The Covid-19 global pandemic has reinforced the importance of public health as a top governance priority. In the absence of a robust public health infrastructure India has had to settle for a prohibitively expensive, massively disruptive alternative strategy of a nationwide lockdown though cases here were relatively few. The possibility of cases skyrocketing like Italy, Spain or the United States in a poorer, more populous nation was reason enough to embark on this course. But our sacrifices may still not suffice: Covid-19 could still slip through a leaky public health system. After decades of underfunding healthcare, the consequences are coming home to roost.
It is time now to let go of penny wise, pound foolish approaches. At around 1.1% of GDP, government’s spending on healthcare has remained stagnant for over two decades. The corresponding expenditure was 4% for Brazil, 2.9% for China, 4.4% for Iran and 8.6% for the US in 2017. India is like Pakistan in this respect, which devotes 0.9% of GDP to healthcare. Central government accounts for a quarter of India’s measly healthcare spending. Not surprisingly, the recent pan-India survey of IAS officers from 410 districts to assess Covid-19 preparedness revealed many requests for more critical care facilities, life support systems, ambulances and beds in district and taluk hospitals.
There are other systemic infirmities too. Medical education in India has been skewed largely towards urban areas. New medical and nursing colleges must now open in underserved districts. Expenditure on preventive healthcare – involving activities like immunisation, nutrition monitoring, disease screening and related capacity building – is just 7% while treatment and cure accounts for 80% of spending. Ending the lockdown will require intensification of labour intensive contact tracing, household visits by health workers for disease surveillance and rigorous aggregation of data they collect.
Without adequate manpower and resources such activities are difficult at grassroots. Other public health areas like maternal and child health, legacy infectious and lifestyle diseases, and other government services cannot be neglected just to combat Covid-19. The confidence displayed by some states in managing the outbreak stems from long-term investments made in public health. While health is a state subject a national thrust can produce results, as seen in the dramatic improvement in toilet coverage after the Swachh Bharat scheme. Central funding for a decentralised public healthcare system can be the Modi government’s next big national mission.
