The world must invest in robust public healthcare systems and universal access to healthcare
The novel coronavirus pandemic—more than 2 lakh infections and 10,000 deaths, with experts warning that a large part of the global population could end up infected if countries don’t make urgent containment efforts—underscores, like never before, the need for all countries to develop robust public health systems, and to ensure universal healthcare access. Early warnings of global vulnerability to contagion—the 2002 SARS, and the 2012 & 2017 MERS outbreaks—went unheeded. Now, the health systems of most nations hit by Covid-19 are severely challenged—in Italy, overwhelmed hospitals are having to take extraordinary triage decisions. In the US, where testing was made free only on Wednesday despite the spike in cases, the average per capita out-of-pocket healthcare spending (in purchasing power parity terms), at $1,103, is one of the highest in the world—nearly twice that of neighbouring Canada—an analysis of WHO data by KFF cited in a Vox report shows. CNN talks of how 28 million “non-elderly Americans” were uninsured in 2018. If high costs prevent infected persons from seeking the right treatment and containment, including quarantine, it significantly affects the chances of contagion. The UK (~2,000 reported cases) has free healthcare for all, but drastic cuts to the National Health Services funding by Conservative Party governments have meant it lacks both infrastructure, and manpower.
India seems to have escaped, so far, the levels of infection many Western and Asian nations have reported. But, given the contagion’s exponential growth curve—new infections number shoots up from single/double digits to hundreds, even thousands, almost overnight as community infection breaks out—the number could spurt if all efforts to contain community infection are not made. Also, until deeper community testing is carried out in and around geographies where cases have been reported, especially in states with a history of poor public health, the likelihood of containing Stage III spread is low. Public health is critical for such response, but the country sorely lacks this. For instance, Uttar Pradesh, as of March 31, 2019, had one functioning primary healthcare centre (PHC) for every 91,700 people—against one PHC for every 64,800 people at the national level. The country has one PHC doctor for every 37,652 people, compared with the overall doctor-population ratio of 1:1,457. On healthcare access, the Ayushman Bharat scheme, which provides cover to nearly 50 crore individuals, now includes Covid-19 as well as other illnesses in confirmed Covid-19 cases. Swacch Bharat, Nal se Jal, Poshan Abhiyaan, etc, also show that the government is batting on the front foot for a robust public health ecosystem. But, getting it right—i.e., pandemic ready—is a different ballgame altogether.
India—indeed, the world—would do well to heed former chief economic adviser Arvind Subramanian’s advise in a Project Syndicate article: International aid should be funding the creation of global public goods (GPGs) that improve global welfare—through “development of technologies to promote agricultural productivity, actions to prevent climate change … course, preventing and dealing with pandemics”—whereas it largely gets channelled into country-lending linked with certain outcomes (usually, infrastructure that ties in with the donor’s interests). If India is to train its focus on increasing spending on GPGs, it must begin by scrapping wasteful subsidies—the NFSA that gives heavily subsidised grains to even the non-poor, the fertiliser subsidies and MSP policy that benefit large farmers the most, etc. The savings can be used to create hospitals and R&D facilities, extend state-sponsored health insurance to a larger pool, or a more expansive coverage to those already covered. With climate change and the need for deepening globalisation, pandemic threats could grow. India’s readiness for such threats will hinge on how it moves on its legacy of wasteful, populist policies.