India’ and founder of Health Parliament – a Think Tank on Health. He tweets @rajendragupta. Views expressed are personal.)