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India has never been prepared for a public health emergency of the scale of covid. No country has. But the government’s dislocated priorities have left the nation particularly vulnerable. It is now running short of basics, including oxygen tanks, ventilators, antiviral medication and hospital beds, with hundreds of thousands of new infections being recorded every day. Public health spending was dismally low to begin with, at just close to 1% of India’s gross domestic product. The country ranks 179th out of 189 on prioritization of healthcare in the government budget. It spends as much as donor-dependent nations like Sierra Leone on a per capita basis. The country’s medical facilities are so inadequate that overall hospitalization rates for the sick are among the lowest in the world: 3% to 4%, compared to an average 8% to 9% in middle-income countries and even higher elsewhere.

The country has never quite focused on its public healthcare infrastructure—which is perpetually on the brink, making its apparent success holding down infection numbers last year remarkable. But the country is having no such luck with the enormous numbers emerging right now.

Prime Minister Narendra Modi has encouraged the growth of private hospitals by providing them with land and tax exemptions, creating a healthcare market expected to be worth $133 billion by 2022. Most Indians now depend on private medical facilities. The problem, of course, is that the financial burden ends up being shouldered by households: India’s health-related out-of-pocket expenses are some of the highest in the world, and continue to rise.

A significant amount of India’s health budget is spent on subsidies for private service providers, which does little to build medical infrastructure or further its healthcare goals. Private hospitals are built to make money without committing to such national outcomes as lowering mortality rates or disease. Fundamental health infrastructure doesn’t even make it onto the political agenda. The public investment necessary to effect change has limited returns for ambitious politicians over the short-term. The Modi government enables this abdication of responsibility. The country’s latest Economic Survey noted that “better health infrastructure is no guarantee that a country would be able to deal better with devastating pandemics like Covid-19" because the next one could be different.

As an example, the government will probably point to Brazil, which has been posting tens of thousands of new cases a day and has one of the world’s highest virus-related death numbers. Its population is around the same as that of Uttar Pradesh, and it spends over 16 times the amount India does on a per capita basis on healthcare. Yet its medical system is overwhelmed.

But that’s exactly why India should be worried now. If India falters, its failure will be many times the disaster in Brazil.

More than a year after the outbreak, countless infected people in India have been denied a chance to recover because the government hasn’t built a system that will get them the medical supplies they need. A country of nearly 1.4 billion people needs a system to support their most basic need: survival. The idea that a private health system focused on profit could adequately attend to almost 18% of the world is ludicrous. A real healthcare apparatus would’ve ensured the populace understood risks, remained vigilant and received care.

Instead, overwhelmed hospitals have just hours of oxygen supplies available, antiviral medications are hard to find, and intensive care units are close to capacity. Ad hoc measures may well help India slowly make its way out, but it won’t guarantee things stay that way. Just as they didn’t when the country thought it had miraculously fought off the virus.

India’s paltry public healthcare spending isn’t guided by holistic, national-level priorities. It varies by state and each ends up funding far more than the Centre does, leading to unequal outcomes for people in different regions. The differences have become political, as federal and provincial governments battle over who is responsible for specific needs.

All this means India isn’t set up to survive the covid waves that are bound to follow as they have elsewhere in the world. Blame who or what you want, the reality is India needs to assess how prepared it is for future surges. The Modi administration will have to do far more than just invoke unity, as he did in last week’s national address.

Negligence—individual to bureaucratic—is being blamed for India’s latest covid wave. That is true. It will be even truer if India does not do what it must: go back to the basics of building the country’s healthcare infrastructure. It’s pointless being the ‘pharmacy of the world’ if you can’t heal your own people.

Anjani Trivedi is a Bloomberg Opinion columnist covering industrial companies in Asia.

©bloomberg

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