Hard lessons: Layers of government must work in tandem to beat Covid-19

public health spending in budget 2023
Half of the public health budget comes from the National Health Mission that saw a 1.2% increase in allocation compared with the previous year.

The most severe health emergency in more than 100 years has hit India hard. The country has suffered huge losses in terms of economic growth and human lives. While the country managed to tackle the first wave of Covid-19 pandemic well, the second wave had the entire nation on the defensive. The unprecedented human suffering led to a blame game between different layers of the government. But, solution to a crisis lies in focusing on what is available, not on what could have been.

Of course, there is a need to enhance public spending on healthcare and the government needs to address this issue in the coming years. But the massive failure to tackle the second wave of Covid-19 pandemic was the governments’ inability to build new hospitals, ICU beds and ventilators, as well as to boost the availability of medicines and medical oxygen.

This also meant a failure to learn from the first wave of the pandemic. India failed to boost the production of vaccines to immunise at least 50% of the population in a phased manner. This article intends to suggest ways to protect the citizens from the third and subsequent waves of Covid-19 pandemic, or from any other health emergency that may emerge.

No new law, notification, or instructions were required to avoid the disaster. The government should have brought in travel restrictions, enforced physical distancing and use of masks, published protocols for treatment, and addressed supply chain requirements. It should also have made public a curative protocol for oxygen, medicines and beds, enhanced preventive arrangements, and come up with a robust vaccination plan. When you are facing a crisis, there should have been a plug-in for curative and preventive care. Word plan itself means detailing, mechanism of quick reaction, and course correction, not desperate knee-jerk reactions.

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Covid-19 second wave hits India by surprise

The second wave of Covid-19 pandemic affected more people than the first with India contributing 46% of the global case load and 25% of the death toll. The second wave is the result of lowering the guard and celebrating too early. When Parliament, education institutions, malls and cinema halls all were closed, crowding of religious places and election rallies were allowed. All this resulted in Covid-19 spreading into villages, with 10% test positivity in 533 out of 700 districts. This is self-inflicted injury that put the healthcare infrastructure under stress. The prescribed preventive measures of accelerated vaccination, physical distancing and use of masks were not followed in spirit.

Even in curative care, no proper planning resulted in paucity of oxygen, beds, ICU beds, and ventilators. Delayed instructions steel and oil industries and delay in ensuring logistic arrangements to transport medical oxygen resulted in at least three weeks of chaos that could have easily been avoided. There are lessons for both citizenry and the administration in the April-May period.

The citizenry will need to adhere to prescribed Covid-19 protocol of physical distancing, wearing masks and getting vaccinated. Avoiding crowding during marriages, religious events, political gatherings or in protests is of paramount importance. Nothing is more precious than your life and that of your dear ones. This singular message is needed to be spread and understood by all.

The next issue is planning and governance. The Union government, states and district administration should work as one unit and avoid blame games and publicity stunts must be shunned. If good work is done, credit and respect will automatically come without being demanded. Even today islands of success are being recognised and praised by all without seeking any publicity.

Make in India focus for oxygen, medicines and beds was eminently possible. If one looks at the statistics for the worst days, the oxygen demand was around 7000 tonnes, Delayed direction to industry to produce medical oxygen and lack of preparation for transporting cylinders cost hundreds of precious lives. The delay in tapping and optimising facilities available also resulted in heavy losses. The disaster management plan is not just a document. At the first symptom, all plans must be triggered — the untapped facilities to manufacture oxygen, medicines, and logistics to carry them to the end point.

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Hoarding profiteering hit war on Covid-19

There was an argument on ‘patents’ in the case of medicine and vaccines. With product and process patenting, the making of medicines for treating HIV AIDS got restricted when India had capacity and capability to make the medicine at the lowest cost. National Human Rights Commission took up the issue to UN in 2006-2008 and the patent was exempted. India was allowed to make life saving medicines for the world. This learning was not used to produce additional doses of vaccines and medicines.

Hoarding of medicines and profiteering remind one of vultures that thrive in disasters. The Essential Commodities Act is available to ensure that enough stock is available at government-monitored shops to stop profiteering. The amendment of the Act in 2020 for foodgrains would make the government helpless in times of food scarcity. The drug controller will need to expedite checks both on pricing and on spurious drugs, instead of wasting time as regulator. If oxygen concentrators, cylinders and medicines are imported, the disaster management plan should immediately arrange for quick customs clearance.

The various phone numbers and links offering bed availability status (80% of them not working) added to the chaos. India has strong network of BPOs, the planning needs a BPO dedicated to cities and districts that will give bed availability status. India has successful examples of immunisation programmes. We have eradicated small pox and polio from the country. Same model with cold chain is the need of the hour to reach the remotest of areas.

Role of three tiers of administration – the Centre, state and district – must be made clear. The supply chain of essential vaccines, medicines and logistics is clearly the responsibility of Centre, along with the pricing. The state government is to correctly access its requirements and optimise use of health facilities. The district administration will do planning and execution according to local requirements. None can, or should, pass on the responsibility. All three layers need to work together to deliver their best.

The Covid-19 crisis has impacted the livelihoods of millions of citizens. A large number of households are slipping into poverty and this will put pressure on the government’s resources. So, one cannot afford to be caught napping. Channeling all management and financial resources to tackle the crisis must be the top priority of the government. If the crisis is managed well, all will get due credit. But if the effort fails, then the country will be the loser.

(Aruna Sharma is a development economist based in Delhi. She is former secretary, ministry of steel, Government of India).

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Dr Aruna Sharma is a New Delhi-based development economist. She is a 1982-batch Indian Administrative Service officer. She retired as steel secretary in 2018.