Dr KVR Prasad, Dr Hari Kumar, Dr Zaheer Khan, a 70-year-old popular physician, a head nurse at a government hospital: The common thread linking them is the sacrifice they made as they performed their duties with dedication in the face challenges posed by the ongoing coronavirus pandemic. These doctors and over 150 medical professionals from Hyderabad and across Telangana caught Covid-19 infection as they continued serving patients in the past two months.
At the all-India level, over a 100 doctors have lost their battle with the virus since the lockdown in March, according to the Indian Medical Association (IMA). Another 1,300 have tested positive. Maharashtra is the worst and the nationwide percentage of fatality among infected doctors is about 8%.
Another important pointer from the IMA is that 73 of the 100 doctors who lost their lives were above 50 years. The higher percentage of fatalities is also very worrisome indeed, it stated. Sounding a serious note, the IMA urged the medical fraternity, especially hospital administrators, to raise their guard and start working on improving safety standards and protocols that ensure protection of the health workers.
From the early days of the pandemic in March, the common demand of the healthcare fraternity across the country has been access to better protection equipment, improving safety protocols and beefing up healthcare in government hospitals, which are bearing the brunt of the virus.
From the famed All India Institute of Medical Sciences (AIIMS) in New Delhi to the Gandhi Hospital in Secunderabad, medical practitioners have been voicing this concern. Ironically, the chief of the sanitation wing of the AIIMS succumbed to the virus while hundreds of junior doctors and healthcare workers of the Gandhi hospital took to the streets protesting against attacks to lack of protective gear as the cases started rising and hospital infrastructure was being overwhelmed.
The pandemic exposed the chinks and shortfalls in the healthcare infrastructure in the public sector. Though in the initial phase and also as the virus spread fast, medical practitioners have done a wonderful job so far. What’s wanting is the fast track help from governments in building support systems.
As things stand today, with nearly 15 lakh cases, and expert projections of the numbers going into crores in the next few months, the government is faced with a Hobson’s choice. Invest big and quickly in both infrastructure and recruitment of healthcare professionals, even while taking care of the ‘frontline warriors’ now. The question of funds shortage in budgets catering to medical and health at the Centre or States perhaps can be addressed through transfers from other ministries with the concurrence of the Finance Ministry as this is an extraordinary situation.
In Telangana, there has been a steady dip in allocations to health. In 2018-19, it accounted for 3.9% or Rs 5,976 crore of the Rs 1.49 lakh crore Budget. In 2019-20, it dropped to 3% or Rs 5,536 crore of the estimated Rs 1.82 lakh crore Budget (later downsized to Rs 1.46 lakh crore due to fall in revenues). In 2020-21, the State allocated Rs 6,186 crore of the estimated Rs 1.82 lakh crore Budget. Even at the Centre, the allocation to health has been slowly increased in the successive Budgets, it accounts to around 1.5% of the GDP, way short of the required minimum of 2.5%.
One of the prominent reasons for the inadequate to shrinking budgets towards health is the shift towards a greater private sector role in this important area in most of the States. No wonder that in the past 25 years, nearly 70% of the country’s healthcare capacities have been built in the private sector, according to official estimates. Consequently, cities like Delhi, Chennai, Bengaluru, Mumbai and Hyderabad have witnessed a big growth in large corporate and privately-held hospitals. It has meant two things — brought the best in class medicare to those who can afford and simultaneously pushed up healthcare costs.
The other visible feature of the shift to the private sector has been the rapid growth in private practitioners, nursing homes and smaller hospitals in cities, district headquarters and in some smaller villages too. This growth happened in most places at the cost of the extensive public healthcare centres (PHCs), which were the lifeline for affordable care to the poor. In Hyderabad, for example, the old government hospitals like Osmania General Hospital, Sir Ronald Ross Fever Hospital, Niloufer, King Kothi have hardly seen improvement and on the contrary, have been deteriorating over the past two decades.
While States and the Centre have been making noises on strengthening the PHCs, they have often remained promises or on paper, with a few exceptions like in Kerala or pockets of other States.
In this scenario, the next few months present a grim picture for the large percentage of people dependent on affordable healthcare as the country braces up to tackle lakhs of cases spreading throughout the country. There is no doubt, that the task is Herculean for governments alone.
Should the government then rope in the private sector with a greater role? The choice seems limited with neither an effective drug nor vaccine in hand to halt the virus. However, the synergy is fraught with many issues that need to be ironed out as the private sector cannot be expected to do charity or lower its costs too much in a competitive environment. This calls for a few rounds of consultations between expert groups drawn from both the government and private hospitals to define clear guidelines that can ensure clarity in operations and managing the challenges at hand.
The half-hearted attempts made in some States have led to confusion in testing, treatment costs, etc. It’s time to iron out these ticklish issues and move forward concertedly as the challenger in the form of Covid-19 is too formidable.
(The author is a senior journalist and former Associate Editor, The Hindu BusinessLine)