Introduction:-
All of a sudden the country has turned into despair and desperation. And why not people are not getting medicines, oxygen, hospitals etec. There is real anger in the air. Yesterday we saw a video of the usual suspects like Barkha Dutt who as while speaking to a foreign channel , blames the country and poor medical infrastructure. The statement by former Home and finance minister P Chidambram is more disturbing where he is suggesting people to revolt (https://www.ntvtelugu.com/en/post/p-chidambaram-calls-for-peoples-revolt).[1] . The difference between positive people and negative mindset people is that the previous category always tries to sit down at home and attempts to solve the problem while the other will rant about it with every other outsider.
As the PSA to the govt of India Sh VijayRaghvan acknowledged today that the ferocity of the crisis had surprised everyone with the correct diagnosis [2]. Of course there will be critics saying so why the govt was sleeping after wave 1 ; true there is no convincing justification for that, except that we all know how our Indian system moves then no explanation is further required. People are expecting from PM Modi to wipe the legacy of the past 70 years or so in one go. However they forget that we have inherited a system which has people as its main resource besides how they act and move . One cannot change this system in one go even if there is a PM like Modi.
When the Corona crisis started last year sometime in December 2020, how many Ppe kits and ventilators did the country had ? This time we are shouting for O2 as there is a real crisis and chaos for medical oxygen. Something similar happened at that time for ventilators. This too will also pass and we will have the capacity to manage our futuristic oxygen needs. The legitimate question therefore would be why are we not able to see such catastrophe beforehand. In the third wave we are sure there will be chaos for something else may be Beds, hospitals and nurses /doctors. Because during the past 70 years we have just not allowed the private institute to develop and all our nurses from Kerala served the rich gulf countries for their livelihood. So before blaming Modi let us also have a look at ourselves in the mirror.
This crisis provides all of us with a unique opportunity, to sit and muse over our contributions, weaknesses and strengths.
This is the right opportunity for all of us to boost and strengthen our primary health services and facilities in the country. WE can ALSO TRY TO COME up with something ‘DRAMATIC’ , AN ATTEMPT TO SOLVE THE PROBLEM AT HAND. AS THEY SAY WHEN THE TIMES ARE TOUGH THE TOUGH (MODI) GETS GOING ! SO BASICALLY WE HAVE TO THINK WHAT CAN BE DONE IMMEDIATELY AND DRAMATICALLY TO MITIGATE THE CRISIS.
Before we suggest our views let us quickly go through what all has happened during the past 70 years or so of independence.
Background:-
The Government of India’s 1946 Report on the Health Survey and Development Committee (also known as Bhore Committee) had declared “the inadequacy of existing medical and preventive health organization” as one of reasons for India’s poor health condition in its report. Moreover, the recommendations included an infrastructure plan for a three-tier health care system district level to provide preventive and curative health care to dwellers in both rural and urban areas.
Since the Bhore committee nine other committees have been formed, to examine the challenges faced by the healthcare sector in the post-independence period, the latest being the National Commission on Macroeconomics and health 2005. The report highlighted the problem of lack of resources which have made the health system unaccountable and disconnected to public health goals, and inadequately equipped to address people’s growing expectations. The estimated total investment of Rs 74,000 crore consists of a whopping projected Rs 33,000 crore for capital investment required for building up the battered health infrastructure alone. The commission recommended that an institutional infrastructure which consists of a number of autonomous and self financed bodies is a bare minimum to cope up with the health situation in India. Thus in the period of about 60 years the problem of health infrastructure has remained unresolved.
The National Rural Health Mission (NRHM) was launched by the Hon’ble Prime Minister on 12th April 2005, to provide accessible, affordable and quality health care to the rural population, especially the vulnerable groups. The Union Cabinet vide its decision dated 1st May 2013, has approved the launch of National Urban Health Mission (NUHM) as a Sub-mission of an overarching National Health Mission (NHM), with National Rural Health Mission (NRHM) being the other Sub-mission of National Health Mission.
The BJP government did acknowledge this ground reality. Sushma Swaraj the vibrant and one of the best MP / Minister to have , had the vision to create more AIIMS in the country . Today these AIIMS are providing valuable services to man in state capitols and some of them have become excellent medical facilities. WE have been the AIIMS Rishikesh and have seen first hand the administration of the hospital.
A natural question at this point will be how India compares with China in terms of GDP spent on health services. Obviously we are lagging behind on this critical criterion. China being a more centralised authoritarian government is able to allocate funds and see that they get executed.
Unfortunately / fortunately in India health services fall under the state jurisdiction. While some of the states have progressed well others have failed to keep the progress. During the past decade , The phenomenon of rapid growth of the private health sector has resulted in a situation where a large share of health infrastructure has come under the private players. States like Delhi have really failed to boost its medical facilities . Both the apex cout and High court have chastened the govt over the recent crisis over oxygen and hospital beds.
