A pandemic in an unequal India-01-04-2020

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Migrants walk to their villages after the announcement of the nation-wide lockdown near the Delhi-U. India’s impoverished millions are likely to overwhelmingly bear the brunt of the suffering which will ensue. The measures adopted by the government to stymie the progress of the virus were first to introduce a ‘work from home’ measure, to urge people to wash their hands frequently, physical distancing, and then an unprecedented 21-day lockdown.

Deepening a social divide:

Public health experts are divided about whether this lockdown was absolutely necessary and indeed implementable. It should have been clear that a total lockdown was possible only for the rich and the middle class with assured incomes during the period, homes with spaces for distancing, health insurance and running water supply.

And I cannot forget those confined to detention centres in Assam, which are jails within jails. And then consider the capacity of the health system to deal with the pandemic if it actually submerges India. India’s investments in public health are among the lowest in the world, and most cities lack any kind of public primary health services. The irony is that a pandemic has been brought into India by people who can afford plane tickets, but while they will buy private health services, the virus will devastate the poor who they infect and who have little access to health care.

Most of the official strategies place the responsibility on the citizen, rather than the state, to fight the pandemic. The state did too little in the months it got before the pandemic reached India for expanding greatly its health infrastructure for testing and treatment. Pensions must be doubled and home-delivered in cash. There should be free water tankers supplying water in slum shanties throughout the working days.

India must immediately commit 3% of its GDP for public spending on health services, with the focus on free and universal primary and secondary health care. But since the need is immediate, authorities should follow the example of Spain and New Zealand and nationalise private health care. An ordinance should be passed immediately that no patient should be turned away or charged in any private hospital for diagnosis or treatment of symptoms which could be of COVID-19. While one part of the population enjoys work and nutritional security, health insurance and housing of globally acceptable standards, others survive at the edge of unprotected and uncertain work, abysmal housing without clean water and sanitation, and no assured public health care.