e-Dialogues: ‘India needs to invest more in health, improve local response’

The second webinar in the series of e-dialogues, ‘Health crisis and cities: Fixing the system’, was organised by All India Institute of Local SelfGovernment and Urban Update, in association with United Cities and Local Government (UCLG-ASPAC). Medical practitioners  and experts from different areas expressed their views on the ongoing health crisis and highlighted the problems in the healthcare system of India that were exposed in dealing with the COVID-19 pandemic. Speakers in the webinar also suggested a range of solutions that included increase spending on health care, focus on data collection and also encourage manufacturing of medical equipment in the country.

Ravi Ranjan Guru, Deputy Director-General, All India Institute of Local Self-Government; Dr Prakash Tare, President of the Association of Otolaryngologists – Indore Chapter; Dr Rajeev K Sharma, Chairman of Institute of Orthopaedics, Joint Replacement and Sports Medicine; Basudev Mahapatra, Senior Journalist from Odisha; Dr Prof Sneha Palnitkar, CEO, WMRC, AIILSG, joined the webinar as speakers. Kumar Dhananjay, Consulting Editor, Urban Update, moderated the discussion.

In his opening statement, Dhananjay expressed that as the duration of the pandemic extends, people have gotten acclimated to the ongoing conditions of lockdown that have ensued as a part of the global exercise to curtail its further spread. “It will certainly leave a big impact on our lives,” he said. Dhananjay further added that the abrupt pandemic condition has brought out the flaws in the level of preparedness in dealing with a crisis of such magnitude. For India, the health care infrastructure and the system is inapt for such a large population, as many reports have pointed out shortages of medical equipment in the country. He quoted a 2019 report released by the World Health Organisation, which said that low-income countries, from 2000 to 2017, have spent an average of $41 per person on the health care of an individual, while high-income countries spent an average of $3000 for the same.

Focusing on India, Dhananjay said, “There is a history of neglect for India, where health and education have always been left behind by successive governments.” Budgetary allocation for the public health in India stands at a meagre 2.2 per cent, while GDP allocation at 1.29 per cent.

Ravi Ranjan Guru, in his statement, said that the pandemic is not only a health crisis but also a global social, economic and political problem. Guru  noted that the spread of the disease has been curtailed to a great extent due to the imposition of the lockdown..  Guru suggested that emergency operation centres be set up by the inputs of the Central and State Governments, especially in the states with weaker public health systems. Lauding the successful efforts of Goa, Agra, Kerala, amongst others, Guru said that other ULBs could look into their models and could use relevant information to develop their models.

Dr Prakash Tare told that Indore, which has been one of the worst affected cities in India, is dealing with a more virulent strain in the belt. This fact was observed by the National Institute of Virology, after testing 57 samples from the hotspots of Indore. The doctor further attributed the situation of Indore to the initial negligence to the checking of travellers at arrival points of the city. Further, the screening process included only checking of temperatures, as testing kits were not available as per the requirement, and hence many asymptomatic cases went undetected. For the city, Dr Tare noted the lockdown was not very effective as people flouted the self-isolation guidelines carelessly in the initial stage. He further described the local government’s initiative to segregate hospitals into three categories: Red, for active, severe cases of coronavirus; Yellow, for mild cases and Green for people with co-morbid condition. He recommended the government to prepare a specific plan of action to deal with such a pandemic in the future.

Dr Rajeev Sharma praised the response of the government and said that it showed that India currently has strong leadership. “The problem came without notice but has been handled very effectively. Successive governments from now on need to take note of such calamities and anticipate their oncoming for the future”, Dr Sharma said. Although we lack infrastructure, the competency of the medical staff, even under an unprecedented challenge of such a magnitude, must be commended. He urged people to focus more on their health and improving their immunity. “We need a physically strong population. Improve immunity not by medicine but naturally, with exercise and appropriate diets. He also emphasised that hospital staffs’ training must be world-class and several AIIMS-like institutions must come up in all parts of the nation. Further, he added that the condition of primary healthcare centres must be improved as they deal with issues at a smaller scale before they increase in magnitude.

Dr Prof Sneha Palnitkar said that the local governments across India are working with great intensity in dealing with the pandemic, especially in a hotspot-ridden state like Maharashtra. She concurred with the rest of the panellists and said that the budget for health infrastructure needs to be substantially increased. Further, Dr Palnitkar said, “Community health infrastructure needs to be created through a network of community health workers/ volunteers”. She also highlighted the success of the smart city concept during such testing times and the incorporation of the technological medical advancement, though not on a large scale, has been of help. She highlighted the example of Smart OPDs. “Using Smart OPDs, the interaction between the healthcare staff and the coronavirus positive patient is sufficiently reduced and, thus, further infections are prevented,” she said. She noted that a quicker response by the local authorities could be established if the data transmission system is made smoother.

Basudev Mohapatra addressed the successful measures that the state government of Odisha has taken to deal with the pandemic. As of March 30, the total number of cases in the state is reported at 128, with one  death. Hence, Mohapatra noted, the state has been sufficiently able to contain the pandemic as of yet even though it reported its first case back in March. Mohapatra noted that Odisha, which has been frequently struck by natural calamities, banked on its prior experience in handling disaster like situation to cater towards its population in times of crisis. Immediate action as state has been experienced in dealing with the issue. The key to the success of the state government can be attributed to the state government’s support to the Centre’s decisions, he said.