Lockdown as a strategy to contain the spread of the Corona pandemic is questioned by many. More particularly looking at the high rate of transmission of the disease including rise in mortality rate since the opening of the economy ( with lockdown continuing at State/regional level)for economic activities from June 1, opinion is gaining ground against the potentiality of lockdown as a measure to control the spread of the virus.
Hence focus has gradually shifted from this behavioural intervention to providing health facilities to curb the disease. However, India being a large populous country with underdeveloped public healthcare system, there is a need for strengthening the public health to meet the eventualities if there happens to be community spread of the virus.
Realizing the crucial role of public health in the present context , the Prime Minister has recently announced Rs 15,000 crore towards building the health infrastructure. But as it is largely viewed, the public healthcare suffers from long policy neglect and there is a need for a structural reform to make this system contribute quality service to the people along with fighting Covid-19.
On this issue let me explain how health- a basic element for a better human living, remained neglected in the development policy all through the post-independent India.
With the country getting independence, contrary to the expectation that health be treated as a basic human right, the framers of the constitution placed health under the Directive Principles of State Policy with the provision of healthcare the responsibility of the State Governments. Accordingly, the States were also made responsible for raising the level of nutrition and standard of living of their people and improvement in public health remained their primary duty. By this way health as a basic human right was compromised from the beginning.
Besides, over the planned period of development, emphasis was laid on accumulation of capital through large-scale investment in capital goods industries, infrastructure etc. Industrial growth was the keyword of development. The social sectors like health and education were considered as low priority areas. The States could not mobilize adequate resources since agriculture income was exempted from taxation. This led the States to reduce expenditure and it fell largely on social sectors like health and education. All along public expenditure on health ( Centre + States) continued to remain at around 1 per cent of GDP. In recent years there has been marginal increase in expenditure on healthcare at 1.3 per cent of GDP between 2008 and 2015 which has further increased to 1.4 per cent in 2016-17. However, this is less than world average of 6 per cent. The National Health Policy, 2017 has proposed to raise it to 2.5 per cent of GDP by 2025.
Since the beginning of 1980s, the Indian economy witnessed a higher pace of economic development leading to better living standards of the people , particularly those residing in urban areas. As such, under the influence of middle class urban elite, the Government ’s policy focused on establishing hi-tech and super speciality hospitals in the country under private sector. This led to rapid growth of uncontrolled and unregulated private health sector in the country. In the 1990s with the adoption of economic reform, a major shift in Government ’s healthcare policy towards developing tertiary care resulting massive investment in corporate hospitals, diagnostic centres etc, was noticed. As a result whatever little control the Government had on private healthcare sector was done away with and the Government became facilitator to private health sector, rather than provider of healthcare in the country. Taking the available data, today private healthcare caters to 70 per cent households in urban areas and 63 per cent in rural areas.
A weak public health system which does not function well in a normal situation cannot suddenly generate surge capacity when challenged by a health emergency. This suggests adequate investment in creating a public health system that can withstand any kind of health emergency. Besides, as studies reveal the private healthcare sector suffers from excess capacity and this needs to be strategically used by the Government. There is robust evidence that investment in primary healthcare pays rich economic dividends. A re-thinking on the development policy of the healthcare is the need of the hour.
(Dr Panda is a former Professor of Economics, PG Dept of Analytical & Applied Economics, Utkal University, Bhubaneswar)