Back in April, as hopes that the COVID-19 pandemic would be reduced by the Indian summer crumbled with the consistent rise of cases, famed author Arundhati Roy penned an article that offered much-needed solace. Roy, in a powerful piece, argued the possibility of the crisis being our doorway to a more just, compassionate, and rational world. The sentiment became mainstream after Indian Prime Minister Narendra Modi sounded a clarion call to turn the crisis into an opportunity.
The COVID-19 pandemic has exposed and fed off the vulnerabilities of existing systems. As the virus continues to spread across India, with a potential vaccine at best several months off, the only glimmer of hope was that India would take the lessons from this pandemic, introspect, and act. This could have been a watershed moment.
But did India really turn this crisis into an opportunity?
India’s health care expenditure, or the lack thereof, has been a perpetual concern, but COVID-19 made it impossible to look away anymore. As Indians watched first-world health care systems crumble, World Bank data from 2011 revealed India had just 0.7 beds per 1,000 people, compared to the world average of 2.7. That placed India on par with Togo, which is classified as a Least Developed Country (LDC) with 50 percent of its population below the poverty line.
The need to immediately plug the gap in India’s health infrastructure was felt early on; however, the support provided ended up being more symbolic than substantial. The government’s $267 billion COVID package had a paltry $2 billion allotted for health care. A 0.7 percent allotment of the package during a primarily health-related crisis showed a continuing apathy for health care. The funds were spent on procuring immediate resources to fight COVID-19 and will have little impact on the sector in the long run.
Modi assured that there would be greater investment in health care, something that was voiced by his predecessors too. Despite those promises, India’s public health expenditure (the sum of central and state spending) has remained between 1.2 percent to 1.6 percent of GDP between 2008-09 and 2019-20 and the initial target to increase the outlay on healthcare to 2.5 percent of GDP by 2017 was pushed back to 2025. Health care made a token appearance in Minister of Finance and Corporate Affairs Nirmala Sitharaman’s COVID package and her announcements were generic, with more assurances than concrete measures.
The biggest issue is that the process of reform can only begin after accepting that something needs reform. The Indian government’s constant emphasis on how well India has handled the crisis somehow fails to acknowledge the need for reforms and instead tries to brush aside pertinent concerns.
The Public-Private Balance
An outpouring of disbelief filled social media as a pricing chart for COVID-19 treatment from a private hospital in New Delhi went viral in June. While the particular facility received a backlash, the episode only laid bare the reality of India’s private hospitals.
There has been a stark contrast in how private hospitals have dealt with COVID-19 vis-a-vis their public counterparts. There have been reports of private hospitals denying admission to patients and overcharging for their services, forcing many state governments to threaten to cancel licenses and capping COVID-19 charges.
As private hospitals played a supporting role, it was the government hospitals, even with stretched resources, shouldering the COVID-19 response. In fact, state companies have played a key role in all sectors during the crisis, from treatment to transportation. It was Air India that flew Indian citizens back from abroad while Indian Railways brought migrant workers home. Railway coaches are being used as makeshift COVID-19 care centers. Government schools have been turned into quarantine facilities.
It’s hardly a new revelation, but the crisis highlighted how strong government institutions bring in transparency, accountability, and allow governments greater control and flexibility. Coupled with affordability and reliability, public institutions serve the masses and yet are understaffed and face budgetary constraints. On the flipside, the private sector is driven by profit and is rarely known to be charitable, even if it’s a pandemic of the greatest proportion.
This begs introspection into the government’s growing apathy toward the public sector and privatization of its assets. The government could also have looked at need-based policy reforms to dissuade the private sector from surge pricing their customers during a crisis and giving them greater control, but it has done just the opposite.
India opened itself up for further privatization with the approval of 100 percent FDI in the coal sector, and privatized six airports while Air India has already been put up for sale. The first step to privatize Indian Railways was also taken, a move which will allow private companies a greater monopoly in the sector, including dictating pricing. The biggest worry is that an increasing dominance of private players across essential sectors along with lesser government control in essential sectors is likely to deter a cohesive and quick response to future crises.
Visuals of exhausted, starved migrant workers, many barefoot, some carrying little children, walking thousands of kilometers back home in an unforgiving Indian summer shook India’s conscience. The outrage and calls for urgent labor reforms, however, lasted slightly longer than the #MeTooMigrant trend on Twitter.
These workers, many of whom live hand-to-mouth, were laid off in cities far from home due to the abrupt lockdown. While state governments and NGOs tried to meet their basic needs, an absence of government data on the number of workers in the unorganized sector was a major detriment.
The central government has schemes like Ayushman Bharat, for health care, and Pradhan Mantri Shram Yogi Mandhan, for the retired, but the absence of a national database of workers in the unorganized sector leaves a gap in policy implementation. The need for a database was first discussed in a Labor Ministry meeting in 2015. Had it been ready within the next half-a-decade, it would have done well to mitigate the condition of the workers during the pandemic. This should have given the government new impetus to set deadlines and start working on a national database as a priority, but no such announcement has come so far.
Instead of using the crisis to strengthen the rights of these workers, several state governments used the economic fallout of COVID-19 to strip the remaining dignity of labor in the garb of attracting investment by suspending several labor laws, continuing the cycle of exploitation at a time migrant workers are at their most vulnerable. The suspension of these laws doesn’t just violate basic human rights but also compromises the health and safety of people and further dehumanizes a community that was reeling from increasing stigmatization as potential carriers of COVID-19 in their home states.
So far, the Indian government hasn’t shown any signs of adapting to the harsh experiences of COVID-19, instead continuing on a path well-known. One would have hoped our learning from this pandemic would put us in a better position the next time there is a crisis of a similar nature, but so far that seems unlikely. There is still room for reevaluation, but the government must move beyond hyperbole to introspect and set forth concrete actions with strict deadlines to be ready for the next crisis.
Rwitoban Deb is a policy research and communications consultant at Indian Political Action Committee in West Bengal.