Impoverishing Lockdown
•Around forty crorespeople have been pushed to poverty due to the lockdown
•Around 12crores of them reside in urban areas and another 28crores in rural areas
•More than 62crore (47.5%) people living in extreme poverty
•Most of them working in informal works or are self-employed
Indispensability of a strong public health system
•The global crisis in the wake of Covid-19 pandemic has underscored the indispensability of a strong public health system.
•Due to systemic challenges, the response of the government health system has been grossly inadequate.
•Private sector has completely failed to respond to the crisis,
•Majority of private providers have been either incapable of or unwilling to help in overcoming the national crisis, despite much hype created by PMJAY.
Public Health response to Covidhas come at the cost of routine health care
•The response of the Union and State governments in trying to manage the procurement of equipment, kits and setting aside facilities for Covidmanagement has come at the cost of compromising routine health services –
•Affecting people’s access to routine maternal and child health, family planning services, TB, dialysis, cancer care etc.
•Severe long term consequences.
•All these clearly point out the lack of comprehensive primary care, particularly in the urban areas.
•Significant efforts from frontline health workers across the country working overtime and
•putting aside threats to personal safety, family interests, and
•Stigma to provide the best possible care despite limited resources,
•Lack of protective equipment, testing kits and other necessary resources.
•Several frontline health workers such as nurses, doctors, ASHA workers became victims of the disease while fighting against it.
•There are also reports of ASHA workers being beaten up or harassed while performing their duties during the pandemic
PMJAY exposed: Abandon PMJAY, Use public resources to Strengthen Public SystemsThePMJAYauthorities,whoweresofarveryvocalabouthandingoverhealthcaredeliverytotheprivatesector,
PMJAYasaschemeandprivatesector,ingeneral,havefailedmiserablyinprovidingdesirablequalitycaretosignificantsectionsofthepopulationduringthepandemic
Public system strengthening with World Money?
•In its first response in April, Centre announced Rs. 15,000 croreas Covid-19 emergency response and health system preparedness package. Centre is to release Rs. 7,774 crorefor immediate use and Rs7226 crorefor medium term support till 2024.
•This amounts to less than 0.1% of country’s GDPand even less than the amount of money spent on health by some States currently.
•USD 1 Billion funds for Covid--19 Emergency Response and Health System Preparedness from World Bank-explicit privatisation
•The Rs. 15,000 crorepackage is probably out of this loan grant and not a provision from own resources as is being projected by the Centre.
Inverse relationship between public spending and OOPs across 155
countries: 2010
Global trends show clearly that as public spending on health
increases share of out of pocket expenditure in total health
expenditure decreases. India’s position at the top left shows that
people bear a huge share of health care expenses at the time of
health needs in India.
Expenditure on health by union and state governments (% of GDP)
Since 2005-06 state governments have increased their investment on health:
From 0.62% of GDP in 2005-06 this had increased to 0.91% in 2014-15
Union government expenditure of 0.23% of GDP in 2015-16 is lowest in the last three decades-this is even lower than what was being spend during the early 1990s.
Stronger public system could prevent the pandemic: experience from Kerala
•Invested substantially in strengthening primary care, preventive and public health services over a long period of time.
•Most other States have neglected preventive services beyond a few services related to maternal and child health.
•Failure of resource rich states such as Maharashtra and Gujarat weak public health and primary care in urban areas in these States.
•Community based model in Kerala
Strengthen public sector manufacturing of medicines and equipment:
•It was expected that the government would provide considerable support to pharmaPSUs through the relief package.
•However, last year the government shut down IDPL and its subsidiary Rajasthan Drugs and Pharmaceuticals Limited and put HAL and BPCL on strategic sale.
•It is of utmost importance that self-reliance in equipment manufacturing is achieved through robust investment in pharmaand medical equipment manufacturing industries.
•Centralised and transparent procurement, and decentralised distributionto ensure regular availability of good quality generic medicines in public facilities both for national programmes and State systems, as we have in Tamil Nadu, Rajasthan and Kerala.
•Compulsory licensing for ARV drugs
Rights of health workers
Considerableshortageofskilledhumanresourcesinruralareasandhighdensityofmedicalprofessionalsinmetropolitancities
createshugedistortionsinthequalityandrationalcareprovidedinbiggercities.
Alllevelsofpublichealthsystemstaffshallbeprovidedwithadequateandcontinuedskilltraining,
Fairwages,socialsecurityanddecentworkingconditions.
All contractual health workers, an overwhelming majority of whom are women, should be regularised and receive protection under the entire range of labour laws.
Invest in health research
•Health research budget has been a meagre 3% of the total budget of MoHFW.
•For some of the sub heads aimed at strengthening the surveillance for Zoonotic Diseases and other neglected tropical diseases the utilisation of the already meagre budgets has been as low as 15% (in 2018-19).
•Public investment on health research needs to increase manifold to be able to meet the upcoming public health challenges
