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3rd April – Editorials/Opinions Analyses

Contents:

  1. Making the private sector care for public health
  2. Safe forests, safe people: Zoonotic Diseases

MAKING THE PRIVATE SECTOR CARE FOR PUBLIC HEALTH

As the battle against COVID-19 continues in India, it is unclear how well prepared the healthcare system is in dealing with the pandemic.

There exist resource constraints at both the Central and State governments and it is clear that government hospitals alone will not be able to manage the fallout. Moreover, even within the government system, tertiary care and public health are the weakest links.

Lax preparedness

A preparedness plan has to address all levels of care in terms of infrastructure, equipment, testing facilities and human resources in both the public and private sectors. Yet,

  • Both Central and State governments have not hinted at increase in public expenditure on health – thus meeting increase in moderate and severe cases by already overburdened system will not happen
  • Some private sector companies/hospitals have come forward with offers of creating capacity and making it available to COVID-19 patients, but a comprehensive national policy to ensure that private healthcare capacity available to public for free is needed
  • Some States like Chhattisgarh, Rajasthan, Madhya Pradesh and Andhra Pradesh have already roped in the private sector to provide free treatment.

What can be done?

The governments at the Centre and in States have to take responsibility for providing universal health services free of charge and accessible to all.

  • This will require governments to not just expand the capacity within the public sector, but also to tap into the available capacity in the private sector.
  • The National Health Authority has recommended that the testing and treatment of COVID-19 be included in the PM-Jan Arogya Yojana (PM-JAY). This is to be done at the earliest
  • A visible central command, by creating a task force, with Union Health ministry as node, should be able to make policies and communicate them to state governments
  • Some states have capped the testing cost at INR 4500 in private hospitals. This is to be made free because it is unaffordable even for lower middle income families
  • Before the lockdown ends, adequate testing and quarantine facilities are to be created. The Central government has already taken over some private hotels to accommodate persons quarantined for COVID-19.
  • One way of expanding such facilities would be for the government to ‘take over’ private corporate laboratories and hospitals for a limited period.
  • A graduated approach to this is possible by asking tertiary private hospitals to create ICU facilities and isolation wards to care for the moderate and severe cases under the supervision of the government.

The Spanish parallel

This may not be as impossible as it sounds. The Spanish government issued an order bringing hospitals in the large private corporate sector under public control for a limited period. This tough decision was taken with the understanding that existing public healthcare facilities would not be able to cope with the sudden, if short-term, rise in COVID-19 cases.

Time to giveback

In India, private corporate hospitals have, in the past, received government subsidies in various forms and it is now time to seek repayment from them. They are also well poised to provide specialised care and have the expertise and infrastructure to do so.

A case for Universal healthcare

The government may argue that treatment for COVID-19 has been included under Ayushman Bharat, and this will take care of the poor.

  • But the large, differentiated middle class, many of whom are employees in the services sector will be left out. They do not have secure employment, nor do they have insurance cover.
  • Crisis situations help reveal deeper realities to societies. Universal public healthcare is essential not only to curb outbreaks, but also to ensure crisis preparedness and the realisation of the promise of right to health.

SAFE FORESTS, SAFE PEOPLE: ZOONOTIC DISEASES

The rapid spread of the SARS-CoV-2 virus has brought into sharp focus the entry of pathogens originally found in wild animals into the humans

In the recent years, the diseases of such nature that have raised alarm are: Ebola, HIV, Severe Acute Respiratory Syndrome, Middle East Respiratory Syndrome, bird flu and swine flu

The origins

The contagion, thought to have originated in a wet market that kept live animals in Wuhan, China, points to many underlying factors:

  • the destruction of forests and trapping
  • farming of wild species
  • rising economic activity, such as road building and mining cutting through forests, bringing more people in close contact with animals.
  • global trade in wild species — in Wuhan, they reportedly ranged from wolf pups to rats, civets and foxes, among others — and their sale in markets along with domestic animals

All these activities have brought these animals closer to humans, and the viruses they harbour find ready hosts in domestic animals, moving to humans.

Similar to Nipah and Hendra transmission

The well-documented histories of the lethal Nipah and Hendra viruses, involving transfer from bats to pigs in the former, and bats to horses in the latter, underscore the value of maintaining viable ecosystems, and eliminating the need for wild bats to colonise human surroundings.

The role of Biodiversity 

Biodiversity in forests harmlessly retains dangerous viruses and other pathogens among a vast pool of wild animals, away from people.

What this phenomenon makes clear is that governments should stop viewing undisturbed landscapes as an impediment to economic growth.

  • As COVID-19 has proved, these short-term high growth trajectories can come to an abrupt halt with a pandemic.
  • Such a terrible outcome could be witnessed again, potentially caused by reckless exploitation of the environment.

Pay heed now

Unlike previous epidemics, the latest one has extracted a staggering toll, killing people, forcing a lockdown and causing economic devastation.

  • This should serve as a dire warning to the government that hasty permissions granted for new roads, dams, mines and power projects in already enfeebled forests can unleash more scourges.
  • It would do well to roll back its dilution of the environmental clearance system, strengthen it with a mandate to the States, and leave protected areas to scientific experts.
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