Amid the coronavirus crisis, there is a dire need of fighting back the present situation in the most efficient way possible. Human kind in its civilizational process created the entity of state to take care of the people who constituted its existence, In Hegel’s words “State is the march of God on earth”. As democratization of the social sphere increased, so increased the demands from the state to facilitate the people differently to equate their requirements.
The World Health Organization defines universal health coverage (UHC) as means to enable all people and communities to use promotive, preventive, curative, rehabilitative, and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship. It embodies three objectives: equity in access, quality, and financial risk protection.
The spread of Covid-19 virus which has no structural spreading pattern and is impacting everyone who comes in contact with the virus equally. There is a need to equate the needs of people, As the historical process of development has created various types of inequalities in the society, there is an onus on the state to take differential steps in order to provide bare minimum facilities to the people so that they exist and exercise their Right to life.
According to recent figures of the World Bank India spends around 3.66% of its GDP on health care out of which 1.7% is the present government expenditure. The global average stands somewhere about 10.02% of its GDP on health care. Public spending constitutes about 60% of global spending on health and it grew at 4.3% a year between 2000 and 2017. This growth has been decelerating in recent years, from 4.9% a year growth in 2000–2010 to 3.4% in 2010–2017(WHO).
India’s spending on health care has dropped down from 4% in 2000 to 3.66% presently and so has the state funding decreased. Due to the decrease in state funding conditions of public sector health care facilities are getting degraded. The public sector is not able to bring in research innovations and better facilities due to shortage of funds. The public sector is also facing tough competition from the private health care sector which comes in with immense national as well as international capital to fund them.
Through the process of privatization of medical sector in India in the recent times, health care facilities have been priced extremely high. This highly priced health care is beyond the consumption capacity of individuals who come from a lower strata of economy to afford those facilities. Achille Mbembe, in his concept “Necropolitics” talks about the idea of walking dead, how “contemporary forms of subjugation of life to the power of death” forces some people to remain in a state between life and death.
India represents 20% of the disease cases throughout the world, majority of which is preventable. Health is a state subject in India, though the center also spends on healthcare through centrally sponsored schemes like National health mission (NHM) etc. 80% of the cost is spend by States. The 14th finance commission recommendations suggests greater financial provisions to the states for health expenditure.
In the present scenario as we can see states taking up the responsibilities to tackle this pandemic. There is an urgent need for the center to take admire the fact that states are differentially equipped to deal with this situation hence should be provided funds in order to meet their differential requirements. Though there are appreciable medical facilities in the urban spaces and developed areas, there is still a void between urban and rural, metropolitan and non-metropolitan cities which needs to be filled in.
Though by setting up NITI Ayog there is a positive way forward towards cooperative federalism, which will provide a greater federal devolution. The center to come out in a greater way to deal with this emergency situation. Through the measure of the Central bank in recent times by decreasing policy rates and increasing the “Ways and Means Advances” (WMA) limits of the state government. The center has tried to provide relief but both are short term solutions.
The states are demanding rather an increase in fiscal borrowing. The FRBM limit which is presently placed at 3% of Gross State Domestic Product (GSDP) has to be increased in order to deal with the present financial requirements. The Finance Minister of Kerala for an example has been demanding an increase from 3% to 5% of the GSDP, according to him the 60% increase in Ways and Mean Advances (WMA) may appear a big amount but in reality it is not adequate enough to deal with respect to the present scenario.
Due to the shortage of financial funds, there is also inadequacies with respect to the equipment’s required for testing. Thus there is low level of testing in India. This will in the long run increase the number of people under threat who will die due to the virus at an exponential rate. There is also a shortage of protective gears which are required for the health care workers, which in turn has increased the casualty rates within the heath care sector.
By bringing in the PMJAY Scheme to provide testing and treatment facilities to the beneficiaries covered under it, free of cost has given some relief to the disadvantaged. PMJAY is based on data from the Socio Economic Caste Census (SECC) of 2011. There are various expected discrepancies which may act as a shortcoming of the intended action while creating a huge void for exclusionary errors. The state in the times of emergencies should also look at these limitations.
There is also a need to see through the areas which are most likely to get impacted in the future due to reverse migration process of the labor force. The migration phenomenon takes place in search of better facilities which are not available in an area. Post reverse migration these areas such as Bihar, Jharkhand, Odisha and other hilly areas of north eastern India are expected to see a high rise in spread of the disease. Due to their underdevelopment, health care facilities are not adequate in these areas.
There is an urgent need to club the public and private sectors of production into an abstract machine as suggested by noble laureate Abhijeet Banerjee which works for the betterment of human kind. Clubbing in public and private hospitals, healthcare systems, procurement and service delivery system to work for sustenance of human kind rather than profit generation. The Chinese model or the Kerala model to deal with COVID-19 by pooling in all resources to facilitate basic public infrastructure and services can be taken into consideration.
There is also a need to bring financial measures at the disposal of differential need of the people and geographical space and time requirements. Democratic decentralization can be taken as a measure to solve various problems at the grass root level. From diagnosis of individuals and getting them cured to the level of basic production, procurement and redistribution shall work in a better way if we align the factors of centralization and decentralization synchronously.
Needs of the unemployed, daily wage labors, students, workers, middle class, students and the capitalist class are to be taken into course differently and equitably. There is utmost requirement of need based resource allocation from the state. In a democracy no one should be left out despite of their social, political or economic positon as every element of the system plays a vital role to keep the system working.
As Slavoj Žižek states that it becomes highly impossible for human kind to return to the normal after facing a crisis, creation of new normal is indispensable. What is required is to create a new normal which is facilitating the demands of the people, the demands which are differential in nature. Thus there is a need to come out of grand ideas, meta-narratives and focus to prepare a people’s policy to tackle this pandemic and create a better normal for tomorrow.
The author, a young professional engineer from Ranchi ( Jharkhand ) , now lives in New Delhi. He may be contacted at his mail ID [email protected]