On June 8, India began to emerge from the world’s most stringent lockdown – a lockdown that devastated the country’s economy and led to a staggering humanitarian crisis. Images of millions of migrant labourers trudging across the country on foot to make it back to their villages – many of them dying en route of exhaustion and starvation or mowed down by vehicles – have seared the tragedy on the nation’s consciousness.
The only way to make sense of what we lost was to hold on to the belief that the opportunity cost of not imposing the lockdown completely and suddenly might have been higher – that, perhaps, the policy decision had bought the government time to prevent many more of us dying from the virus.
News from the last couple of weeks, however, has ripped through that belief. As hospitals in India’s major cities begin to run out of beds, social media has been flooded with pleas for help from relatives trying to find medical care for critically ill family members. Many Indians – from a well-connected former MP to middle-class citizens – have lost their loved ones before they could find help.
Coronavirus patients across the country have been forced to isolate in wards unfit for human habitation – sometimes without food and water. Others have faced acute neglect in overwhelmed hospitals where, at times, their relatives have had to care for them in the absence of hospital staff. Some have also been forced to buy or even illegally import their own medicines at huge costs.
Healthcare workers have not had it any easier. They have been denied wages and protective equipment, muzzled, persecuted, and made to work overtime. They have also been contracting the virus at an alarming rate due to negligence.
Even the dead are not spared indignity. Dead bodies of coronavirus patients are left unattended on hospital floors, corridors, or even under hospital beds – naked. Others lie in mortuaries for days and arrive stacked up in hearses before they are cremated. In one case, the dead body of a man suspected to have died of COVID-19 was taken for post mortem in a garbage truck, and in another, health workers were caught on video dumping a corpse in an open ditch. In one of the most horrifying cases to come to light, the dead body of an 82-year-old woman who died from the virus lay rotting for eight days in a toilet cubicle in the hospital where she was being treated before being discovered.
It is evident that the state has failed to use the lockdown to build capacity, but even if it had put in its best effort, two and half months are not nearly enough to cover a healthcare deficit created over decades.
India spends just over 1 percent of its GDP on public health, ranking 170th out of 188 countries on this count. In public hospitals, the number of beds available per 1,000 people is 0.5 and 12 states, which account for roughly 70 percent of the country’s population, lie below the national average. The number of ventilators and critical-care beds is far lower.
Rural India is the worst equipped when it comes to public healthcare, with certain areas lacking even basic and primary healthcare. Where care is available, standards are abysmally low. A Lancet study estimated that 4,300 Indians die every single day due to the poor quality of healthcare in non-pandemic times.
It is no wonder that nearly 70 percent of health costs are paid by citizens out of pocket, not by the state budget, due to which at least 7 percent of the country’s population is pushed below the poverty line each year. While private healthcare is more reliable on average than public healthcare, particularly in larger cities, overall its quality is drastically inconsistent.
To add to that, over the last two months, several private hospitals have taken to profiteering – charging rates unaffordable even for the middle class. Others have been turning patients away or lying about the availability of beds. A large part of the blame, again, lies with the state for having failed to regulate healthcare in the private sector effectively.
In a democracy, however, the buck for the repeated failure of elected representatives must stop at the electorate. The pathetic state of healthcare in India is a lived experience for most Indians. The pandemic has only served to exacerbate the massive toll it takes on citizens. Even so, it has not been an election issue in India.
Take, for instance, the 2019 general elections. Election manifestos of both parties had healthcare reform on their agenda. But while the ruling Bharatiya Janata Party (BJP) opted for a rather weak insurance-based healthcare model in partnership with private healthcare providers, aimed at covering less than half of India’s population, the Indian National Congress had promised universal coverage by investing in public health infrastructure.
An analysis of Prime Minister Narendra Modi’s speeches in the run-up to the polls showed that out of the 24 topics examined by the frequency of mentions, health featured at number 21. Even so, the BJP swept the elections.
This is not surprising. By and large, Indians tend to vote along sectarian lines – either caste, community, or religion, or a combination of the three, and electioneering in India tends to reflect these preferences.
This, in turn, creates a system where institutions are systematically compromised, and resources and rights are made more readily available to those whose community representative is elected at any given level. Budgets available are spent on populist schemes that yeild votes rather than on health and education reform that takes a longer time to yield returns.
Media can play a defining role in breaking this vicious cycle. One way to mobilise democratic engagement in demanding universal healthcare is through public debates underpinned by facts and figures on India’s innumerable news channels and widely read regional publications. Another is to buttress social media outrage with specific policy demands. And yet another is through grassroots organisation facilitated by civil society.
Either way, this much is certain – if Indian voters fail to rise above increasing polarities in politics and incentivise their representatives to deliver on healthcare; if they fail to pivot India’s democracy into a system that prioritises equity delivered through evidence-based policymaking, future generations will meet the same tragic fate that citizens abandoned by the state and left to themselves to fight a losing battle against the pandemic are facing today.