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.
