“In a crisis, be aware of dangers but recognize the opportunity” – John F Kennedy
It’s been months since someone in China decided to consume a bat and everyone knows how the bat and the little monster inside it have brought about a new normalcy in the World. Since then we have been forced to go through situations similar to what we had heard from our grandparents or the likes of which we had seen in movies; situations we never thought we would have to experience in real life. Countries all over the world closed down their markets, international flights were suspended and lockdowns were enforced wherever it was considered at most necessary. In India, lockdown started when the month of March was about to end, it was extended thrice and we stayed in lockdown until the end of May. Lockdown here came almost out of the blue and was enforced much more stringently as compared to other countries like Vietnam, Indonesia and Pakistan etc. which left no room for people to prepare. It was around that time WHO Director General Tedros Adhanom warned countries which opted for a lockdown that it may not be enough to contain the pandemic. He urged countries to use the lockdown period to boost the public healthcare system, train and deploy workforce and stressed on tracing suspected cases1. However, with clanking utensils and showering flowers it seemed like the Government of India had other plans.
Failing the true spirit of Aatmanirbhar Bharat
Soon after the Prime Minister declared lockdown, we saw an exodus of migrant labourers throughout the nation. Despite being in the middle of a crisis, the government could neither minimise the danger nor leverage opportunities to save the affected. Men, women and even children were dying on the road due to thirst and hunger and yet various governments defeated sloth in terms of speed to take action. Finally, when governments allotted trains and buses to various locations, migrant workers were charged hefty prices to book a seat. Yet we saw trains going to wrong locations and in some cases reaching entirely different states than the ones they had set out for, showing the disregard of the government towards the concerns of the citizens. We even witnessed the Karnataka State Government cancelling its application for trains meant for migrant labourers just because building contractors lobby wanted them to do so2.
Forced by the circumstances and the public pressure, soon after the announcement of lockdown, the government rolled out a relief package amounting to 1% of the GDP, but it was not enough to cater to 1.3 billion people. That’s when our Prime Minister decided to appear on TV and announce his grant plan for Aatmanirbhar Bharat. This included a financial package that amounted to 10% of the GDP to revive the stalling economy. Once we get into the fine print of this package, we realise that figure 10% of GDP included prior measures taken by government bodies at various times prior to the announcement. For instance, it included the first economic package of 1.7 lakh crore rolled out by the finance minister in March along with an 8 lakh crore that was announced by the Reserve Bank of India for liquidity enhancements for over three months.3 Experts say that the stimulus package that the Prime Minister claimed to be 10% of GDP cost in reality close to 1% of GDP.4 Manipulate the numbers to project an ant as an elephant!
Twist it if you cannot make it – the welfare funds
It gets even scarier if we look into the fact of how the government managed to raise the leftover amount in the package. According to Deval Desai, Christine Lutringer and Shalini Randeria of The Graduate Institute, Geneva, 5.2 lakh crore was raised by diverting the welfare fund meant for construction workers.5 The money was accumulated through a special tax levied on construction projects since 1996. Another one lakh crore was raised by diverting the welfare fund meant for workers and communities affected by mining. The amount was accumulated by a law passed in 2015. It is important to ask how these funds remained unused throughout these years?
The fund diversions spilled over into the CSR realm as well. Under the CSR law corporate companies have to spend 2% of their net profit towards social responsibility. The CSR funds are the backbones of NGOs throughout our nation using which social welfare activities are carried for the marginalized sections of society. Be it health, education or sanitation, the lion’s share of our population relies on any one of the NGOs working in those sectors. However, since the inception of the PM-CARES fund, a major portion of the CSR fund goes to that with no information on where and how it is spent.
For the sake of argument even if we overlook the diversion of funds the states were still not able to disburse the amount to all construction workers citing the reason that many are not registered under the welfare board. Due to shifting sites, illiteracy and ill awareness, many construction workers are not registered. This is coming during a time when more than 90% of construction workers have lost jobs because of the pandemic. The conditions are not different with mining workers as well. Even after diverting and renaming the funds, when disbursing it to the beneficiaries the government could not ensure that it reaches everyone who is affected.