We would like the attention of readers to this excellent paper / report by some scholars at Vivekananda International Foundation. (VIF) [3.a]. There is another updated report on health policy that can be seen in this paper [3.b] . Health infrastructure is an important indicator for understanding the health care policy and welfare mechanism in a country. It signifies the investment priority with regards to the creation of health care facilities. Infrastructure has been described as the basic support for the delivery of public health activities. Five components of health infrastructure can be broadly classified as: skilled workforce; integrated electronic information systems; public health organizations, resources and research.
Solution and Conclusion:
While we Indians have a habit of blaming everyone but self and also looking for excuses rather than finding solutions and executing them timely it will be really foolish if we still indulge in mud-slugging . It is important to see what can be done now. WE propose the following to the government:-
1. Decentralise: Utilise the already functional institutes and organizations of the state and central government. The 23236 primary hospitals centers can be trained and equipped immediately to cure not only coronavirus patients but others also. If we divide around 100 crore people on these 23236 centers then the accountability of each center comes around 43000 which can be handled judiciously, out of which only a few will need critical treatment.
2. Utilise Human Resources: The govt has 1399697 Aaganwadi workers who are paid monthly salaries Thus we already have a pool of human resources who all can be trained medically to provide first hand treatments. Similarly
3.Need for a Health Model: In the long run the govt can think of developing model health infrastructure in the country. The status report on Public Health Infrastructure prepared by the Department of Health and Human Services (Centers for Disease Control and Prevention ) provides a helpful model through its recommendations. [4]. The country has National health mission (NHM) , PHS Primary health services) , CHS (Community health services) , NRHM (Rural Health mission), NUHM (Urban Health mission) etc. THEN THERE ARE STATE DRIVEN PROGRAM AND CENTRAL PROGRAMS AND SCHEMES. [5.a] . There are health wellness centers under AYUSHMAN BHARAT Yojana [5.b] .
There is a NEED TO MERGE AND COLLAPSE ALL SUH CHEMES WITH THE HELP OF A ROBUST DIGITAL DRIVEN PLATFORM. We could have solved and made some architecture had the govt invited us. But the problem in the country is no one hears you until there is chaos.
need to merge .
4. IT and ICT:- In the United States, a national Health Alert Network (HAN), consisting of a network of Centre and State funded websites, had been established which provided basic implantation of Internet Connectivity, broadcast communications and distance learning capacity at local level. As per recommendations provided by the report all health care departments must have immediate access to current public health recommendations, health and medical data, treatment guidelines, and information on effectiveness of public health interventions..
6. Vaccination Policy:- Make a centralised Vaccination policy for the long term. This crisis can be used to formulate a national vaccination policy for the long term. Indian government already has certain vaccination schemes and there is always PRESSURE FROM THE international community and organizations like WHO etc. It will be wise and prudent at this stage to go the whole hog as coronavirus is here to stay with more variants and mutants. The govt must hurry up on this front.
7. Revamp NHRM: Rural India needs to be protected. The rural infrastructure of India is in a very sad state of affairs. Although the government initiated National Rural Health Mission Programme (NRHM) aims to bring qualitative and quantitative changes in the rural infrastructure, however the goal to provide a universal access to healthcare facilities remains a distant dream in rural India. The government can focus on the Rural health care system by taking into consideration the Aaganwadi and primary health care centers infrastructure.
8.Scale up Cowin and Arogya Setu Digital platform: During the coronavirus pandemic, in December 2020, a new COVID-19 vaccine delivery digital platform called ‘CO-WIN’ [6] was prepared to deliver vaccines. As a beneficiary management tool with different modules, this user-friendly mobile app for recording vaccine data, is in the process of establishing the ‘Healthcare Workers’ database, which is in an advanced stage across all states/UTs. The Cowin platform can be extended with a real time database of hospitals , beds, oxygen facilities. There are already social media posts that provide real time data one of them being from IIT delhi which have made a Covid data app that provides all such information [7]
References:-
[1] https://www.ntvtelugu.com/en/post/p-chidambaram-calls-for-peoples-revolt
[3.b] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5144115/
[4] Centers for Disease Control and Prevention (2010), Public Health’s Infrastructure, CDC Publishing
[5.a] https://www.pwc.in/assets/pdfs/publications-2012/healthcare_financing_report_print.pdf
[5.b] https://nhm.gov.in/index1.php?lang=1&level=1&sublinkid=112&lid=205
[6]. https://www.ibef.org/industry/healthcare-india.aspx
Asheesh Shah
Samanvaya.
