Release of Lockdown: Gearing of health sector vital

Release of Lockdown: Gearing of health sector vital

In a recent interview to a news channel, WHO Special Envoy Dr David Nabarro praised India’s efforts in tackling the corona pandemic by taking the silent enemy seriously, reacting early, getting people’s attention even if it meant taking strong measures. However, what begs attention is when will it be time to release the lockdown, to which his answer was it depends on indicators—are hospital and its health workers prepared, have they got enough protective gears, are the communities down to the panchayat level ready up and do all people know the protocols.

There is no denying that the country’s public health infrastructure and its workers are battling against this unprecedented situation against heavy odds. Perhaps, it may not have been too to tough if only health was not a low priority sector in the country, even compared to emerging economies. It is well-known that allocation of resources for health is quite low compared to the high population density.

Fortunately for us, the pandemic may not percolate to the community level only due to the fact that most village people are very poor and do not have the need and means to travel beyond the block level, at the most. If one examines the corona cases in India, most of those affected have a direct or indirect travel history and it is difficult to believe that the virus has percolated to the community level, at least in the rural areas.

As experts talk of human behaviour and action, the rural populace are concentrated in their villages and the immunity of those who can afford decent meals is quite high. The prolonged lockdown will have a serious impact on hundreds of millions of Indians, who simply cannot afford to stay at home without losing their means of sustenance for themselves and families.

It is important to note that understanding of a problem differs from person to person, more so if they belong to different strata and income group. The urban elite or even the urban middle class are totally ignorant of the problems faced by the rural poor or even the EWS. As such, it is difficult to realise the magnitude of the problem of health infrastructure existing in the entire country.

Insofar as WHO and its guidelines are concerned, India obviously is much below in the index, even compared with countries like Brazil, South Africa, not to speak of China. Over the years, subsequent governments have ignored health infrastructure and allotted meagre resources for its growth, specially in backward districts. Even all sub-divisions of the country do not have a hospital today, even after over seven decades since Independence!

At the same time, doctors with Jan Swasthya Abhiyan and All India People Science Network are concerned over the lack of testing facilities, even in big towns, and insist such testing needs to be carried out to anyone having symptoms such as fever and dry cough and not merely hospitalizing them. Regrettably, testing facilities are only now being gradually expanded to big towns, which do not augur well for our health care system in district towns, leave aside villages.

A major reason why the pandemic has been somewhat under control is due to the fact that very few people travel, even within the country, and contacts are minimal. Moreover, with the lockdown, this has been even less. But questions arise whether such lockdown was necessary for small farmers working in the field or very small traders concentrated within their village? Do they have any chance of spreading the disease? Will not production of various types of foodgrains be affected if there is continuous lockdown, say for a period of 24 days as in a State like West Bengal (since March 22)?

Another important aspect is regarding temperature, which has generated a debate. It is generally believed and has been confirmed in a recent MIT study that warm temperature, say above 180-200 C, makes the chance of spread of infection less. In India, temperatures are mostly dry and hot – sometimes humid – and poor people working in the fields are exposed to this heat. Whether it could be argued that such people, without any contact with people from foreign countries or even other States, as also daily exposure to heat, are less vulnerable to the coronavirus, is a question for future medical research.

It is unfortunate but true that many of us are simply oblivious to the critical problems faced by the millions in our villages. Way back in late 70s and early 80s when the undersigned was propagating Gandhian thought, a veteran Gandhian had asked me about my understanding of poverty, squalor existing in villages and repeated hunger faced there. Unless you see the squalor with your own eyes and remain without food for at least half a day, it would be difficult to comprehend the enormity of the problem, he told me.

Again, about two decades back, a tea delegation from India that toured China prepared a report, wherein it stated that India was some 50-odd years back compared to its neighbour, including in health, education and economic development. The way China tackled the disease eventually has been widely appreciated, obviously due to its much-improved public health infrastructure and doctors.

The steps taken by Indian government are no doubt laudable. But here the situation is possibly similar to the dichotomy between development and growth or between development and environmental concerns. One is reminded that we are a poor nation plagued with not just high population growth but also having high density of population, which needs proper health facilities.

If only governments had a clear vision on building upon health infrastructure over the years, the country would have done justice to the delivery system in backward areas and where incidence of communicable diseases are more. Perhaps, the present 21-day lockdown across the nation, including villages, may have been avoided. Besides, we should not make comparison with European nations because their lifestyle, food habits etc. are different.

The leadership needs to be prepared for grave economic consequences. According to economist Prof. Amitabh Kundu, distinguished fellow at Research and Information System for Developing Countries, nearly 2 crore people — inter-state migrant workers in the informal sector and 80 lakh vendors — risk losing employment because of the lockdown. Recession is bound to set in with demands being suppressed at least in the coming two months, leading to the big question being asked whether the fear of hunger is as grave as the virus.

Further, let us put behind the earlier observation of Economic Intelligence Unit that India would be the fastest growing economy at even 2.1 per cent growth in 2020-21. For a poor country like ours lacking both social and physical infrastructure, far less than China not to speak of the developed West, the challenges are beyond comprehension and the pandemic has made it even worse.



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Release of Lockdown: Gearing of health sector vital