Then Union Home Minister Rajnath Singh observed in December 2014 — a few months after the NDA government took office for the first time — that a major change in the healthcare system of India was needed. The country, he said, was at present having a fragmented healthcare system which was not at all enough to cater to the needs of the people, particularly the poorer sections of the society.
Addressing the 10th convocation of King George’s Medical University (KGMU) at Lucknow, he said, ‘if the primary healthcare centres are strengthened, almost 85 per cent of the burden on the major institutes like All India Institute of Medical Sciences, Sanjay Gandhi Post Graduate Institute of Medical Sciences and King George’s Medical University can be brought down.’ He added that the government of India was working to bring about this change.
However, in the very first Budget (2014-15) the Modi government slashed health services allocations by nearly 20 per cent; public spending on healthcare in India was already among the lowest in the world. A year later a Parliamentary panel report pointed out that in India there is just one government doctor for every 10,189 people, one government hospital bed for every 2,046 people and one State-run hospital for every 90,343 people ( most of these facilities concentrated in urban areas). With a doctor-patient population ratio worse than Vietnam, Algeria and Pakistan, the shortage of doctors is one of the biggest ailments afflicting the country’s health management system, the panel had noted.
The Union Budget for 2018-19 promised a National Health Protection Scheme (NHPS), a publicly funded health insurance programme for half a billion (50 crore) citizens of the country. But no sufficient funds were allocated for what the Finance Minister had boasted would be the world’s largest government-funded healthcare programme. In the first phase, 1.5 lakh health and wellness centres were proposed to be set up across the country to provide comprehensive healthcare including free medicines and diagnostic services. But the Budget allocation for his was a mere Rs 1,200 crore. This worked out to about Rs 80,000 per centre. If a centre receives 100 patients on weekdays which will make 25,000 a year, the average allocation per patient would be a little over Rs 3 which is much too insufficient even to cover the medicines and diagnostic services, leave aside the overhead expenses on running a centre.
Add to the inadequacy of allocations the massive mismanagement and corruption at every level of the Government — and not only the central government. Prime Minister Narendra Modi started some health-improving projects, though not directly part of health services, such as Swachh Baharat Mission. For this he set up a Fund in October 2014, called Swachh Bharat Kosh (SBK), which consisted of contributions received from Corporate Sector, philanthropists and individuals. Nothing has since been heard of this Kosh; how much money it had received and how that money was used.
How corruption eats up allocations for health services is best explained by what has been happening in the BJP-ruled Madhya Pradesh. When the Lokayukta police raided some years back the residence of then Director of Health Services Dr A N Mittal, he was simply stunned. But his wife Alka Mittal could not keep her cool and shouted at the raiding party: ‘why don’t you raid the house of the Minister (Narottam Mishra was then Health Minister) whom we give Rs one crore every month. You are only after small fries like us’. Before she could say something more, Dr Mittal rushed to her, put his hand on her mouth and dragged her inside a room. The Lokayukta/Income Tax raids on houses of Dr Mittal and two other Directors at other times had recovered currency notes packed in such places as quilts and washing machines, in addition to incriminating documents.
India is a vast country and a vast majority of its people are firm believers in destiny, always wrapped up in religio-superstitious mumbo-jumbo. Besides, they display a pathetic indifference to the government’s corruption and misdeeds unless they are directly affected by it. So the governments’ bungling of health services did not evince the vigorous, collective reaction among the people as it should have, virtually allowing the government to do what it is doing. The outbreak of Coronavirus has, however, changed all as the complacent, destiny-believing people find their relatives, friends and acquaintances infected by the virus and completely collapsed health services. People are dying by scores in urban areas for want of hospital beds, medicines and oxygen. There are queues of bodies at cremation/burial grounds. Such horrendous scenes have never been seen by those still living in this country. But the question is: will the people learn from this calamity and be more vigilant about what the government is promising and actually doing?