The Covid-19 variant that is spreading even now in India, after its massive outbreak, has proved to be devastating. World Health Organization’s (WHO) Chief Scientist Soumya Swaminathan lamented that India failed to read early signs of this variant and now it is taking off vertically. Death of infected patients due to the denial of admission in hospitals, non-availability of oxygen, and deficiency of ventilators has become very common. Not only this, even the cremation grounds have run out of space and dead bodies are either being buried near the banks of rivers or are being dumped in the water.
MEDICAL INFRASTRUCTURE OVERWHELMED
When the cases started rising during the initiation of the second wave of the pandemic in India, our governments failed to take notice of it. Only when Maharashtra, Delhi, and a few other states rang alarm bells for ventilators and medical oxygen, the central government came out of its catnap to distribute whatever little stock of ventilators and oxygen it had, and that too, to a few favoured states. Hence, it compelled the affected state governments to approach courts to get solace. High Courts’ warning to punish the central government officials obstructing oxygen supply to different states led the central government and its machinery to swing into action. The panic button triggered, pressed the central government to procure oxygen, cryogenic, ventilators and oxygen concentrators from other countries. India that was boasting ‘vocal for local’ slogan soon knelt down and relied on overseas help to fulfill its medical requirements. From the US and Europe in the west to tiny nations like Bangladesh, Bhutan and Thailand, aid is coming to India from all corners of the world.
The negligence and carelessness on the part of the central government can only be blamed for this monster disaster. An agency under the Ministry of Health had put out tenders worth over `200 crore for setting up oxygen plants in 150 district hospitals in October 2020. However, even after six months i.e. by March 2021, just 33 plants could be installed. Year 2020 too, saw an insubstantial and inadequate additional spending on public health infrastructure. The central government remained hellbent not to scale up the expenditure for improving and expanding the public health system, especially the employment of medical professionals. Here, it won’t be incorrect to hold even the previous governments accountable for the appalling overlooking of the public health sector. Since 2014, the number of AIIMS has grown to 22 from 6; medical colleges have increased to 565 from 381 with undergraduate seats escalating to 85726 from 54348 and postgraduate seats growing to 54275 from 30191. Despite this, there is a serious deficiency of doctors, nurses and technicians even during normal times, set aside this pandemic. The number of doctors per 1000 persons in India ranges from 1.3 to 1.5 whereas for proper care of patients, there should be 14 doctors per 1000 persons -according to UN data.
In addition to the poor healthcare infrastructure, deceptive and dubious guidelines too remained liable for this situation. Almost from the beginning of this year, the Modi government sold the idea that there are two made-in-India vaccines which would take care of the vaccination needs of the first 30 crore people. Not only the made-in-India vaccine was a spurious slogan (since Covishield had been created by the AstraZeneca-Oxford project and licensed to Serum Institute for manufacturing in India), rather, it imprudently threw the burden of vaccination of people below 45 years on to the state governments. Pertinently, as of now, European countries have not permitted Indians with Covaxin shots to enter into Europe and our government is struggling on this front. Besides, the heavily debt burdened states have been communicated to arrange for the vaccine stocks from the global market by placing orders with vaccine manufacturers which is likely to cost `38000 crore. Apropos, the Centre had allocated `35,000 crore for vaccinations in the Union Budget 2021-22 but it has spent only a fraction of it so far.
Creating physical infrastructure at this juncture is a challenging task. To cope with the situation, the government needs to create more medical centres for testing and treating, either through public, private or NGOs. To manage the shortage of medical professionals, the following measures may also be considered sympathetically.
WHAT NEEDS TO BE DONE
v Estimates reveal that government hospitals have a shortage of medical personnel to the extent of nearly 78%. Accordingly, the onus of treatment of patients is falling more on private healthcare. To tide over the difficulty, the government is required to recruit 150000 more doctors and 200000 nurses. Producing so many fully qualified people in such a short time can be a challenge for any government. To offset this challenge effectively, at the outset we need to approach the medical colleges. There are almost 300 medical colleges in India with sitting doctors (also the retired Doctors) who don’t practice but teach. Many of these doctors can be roped in for treatment or for tele-consultation. This will significantly add nearly 15000 qualified and competent doctors. Lot of people who are asymptomatic or have mild symptoms can be managed with a doctor’s guidance at home.
v Further, we also maintain a fairly large pool of army doctors and nurses in Armed Forces Medical Colleges who may have retired but those who are physically fit and mentally alert. Their services can be utilized gainfully. It may also add somewhere between 2500 to 4000 health professionals.
v Similarly, 130000 doctors are waiting to crack NEET to get into the Post graduate courses. But there are just 35,000 such seats available in the country. These doctors should also be engaged for the service of mankind during this crisis period.
v Another 25000 doctors who have completed their formal training are yet to appear for their examinations who may also be involved in softer medical areas.
v There are nearly 220000 student nurses who have completed their general nursing and midwifery courses or B.Sc. and are waiting for the examinations to be conducted. These nurses should be made available for auxiliary medical tasks in the treatment of Covid-19.
v Besides taking into cognizance the possibility of fleecing practices by the private hospitals and to curb black marketing of medicines, oxygen cylinders, ventilator beds, etc. suitable legal provisions need to be enacted to keep a check. To the extent possible there should be an online broadcasting of the medical facilities available throughout the country. Not only at the central level, rather at the district level too, patients should be given access to the availability of hospital beds and other medical facilities.
These recommendations may go a long way in helping the government prepare in advance for the third wave instead of aimlessly hitting the bull’s eye at the eleventh hour. Asian Development Bank has estimated that the economic impact of this virus to the whole world can be to the extent of $8.8 trillion which may grow further. Hence, we need to desperately focus on curing the economy as early as possible.
S. K. Khosla is a Retired Class I officer.
Rajiv Khosla is Associate Professor in DAV Institute of Management, Chandigarh.
The opinion/s expressed in the article are that of the author’s and do not necessarily represent or reflect the policy or position of this magazine