Sunanda K Datta-Ray | After COVID devastation, India to need rebuilding

India Post has just delivered two bank statements posted in late May. This is not the only instance of delay and/or damage caused by the coronavirus pandemic.

Its devastation recalls Rabindranath Tagore’s deathbed despair about British rule in India: “When the stream of their centuries’ administration runs dry at last, what a waste of mud and filth they will leave behind!”

If the pandemic does end in two years, as World Health Organisation director-general Tedros Adhanom Ghebreyesus predicts, it will leave behind a ramshackle India.

This week’s suicide of a five-member Madhya Pradesh family is another tragedy highlighting the despondency that grips much of India.

Most social and welfare institutions were already creaking on March 25 when India ground to a halt. Everything has deteriorated since then, with the government too busy scoring points against China and Pakistan to bother with ordinary folk. Covid-19 is no respecter of rank, but as Raghuram Rajan, the Reserve Bank’s former governor, says, it is “an ‘anti-Robin Hood’ that hits the poor even harder on every front”.

The first charge on the government is to improve a scandalously decrepit healthcare system. Better infrastructure would have mitigated the worst effects of the pandemic.

Instead, the suspicion is that the facts have been brushed under the carpet to conceal the derelict state of rural hospitals, the acute shortage of doctors, enlistment of ayahs as nurses and sweepers and bearers as paramedics. Medicines and equipment are in short supply.

No wonder Microsoft’s Bill Gates bluntly rejected the official figure for Indian (and African) fatalities, saying: “The true number… is probably much higher.” He expects millions more in India and Africa to die and thinks more than 90 per cent of those deaths will be caused by the knock-on effects.

The reason is that people are expendable for our political masters. They will spend money for the greater glory of what they see as India but not for the ordinary run of Indians.

Outsize statues, massive temples, ostentatious religious rituals, state-of-the-art fighters and luxury aircraft for VIPs matter more than the millions of impoverished Indians. Few, if any, good schools are run by the government. The best of them are either Christian missionary institutions or private enterprises.

Understandably, spending on healthcare was low in colonial times; but the colonial norm becomes criminal negligence when governance is by a supposedly nationalistic Bharatiya Janata Party whose leader swears by “Atma Nirbhar Bharat”, or self-reliant India. Within the abysmally small pie of medicare spending, the government’s share is a shameful 26 per cent, 74 per cent being provided by private investors who are in it for what they can get out of it.

The charges have gone up in a once-smart, expensive and superbly professional foreign-managed nursing home that is now Indian-owned while the food, cleanliness and staff care have deteriorated. Amenities like toilet paper and towels are no longer provided. The owners themselves fly to Switzerland or the United States for treatment.

Since much of the investment in healthcare is left to market dynamics, private medical facilities proliferate only where people can pay. State expenditure is confined largely to areas where it can benefit the rich and influential or impress foreigners.
The need for a healthcare delivery system that is available, accessible and affordable to all is ignored. So are the need for healthcare infrastructure, healthcare education, manpower, workforce, health insurance and medical equipment.

India’s bed density is under one while China, with its much larger population, provides more than three beds per thousand. Despite the highest number of medical colleges, India has the lowest number of doctors per thousand of population and is in the middle -- fifth out of seven -- in the number of nurses per 1,000 people. India also has the lowest number of care providers -- 1.9 per thousand.

Medical equipment is another problem that the pandemic has exposed and highlighted. Personal protective equipment is sometimes charged for without being provided.

The government’s claim of adequate imports supplemented by a spurt in the domestic manufacture of nearly 4.5 lakh PPE kits per day does not seem to meet the needs of all frontline workers, while nearly one-third of respondents in a recent survey reported that N-95 masks were not available.

“One of the surprising and important findings is the lack of formal training on PPEs”, a leading doctor is quoted as saying. Over half these workers had not received any training at all, while a fifth reported that they had taught themselves.

Of course, many other aspects of decline deserve attention. India has slipped to 150th place in the health and survival list, to 149th in terms of economic participation and opportunity, and to 112th place for educational attainment.

It has also fallen four places to 112th in terms of the gender gap, now grovelling among the bottom five in terms of female participation in economic life.

Underlying it all is an erosion of confidence; confidence in the self (atma-vishwas), and confidence in the elected government’s ability to deliver. A survey shows that 62 per cent of parents will not send their children to schools even if they were to reopen next week.

The survey also found that only six per cent of respondents would visit a theatre. There is obviously little faith in the government’s ability to check infection in schools and theatres.

The challenges are on a variety of fronts. A beginning can be made with healthcare for that bears closely on the peril that still threatens to decimate the nation. But there can be no cure without official recognition of all that is wrong, of the extent to which policy has fallen short of public expectations.

Alas, our leaders remain blissfully complacent that they have not failed the country because the colonial-style culture of governance does not say that the rulers owe anything to the ruled.