indianarrative

The true lessons of Covid-19: Give people health, not just hospitals

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Every crisis has a lesson in it. Does the present crisis of Covid have a lesson for the Government and the electorate?

Every crisis has a lesson for the government. Does the Covid pandemic contain a lesson for the electorate as well?

Every election becomes an occasion for demands. Whenever the demand for health care arises, voters ask for a hospital, preferably a replica of the All India Institute of Medical Sciences. A sophisticated hospital, however, largely addresses the last phase of health care. It is a zone of individual crisis management; and no one goes to hospital until that crisis arrives. In our anxiety to postpone death, we seem to have forgotten that the larger purpose of health care must be to nurture life. Hospitals are necessary, but they are only the last chapter of the story.

The science of medicine has three objectives: preventive measures like inoculation to protect the vulnerable from mass-killer or crippling disease; curative action through easily available, inexpensive medicine; and crisis management. The basic health of the Indian people needed, from the very first budget of independent India,  massive investment in an infrastructure which could ensure the first two, but they  began to creep to the forefront of health policy only in the 1980s. India started  medicine production  on any scale only after Narasimha Rao’s economic reforms of 1990s. Till then, production had been stifled by state inefficiency and the unwillingness to let India’s private sector become a partner in the nation’s progress. Our concentration remained focused on hospitals.

Prime Minister Narendra Modi was the first leader to make health care for the poor a top priority through the practical option of insurance. It was a significant feature of his policy framework, developed over the last seven years, and structured around improving the quality of life at the mass level.

The greatest anomaly of Indian governance is the absence of the poor from decision-making and implementation. I am not merely talking of the administrative services, vital though they are. There is also economic governance, which includes the private sector; and media, which influences opinion; and social services. We have to acknowledge a paradoxical fact: our elections are determined by the poor, but administrative power is controlled by the socially and economically privileged.

We cannot change this by mere good intentions. It is a long haul, but the first step is to rescue the poor from the most deleterious consequences of poverty: lack of education and health. Without both, there is no hope of aspirational mobility. Nobody is literate at birth. God has given the same average of aql, or intelligence, to both the rich and the poor; it is man who has denied the poor ilm, or the education to make the best productive use of intelligence.

But nobody has bothered to ask why elimination of illiteracy became a declared objective of the government only in the late 1980s and 1990s. Why was this not made a national priority from 1947 or 1950? Why was high quality mass education never at the top of the planning agenda? If we had taken education to people below the poverty line even by the 1960s, there would be no poverty today. The people would have worked their way out of harsh poverty. But we denied them the essential tools for social and economic progress. We denied them their fundamental rights.

The Covid pandemic has laid bare the true history of neglect in   a national health infrastructure.  Since lack of education does not kill, and is not viewed as a “pandemic”, we fail to fully realize the damage it does. Moreover, the vast difference between the best available education and the worst is buried in deliberate amnesia.

Statistics are useful as pointers; they should not be confused with facts. Statistics show that the percentage of Indians under the “poverty line” has been reduced to around 250 million. Apart from the fact that 250 million is 100 million more than the population of Russia, we cannot measure poverty only by tipping people over the hunger index. That is a minimal standard. People remain in poverty when they are denied good health care and good education. Every government budget in the country must  make these two subjects its spending priority.

It must be stressed that both health and education need unprecedented budgetary allocations. Otherwise, the dream of poverty-elimination will continue to float in that dangerous miasma of good intentions and poor delivery.

(MJ Akbar is an MP and the author of, most recently, Gandhi’s Hinduism: The Struggle against Jinnah’s Islam.)

Covid-19 In India