The health, the wealth and the crisis
The government could have identified legitimate welfare opportunities during the COVID 19 crisis. There have been clear warnings from time to time from international watchdogs that India has to pay attention to the needs of the healthcare sector. Recently the World Bank pointed out that our investment in core public health facilities are scarce. The report also noted that Indian spending on the health sector is about 1% of the GDP, which is among the lowest in the whole world.6 Similar remarks had been made by the World Health Organization back in 2016. The standard doctor to people ratio according to the WHO is 1:1000 but on an average, a government doctor in India serves more than ten thousand patients! That is more than ten times above what the WHO recommends7. The statistics are no better in case of the number of hospitals or other healthcare workforce. Thus, the lockdown period could have been used to take urgent measures to tackle the pandemic, like the WHO director suggested, by deploying and training the workforce, by setting up First line Treatment Centres and to ramp up testing facilities.
India’s continuous meagre investment in public healthcare has led to a boom in private healthcare facilities. However, for the weaker sections of the society these private sector alternatives are out of reach. Taking that into consideration the government should have invested in them which would have turned out to be beneficial not just for the poor but for the entire society. In the seventh economic conclave conducted by the State Bank of India, many economists agreed that India should grab this opportunity to strengthen the healthcare sector8. However, the healthcare sector found no place for any kind of major investment under Aatmanirbhar Bharat package. It carried a promise to increase investment in grass root health institutions and proposed setting up of new Health and Wellness Centres across India. This should be read along with the fact that there are already 1974 health centres across India operating without a single doctor9.
The way forward
The reforms should start from a robust expenditure in the healthcare sector. Such an investment should cover the entire value chain, that includes infrastructure and human resources with an objective to increasing access to the public. Along with that, the effectiveness of the expenditures shall also be scrutinized. Even if we analyze the Corona cases, we can see that Maharashtra and Gujarat are having higher mortality rates and ironically, both are among the states with maximum healthcare expenditure. However, the State of Kerala and Goa, both widely praised for their commendable work in tackling the virus tops the list of states with best healthcare facilities. It is commendable that they did it with lesser per capita healthcare expenditure than that of bigger states like Maharashtra and Gujarat. Thus, there should be an effective mechanism to ensure proper return of investment. Wherever it is possible, the government should team up with private players to deliver public goods. An example will be that of Kerala where the State collaborated with Tata trusts to set up a 540-bed hospital.
It is evident that with a weak health care sector economy can never run but crawl. Organizations like the IMF have already noted how India can boost its economy by investing in the health and education sector. There are many studies by economists, which show the relation between the health of the population and economic growth. A UN High level commission report of 2016 on health and growth says that an increase in life expectancy by one year can result in an increase of GDP per capita by 4%. The commission put forward ten points of recommendations including fostering women empowerment and institutionalizing their leadership roles10. That is an important observation considering the fact that significant shares of care workers are women in places where healthcare delivery is effective. At least during the time of a pandemic India should pay attention to its healthcare sector, whose resources are on the verge of being exhausted with the rising number of cases with every passing day. However, with policies to encourage the private sector and lousy delivery of services in the public sector it seems like the Government of India is focused on the wrong set of opportunities during this time of crisis and is completely unaware of its dangerous consequences.
2. https://thewire.in/government/karnataka-trains-migrant-workers
4. https://www.thehindu.com/business/stimulus-to-cost-only-about-1-of-gdp/article31617629.ece
7. https://www.downtoearth.org.in/dte-infographics/61322-not_enough_doctors.html
9. https://www.downtoearth.org.in/dte-infographics/61322-not_enough_doctors.html
10. https://apps.who.int/iris/bitstream/handle/10665/250047/9789241511308-eng.pdf?sequence=1
