The Covid-19 pandemic was declared a ‘World Health Emergency’ on March 11 by the World Health Organisation (WHO). This pandemic has led to a partial global shutdown of economic and social activities. Industries and businesses - both public and private - are on a downward curve and are looking for meaningful governmental intervention. Though the Indian government has announced a sizeable stimulus - public welfare domains including healthcare and education could only attract minimum attention.
In the fifth tranche of the government package, Finance Minister (FM) Nirmala Sitharaman announced some healthcare-related measures. The government announced a Rs. 15,000 crore package. This package consisted of Rs. 4113 crore released for the states, Rs. 3750 crore for essential items and Rs. 550 crore for testing labs and kits. Additionally, an insurance cover of Rs. 50 lakh per person for health professionals was also declared under the Pradhan Mantri Garib Kalyan Yojana (PMGKY).
The government has also announced some measures for healthcare workers which include amendment in the Epidemic Diseases Act, adequate provisions for PPEs and pushing for increased indigenous manufacturing of PPEs. It has also declared plans for building infectious diseases hospital blocks in all districts and integrated public health labs in the ground level. The FM also announced that public expenditure on healthcare will be increased but did not mention the details.
Commenting on the recent allocation, Dr. Subhrojyoti Bhowmik, Clinical Director, Academics and Research, Peerless Hospital, told BE, “An amount of Rs. 15,000 crore was announced by the FM but it requires more clarity regarding the segments that the government is intending to invest in. Currently, the hospitals are facing severe shortage of staff. We must keep it in mind that Covid-19 is a healthcare pandemic. As a healthcare professional, my opinion is that a sizable portion from the Rs. 20 lakh crore package should have been released for the healthcare sector. The present allocation seems to be inadequate.”
India has a meagre investment in healthcare (only 3.6% of the GDP), poor per capita ventilation systems, and insufficient quarantine facilities. Under such circumstances, it should have made the announcement more precise regarding the allocation. Additionally, the restoration of civil aviation facilities and trains for migrated labourers threatens to increase the contamination number. In that case, the healthcare system and quarantine facilities in rural areas demand immediate improvements to combat the spread.
The Indian healthcare sector system is separated into private and public sectors. Dr. Bhowmik commented, “In India, approximately 17 lakh indoor beds are available in public and private hospitals. 60% - 70% of the beds are managed by private stakeholders. But the private hospitals are in a bad shape. Patient footfalls have drastically fallen in this period. Apart from only the life-saving surgeries, other surgeries have been delayed. Revenue generation is in an all-time low and the smaller laboratories and nursing homes in tier II and tier III cities are on the verge of closing down. They deserve similar attention like the MSMEs. With a 1.4 billion population and more than 1.5 lakh corona positive patients, India cannot control the situation only by depending on government hospitals. We demand supplementary support from the central government in terms of reduction in electricity charges and reduction in taxes.”
He added, "Huge amounts of ECHS, CGHS and ESI money is still stuck with the government. Our appeal is to release that money now and help private hospitals bear the operating costs. Otherwise, the private hospitals are being forced to cut salaries and are giving pink slips for the first time. The government should allocate an additional budget to recruit more epidemic specialists in hospitals.”
Pointing to a glaring disparity, Dr. Bhowmik stated, "Government hospitals are allowed for free Covid tests for their healthcare professionals but not private hospitals. They have to bear the full costs for their own healthcare professionals. The private hospitals are approximately counting bills in lakhs (Rs. 4500 per test) to pay other private laboratories for the tests. While the government is bearing the expenses for the government healthcare staff, they should not side-line private sector health workers.”
The stimulus has also ignored the pharmaceutical industry which is closely related to the healthcare system. Reports indicate that the industry has slowed down and import of Active Pharmaceutical Ingredients (API) are also temporarily on hold. There is need for some focused governmental plan in this regard to push the Indian pharmaceutical industry.
The lockdown has pushed the education system in a disarray. Many schools, colleges and universities have shifted to online classes. This issue has also been addressed in the recent governmental announcement. The FM has declared to enhance technology driven education with equity in the post-COVID period. She also declared the PM eVidya - a programme for multi-modal access to digital education consisting of e-content, QR coded textbooks for all grades, an earmarked TV channel per class from 1 to 12, special e-content for the visually and hearing impaired. A new national curriculum and a pedagogical framework for school, early childhood and teachers will also be launched. The top 100 Indian universities will be permitted to automatically start online courses by May 30. The government has initiated the Swayam Prabha DTH channels to support and reach those who do not have access to the internet. 200 new textbooks have been added to the e-Paathshaala application. Additionally, the central government has tied up with private DTH operators to air educational video contents.
The advantages of online learning include easy access from the smartphone, laptop or desktop devices while maintaining social distancing. Professor Saikat Maitra, Vice Chancellor, Maulana Abul Kalam Azad University of Technology (MAKAUT), told BE, “MAKAUT is continuously adapting itself to the new digital mode of teaching-learning and it was already in the process for the last two years. Our university is encouraging students and faculties to enroll themselves for Massive Open Online Courses (MOOCs). There is also a system of credit transfer, where if within 160 credit B.Tech. courses, the student is unable to undertake physical curriculum, they can do MOOCs from different learning platforms. This mode of credit transfer is also helping students during this unprecedented crisis due to the coronavirus pandemic.”
Shivani Nag, Professor, Department of Education, Ambedkar University, Delhi, told BE, “It is not clear how the government is distinguishing the top 100 universities for immediate online classes. Each and every university should be exposed to equal opportunities. Moreover, online education can never be a permanent solution in a country like India. Even in the present date, most Indian families cannot afford a laptop/desktop/smartphone for their children. Qualitative internet facility to every village is still a far dream. During the lockdown, many of the parents are working from home and not all of them can afford separate systems for their children. So, in the post-lockdown period, the central government must focus on how the physical educational system can be operated while maintaining distance and hygiene. Additionally, online courses can cause pedagogical disturbances and it is impossible for teachers to give equal attention to each student in this mode.”
A serious concern remains regarding the admission process in various schools, colleges and universities which will be disrupted due to the pandemic. This might lead to a liquidity crunch in many private institutions. However, the stimulus package has omitted this challenge. Professor Maitra saud, “The college admission process will be in accordance with government directives. The colleges are yet to express their opinion regarding their need for a liquidity package from the government.”