HRW Day 3: COVID and Healthcare in India (report)

COVID and Healthcare in India
with Sunila Dixit

Human Rights Week, Day 3 (in collaboration with Rotaract Club, Wilson College)

Session: COVID and Healthcare in India

Speaker: Sunila Dixit 

Date: 12 January 2021

Time: 5-6:30pm

Moderator: Sana Khan

"Health cannot be a question of income, it is fundamental human rights."

~ Nelson Mandela

United Nation's Goal 3 of Sustainable Development Goal is 'Good Health and Well-being', which has been severely affected by the COVID-19 pandemic all across the globe.

As students and more importantly as citizens who have a fundamental right to good health, it becomes more important to know the background of the health sector in India. Human Rights Week Day 3's resource person was Sunila Dixit, a research analyst whose research areas include health policy and development sectors affecting public health.

The public healthcare system in India is divided into District Hospital, Sub District Hospital, Community Health Centres ( CHCs ), Primary Healthcare ( PHCs ) and HSCs that deliver their services population-wise. There are only 11 states in India that fulfil the population norms.

The speaker made us aware of the grim reality of the healthcare system in India. According to the Human Development Report 2020, India ranks 155 out of 167 countries on bed availability ( 0.5 beds/ 1000 population ). 12 states fall below the national average. There are 32,900 shortfalls of SCs, 6,430 for PHCs and 2,188 for CHCs.

Below is the % of public health infrastructure that meets the Indian Public Health Standards:

7% of SCs

12% of PHCs

13% of CHCs.

Shortage of manpower, resources and budget is the major crisis that affects public healthcare in India. The doctor to patient ratio in India is 1:1456 as compared to the 1:1000 prescribed recommended by the World Health Organization ( WHO ) while the nurse to patient ratio in India stands at 1.7:1000 as compared to 3:1000 of WHO's recommendation.

Sunila Dixit explained to us in detail the budget allocation and expenditure for health by the means of charts and graphs that she presented during the session. 1.6% of India's GDP or 69,000 crore rupees is allocated in the Budget of 2020-21. The Ayushman Bharat - Pradhan Mantri Jan Aarogya Yojana has been allocated 6,400 crore rupees. 3,000 crore rupees has been sanctioned to train hospital staff. The speaker also compared the allocation given to Harvard Medical School ( 5,300 crore rupees ) to India's Department of Health Research ( 2,100 crore rupees ), which is indeed a sharp contrast.

Health expenditure of India in the year 2016-17 ( last updated ) is:

* Total Health Expenditure ( THE ) of GDP - 3.8%

* Out of pocket expenditure of THE - 58.7%

* Government Health Expenditure of GDP - 1.2%

* Per capita GHE ( Rs. ) - 1418.

We were also made aware of India's budget allocation to health as compared to our neighbours. 2.3% and 5.6% of Bangladesh's and Nepal's GDP is allocated to health respectively. The government has made it a target to increase India's health allocation to 2.5%, which is the need of the moment as only 0.2% of funds are allocated for preparedness for disasters and emergency responses ( Eg:- COVID ).

The timeline of COVID in India was also discussed - right from the screening of passengers from a select few countries on 17 January 2020 to India's first reported caste on 30 January and the subsequent lockdown from 25 March 2020. 'Testing, Treating, Isolating' is the mantra to deal with the COVID pandemic.

The speaker pointed out to the overlap of functions that take place between The Central Drugs Standard Control Organization ( CDSCO ) and Indian Council for Medical Research ( ICMR ). Both these agencies are tasked with approving drugs, vaccines, research and testing kits. Conflict of interest was noticed when ICMR rejected testing kits by Chinese companies but CDSCO approved them.

The COVID vaccination drive in India collided with PSA's Human Rights Week. As of 13 January 2021, India has approved two vaccines - Serum Institute of India's 'Covishield' and Bharat Biotech's 'Covaxin'. The latter has not released its efficacy data and its vaccine will be phased out 'in clinical trial mode' ( which remains unexplained ). COWIN app is created by the government to collect data on vaccination.

The pandemic has destroyed economics all across the world and India is one of the worst affected. India's GDP contracted by 23.9% in the first quarter of the financial year of 2020-21 and 7.5% in the second quarter. According to CMIE, 5 million people lost their jobs in July 2020. ILO-ADB Report stated that 41 lakh youths were left unemployed. Aviation, Tourism, Real Estate, Transport and Financial sectors were some of the worst affected by the pandemic.

This session was a part of 'Human Rights Week', in lieu of that, the speaker briefly touched upon the impact of the COVID pandemic and the subsequent lockdown on Human Rights.

• Domestic violence cases were recorded between March-May 2020 were the highest in the last 10 years. The Indian state of Uttar Pradesh received 600 complaints.

• Migrant crisis - The sudden announcement of complete lockdown in India on 25 March 2020 left millions of daily labourers and migrants affected. 40 million migrants were affected, they began to walk thousands of kilometres to reach their village. 90% of India's population work in the informal sector. In May 2020, after hearing the distress cries of the migrants, the government started Shramik trains. As many as 80 deaths were reported on these trains but the government has no account or records of such deaths.

• Abuse towards children - The shutting down of schools due to the lockdown left lakhs of students especially young children without mid-may meals. As the parents had lost their jobs, spending for such children became more difficult, as a result, 10,000 cases of child marriage and 6,800 cases of child labour were reported. Traffickers also targeted such vulnerable children into labour and prostitution.

• Frontline workers - If one followed the newspaper through the pandemic, one might have noticed that the ASHA workers are one of the services that were battling COVID on the frontline. The ASHA workers were not paid wages nor any honorarium or incentives. Doctors, nurses had worked overtime and this was overburdened with the pressure on the health sector. Reports of assault and abuse were also reported on the frontline workers. To make matters worse, the government announced that it had no report or records of the number of frontline workers who died serving the nation in distress.

The presentation also mentioned how due to COVID other health services were affected or neglected. For example - lakhs of children missed their routinely dose of BCG vaccine which in return can cause another outbreak in future. The reported cases of Acute Heart Disease dropped from 2,50,000 in February 2020 to 60,000 in June 2020. 60% drop in the number of men screened for HIV was reported by June 2020. The Anganwadis were shut down where Integrated Child Development Scheme ( ICDS ) was rolled out. The scheme provided nutritional food to pregnant women, children below 5 years of age and their mothers.

Due to COVID, other diseases and their screening or treatment were neglected, routinely dosage or vaccines were missed out.

The presentation lasted for an hour which was followed by an interesting Question-Answer round. We all agreed that China should have approached the WHO much before; India should have screened all international passengers in the early days of the COVID pandemic; there should be accountability, transparency and communication to help stop the distrust of the vaccines. Comparisons were also made between the COVID and Ebola outbreaks. The 'Dharavi model' which gained international attention was also briefly touched upon. The speaker also discussed the problems associated with WHO.

The controversy around AYUSH workers been granted permission to conduct surgeries was also discussed. Different vaccines that have been granted permission across the globe; the new strain of COVID reported from the United Kingdom are a matter of concern.

No records or reports maintained by the Indian government on frontline workers or migrants was condemned.

On been asked a question about the novel innovation the health sector should undergo, the resource person, Sunila Dixit said that she believes there should be greater mechanisms and coordination in the policy framework for them to be applied on the ground. A larger point that can be a game-changer was made by Dixit - there should be separate health cadres just like the IAS or IPS!

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Email ID of the resource person - sunila@takshashila.org.in

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Report drafted by the Vice President of PSA - Aniruddha Phadke from TYBA Political Science.