In early June, my 90-plus uncle developed a fever. That was the first indication that things weren’t well, and it took a week of running around for us to finally confirm that my uncle had indeed contracted covid-19. The resident welfare association, district administration and public health authorities kicked into action once my uncle was diagnosed. A week later, the rest of the family, which comprised my aunt, who is in her 80s, their live-in domestic worker, my cousin (their daughter), her husband and son, they all tested positive, except my nephew. My uncle was found to have contracted the disease from his attendant. My cousin lives independently with her husband and son in the same condominium block as her parents, and had been carefully maintaining isolation up until her father’s fever, when she visited them to comfort her panicked mother. The family went into lockdown in their respective homes. Medical attendants were organized, medicines and oximeters were bought. Some of us organized a roster to deliver food to my cousin’s household, and we all waited with bated breath, hoping that hospitalization wouldn’t be required. Luckily, none of them did and all recovered relatively unscathed.
This story will find an echo with many, as increasingly a number of us either personally know or have heard of acquaintances, family members or friends who have contracted the virus, been hospitalized, recovered or lost loved ones to it. India’s tally of covid-19 cases continues to rise—1,535,516 at last count, the third highest in the world. We take comfort in the low death rate of 25 per million population. Various theories abound for this curious anomaly. The Indian middle class has cocooned itself by adopting measures such as work-from-home, online deliveries, etc. In addition, people realize—though gallow-type humour continues with jokes about how if the disease won’t kill you, the hospital bill will—that most of us may not need hospitalization. The “home isolation packs" offered by private health providers of “covid-protocol trained and equipped" medical attendants are a cheaper and safer alternative. But the country’s working classes have no way of accessing or affording it. They are left with our shaky, sketchy and under-funded public health facilities.
We know that countries with excellent resources and far better health infrastructure have crumbled, and that India’s health infrastructure was always overstretched and under-resourced, at best. Journalist Puja Mehra points out that India’s total healthcare spending (out-of-pocket and public) is 3.6% of gross domestic product (GDP) and that the “average for OECD [Organisation for Economic Cooperation and Development] countries in 2018 was 8.8% of GDP". Given that even one illness can drag a family back into poverty, it is odd how we seem not to regard it as an important public policy issue or an electoral one.
There is a difference even in the way we talk of the pandemic in urban versus rural areas. In our cities, private care or public-private partnership models seem to be the solution, whereas for rural India, people must turn to the government’s low-paid, contractual, under-resourced paramedic workers (who are largely women). The flagship programme of the previous United Progressive Alliance government, The National Rural Health Mission (NRHM), is not even referenced in discussions and opinion pieces, though it at least provides a semblance of health architecture and institutions, along with other frontline workers: auxiliary nursing midwifery, anganwadi staff, accredited social health activists (Asha workers), etc. There are few discussions on different models for public health provision. For example, the individualized insurance-based Ayushman Bharat programme, dubbed “Modicare", versus broader bottom-up programmes such as NRHM, which attempted to build local-level healthcare institutions.
The Indian middle-class, which wishes to see “vikaas" (development) and India take its place at the table of “developed" nations, needs to refocus on what actual development is. The view that any social welfare spending is a “handout" and “wasteful" has resulted in a situation where ultimately we all end up as losers—with our healthcare and education systems fostering inequity. It ends up profiting no one; rather, it creates deep divides. In addition, as Mehra points out, “The health sector creates both high and low-skill jobs and can be used for pump-priming the service and manufacturing sectors." She goes on to suggest that post-covid-19, “a specially designed fiscal stimulus can be funnelled into public health and policy bottlenecks removed so that the sector becomes the engine of GDP growth".
We need to recognize how higher spending on public health and education will benefit every citizen. A well-educated and healthy population with easy and affordable access to both is not just a utopian idea, for we have seen the economies of countries adopting such an approach prosper. It’s time we demanded this for our fellow citizens. Eventually, we shall all be beneficiaries of such a system.
Radha Khan is an independent consultant working in the field of gender, governance and social inclusion