We might not have foreseen the approaching COVID-19 crisis but were aware of our medical unpreparedness, says Kandarp V Patel
India is under lockdown, just like many other countries across the globe. It is a step to flatten the curve to avoid large number of COVID-19 cases and resultant fatalities. In times of uncertainty, speculation is dominating many discussions in media while some experts have resorted to scenario-based planning.
Experts have argued how India’s healthcare system isn’t strong enough to cope in a worst-case scenario, which is if millions of people get infected from the virus. Prime Minister Narendra Modi too mentioned this issue in his recent address to the nation. Moreover, fault lines in our healthcare industry are already becoming visible with stories of shortage in supply of essential medical equipment like isolation beds and ICU beds, PPE, workforce and the list goes on.
Several audit reports have highlighted deficiencies in our healthcare system time and again. So what are these early warning signs ‘we’ (including executive government, healthcare workers, elected representatives, media and common public) ignored? It is obvious that a poor country like ours has to maximise its resources. One CAG report (2019) on public healthcare system of UP had following observations:
oICU services were available only in DHs Lucknow and Gorakhpur out of the 11 test-checked DHs/JHs.
oIn the absence of an ICU facility in the remaining DHs/JHs, patients approaching these hospitals in an emergent condition were likely to be referred and/or passed on to higher facility public or private hospitals.
oThe ICUs in DHs Lucknow and Gorakhpur also suffered from shortage of essential equipment such as ventilators, infusion pumps, ultrasound and arterial blood gas analysis machines.
Apart from public health, let’s now talk about it from the lens of accountability.
Public financial management relates to the way governments manage public resources — both revenue and expenditure. It is government’s responsibility to maintain prudent level of public debt and deficit. It involves elements like cash management, public procurement, expenditure management, internal and external audit.
As lockdown greatly impacts the economy, central government and many state governments have announced relief packages. To meet this sudden expenditure requirement, some state governments have started announcing deferment of salary payments to all classes of state government employees. This is taking place as the government has leveraged its balance sheets earlier by breaching FRBM targets and borrowing off-budget to the extent possible. Often other expenditures take precedence over things that do not seem urgent at that time. This can be seen in the CAG Report 20 of 2018 for the Central Government said:
“Government has increasingly resorted to off-budget financing for revenue as well as capital spending. In terms of revenue spending, off-budget financing was used for covering deferring fertiliser arrears/bills through special banking arrangements; food subsidy bills/arrears of FCI through borrowings and for implementation of irrigation scheme (AIBP) through borrowings by NABARD under the Long-Term Irrigation Fund (LTIF).”
It has been observed time and again that our public expenditure needs deep rationalisation. In a recent study on centrally-sponsored schemes by ICRIER, it was observed that 158 schemes out of 204 has just Rs 5.7 crore as average outlay per scheme per state. This is inadequate to run any meaningful scheme for Indian states. Such schemes, if rationalised, can help re-allocation of amount as high as Rs 27,000 crore to priority areas. This is just an example from the central government. Similar cases are widespread across state governments as well.
If governments were held accountable through the existing mechanism by raising right questions in the right forum, we would have been in a better fiscal position to support our poor migrants better in time of this crisis.
Some might also point out that this is not the right time to talk about accountability and past deficiencies. Well, I agree. But I hope when the crisis is over and we are making a list of lessons learnt for future, we remember and look at accountability enforcement as a governance-improving mechanism and not as a fault-finding one. We could look at the accountability mechanism as an early warning system for our public systems to handle such crises. COVID-19 was one crisis we didn’t see coming but medical unpreparedness was something we could.
(The writer is a civil worker. Views are personal.)