Preparing for medical and financial emergencies

The coronavirus has resulted in a serious health and economic crisis. The second wave has not only spread rapidly but has also weakened the resistance of the people. India is reporting more than three lakh cases daily. Many hospitals are scrambling for oxygen as infections surge to new highs. The country leads the world in terms of average daily cases detected.

Having declared a 21-day lockdown during the first wave, the government is now contemplating another lockdown to contain the second wave which includes night curfews, weekend lockdowns and staggered lockdowns.

In Wuhan, the epicentre of the coronavirus, the lockdown has been lifted and they are already on the recovery track. India is in a deeper crisis. The number of positive cases and fatalities has been spiralling. Joblessness has increased and migrant labourers are left to fend for themselves again. Migrants are leaving in hordes fearing another lockdown. It will become worse than the exodus in 2020 if the present situation worsens. According to CMIE, the unemployment rate touched 8.6 per cent for the week ending April 11, from just 6.7 per cent two weeks ago.

The Kumbh Mela in Uttarakhand saw an estimated one million plus devotees gather at the Ganga’s banks in the town of Haridwar for an auspicious dip — their devotion hailed as protection enough. Evidence of supernatural intervention to protect this super-spreader event though has not shown up in the area’s COVID tests, which are reporting a contagion. The Tika Utsav that was supposed to encourage the vaccination drive has failed to accelerate our state run immunisation programme. Fresh curbs on normal life, announced to contain the second wave of the pandemic, will take a toll on the economy.

Crisis management is a governance issue that is more vital and complex and is now in the core of India’s administrative system. The system requires innovative thinking and fundamental changes in order to quicken the emergency response of the administration and increase the effectiveness of the machinery to meet the crisis situation and enhance preparedness to that end. It is necessary that the apparatus of crisis management perform and deliver.

Under the UPA-I regime, the Government of India constituted the 2nd Administrative Reforms Commission under my Chairmanship. The Commission submitted its 3rd Report “Crisis Management – Despair to Hope” in September 2006.

It is quite possible that a severe, widely prevalent epidemic could overwhelm the coping capacity of functionaries. It is, therefore, also imperative that contingency plans dealing with such situations draw upon the general system of disaster management by developing formal and well defined linkages

The Commission had recommended the following.

One, to more effectively prevent the outbreak/spread of epidemics, it is imperative that a comprehensive revised “model” legislation on public health is finalised at an early date and that the Ministry of Health and Family Welfare systematically pursues its enactment by the states with adaptations necessitated by local requirements.

Two, the Union legislation governing public health emergencies be introduced for final consideration in light of the feedback received from states at an early date.

Three, the Ministry of Health and Family Welfare has to ensure that requisite plans envisaged under the Disaster Management Act, 2005, are drawn up in respect to epidemics and that the role of the district administration finds explicit mention in the Public Health Emergency Bill. The structure created by the Disaster Management Act, 2005, should be utilised for managing epidemics also.

Four, while surveillance and management of epidemics are the responsibilities of public health professionals, it is clear that a particularly severe outbreak could overwhelm the capacities of the “line organisations”. The Ministry of Health and Family Welfare and the state governments must ensure that “standard operating procedures” are devised to assign roles and responsibilities of agencies and personnel outside the line organisations wherever a situation so warrants.

Five, state level handbooks and manuals concerning disaster management should have a chapter on “epidemics-related emergencies”. A model chapter may be circulated by the Ministry of Health and Family Welfare for guidance of states. It may be useful to document the past handling of epidemics like the Plague (Surat) and Japanese encephalitis (Eastern UP) to facilitate standardisation of response mechanisms

A policy framework has to be drawn up with requisite legal and institutional mechanisms that focus on risk reduction as a major priority in disaster management.

The world conference on natural disaster reduction held at Oklahoma in 1994, set out the strategy to meet such a crisis. Since COVID-19 has spread all over the world, it is high time a global conference of the kind is held to take stock of this grave situation and work out a strategy and plan of action for a safe world.

Government and insurance companies should play a more proactive role in monitoring the situation in vulnerable areas to spread the insurance cover. We don’t find any such strategy for such coverage. There should be a national and state level approach for an institutional arrangement for medical emergencies. This arrangement envisages involvement of private hospital to a large extent. May be a legislation is required to enforce this.

The UPA-I contemplated a Public Health Emergency Bill. Later this was introduced as Public Health (Prevention, Control and Management of Epidemics, Bio-terrorism and Disasters) Bill in 2017. This new legislation, gave powers to the Centre and the state governments. Unfortunately this bill did not see the light of the day. It is unfortunate that NDA failed to understand the foresight of the then government.

I think it is the right time for the government to review the status of the Public Health (Prevention, Control and Management of Epidemics, Bio-terrorism and Disasters) bill and promulgate the ordinance to meet the present crisis. The bill was to provide for the prevention, control and management of epidemics, public health consequences of disasters, acts of bio terrorism or threats thereof and for matters connected therewith or incidental thereto.

There are four pillars viz. policy, institutional framework, technical matrix and financial regime. These should ideally work in synergy towards managing the crisis. The blanket lockdown in the country or in a given state is only a desperate strategy. A country of 130 crore cannot afford this kind of a crude lockdown. The Government of India and the state governments should have a pragmatic approach of governance to meet with such a serious crisis.

The government will have to respond with additional relief measures for migrant workers who once again flee cities for the social security of their native villages. At the same time, the government and the RBI will have to come up with additional support for the pandemic struck industry, in particular the small and medium sector and the construction industry.

The financial and medical emergencies will have to go hand in hand. We have a fragile economy and social fabric compared to other countries. We have a large army of migrant labourers from different regions of the country and ethnicity. Hence, we need to work out a staggered lockdown exit which is the real solution to the present crisis.

The Government of India should immediately prepare an action plan for both, medical and financial emergencies and implement the recommendations made in the 3rd Report on Crisis Management by the 2nd Administrative Reforms Commission. The adhocism and off the cup solutions will not be able to tide over the present crisis of unprecedented dimension.

The writer is former Union minister