Dr Anamika Ray Memorial Trust, a non-profit research and educational organisation, working for the health right, has decided not to observe Anti-Medical Terrorism Day this year on July 19 due to the ongoing pandemic.
The Trust has been observing this day for the last four years demanding quality and transparent health care system for all in India.
The Trust has also been advocating for the right to health as a fundamental right in India for the last three years.
In spite of Government of India’s commitment in 2004 to raise public spending on health care to 2-3% of the GDP, it has been sadly observed that the annual public spending on health care in the last 15 years remained a meagre 1% of the GDP.
A similar announcement made in the 2017 National Health Policy to increase public spending on health to 2.5% of GDP by 2025 with no sign of implementation has impacted the management of COVID crisis regardless of some emergency spending.
The Trust has been persistently giving warnings that in the face of any kind of epidemic or pandemic, the country would suffer for want of necessary infrastructure.
During this pandemic, the following deficiencies in the public health care system in the country have come to the fore and should be a cause of concern for all right-thinking people:
a) Due to the shortage of public health facilities during this pandemic, many non-COVID patients are deprived of treatment. India is one of the highest disease burdened countries in the world.
The Organisation for Economic Cooperation and Development (OECD) identified India’s poor health outcomes as one of our major developmental challenges. India is a laggard in health outcomes not just by OECD standards, but also by the standards of the developing world.
b) With COVID-19 aggravating the already deplorable sight of public healthcare in India, the situation has led to 884 total non-virus deaths from January 30 to June 17.
Out of this, 335 of them were migrant workers. Though accidents and starvation were the biggest causes of deaths, lack of medical care or attention has led to 63 deaths till July 17. Besides, many deaths went unreported (TNN).
c) Media reported a total of 125 suicide deaths due to the fear of infection, loneliness, lack of freedom of movement and inability to go home during the lockdown phases. This has reflected the nation’s inability to manage the mental healthcare situation of the country during and post-emergency.
d) Due to this COVID-19 crisis, due vaccination of children is being hampered through the existing schemes.
In developing countries like India, diseases like malaria, pneumonia, and diarrhoea pose a greater threat to children than COVID-19, the management of which has adversely affected the immunisation programmes giving rise to an apprehension that at least 117 million children this year would miss out the routine vaccination (Lancet, 2020).
One cannot afford to pay less attention to the efforts required to be taken to improve the health care of children below 5 years, who have also the right to live with dignity.
The children mortality rate in India is, unfortunately, more than that of the underdeveloped countries like Nigeria, Congo. The situation is so grave that every 25 seconds a child under 5 years of age loses his/her life in India.
e) Malaria and HIV/AIDS patients could arguably be the worst affected as reports about Hydroxychloroquine and anti-retroviral drugs being used to treat COVID-19 patients has led to their acute shortage in drug stores.
We have to keep in mind that India reported 3.3 lakh malaria cases in 2019 (estimates by WHO suggest we only report less than 10% of actual cases) whereas 21 lakh people were living with HIV/AIDS in 2017.
In both cases, the reduced availability or affordability of these medicines could be disastrous.
f) Hundreds of beliefs and superstitions swamped the information space during this crisis and primarily infected the minds of the common people, who are mostly unable to check the fake and become the victim of the viral forward messages.
In this prolonged health crisis of the country with poor healthcare at under-resourced hospitals, nobody knows how many COVID-19 carriers were misdiagnosed or undiagnosed.
This situation has also added to the fuelling the menace of beliefs and superstitions on this pandemic.
g) India is dependent on the private healthcare system. As per the data of April, 2020, India has 43,487 private hospitals against 25,778 public hospitals.
During this crisis period, the Government should fix the rates to treat Covid cases, otherwise there will be another crisis when public health will be unable to provide treatment to the Covid positive patients.
From the past experiences, it can be assumed that the private hospitals will try to make up the loss they faced during this crisis from the Covid patients.
h) There is a huge discrepancy of doctor-patient ratio in India.
Although 1.2 million allopathic doctors were registered in India as on September 30, 2019, but the number of practicing doctors is not available and the assumption is of about 9 lakh doctors are serving the country and out of that only about 1 lakh doctors are engaged in the public health who treat nearly 80 crore rural Indian population.
The shortage of doctors varies in different states. The shortage is due to uneven rural-urban distribution.
Public health/hospitals being a state subject, the primary responsibility to ensure the availability of doctors in public health facilities lies with state/UT governments.
i) As found in a recent WHO report published in 2016, only one in five doctors in rural India is qualified to practice medicine. It says 31.4 per cent of those calling themselves allopathic doctors were educated only up to class 12 and 57.3 per cent doctors didn’t have a medical qualification.
In India, self-styled doctors without formal training provide up to 75 per cent of primary care visits.
The report also brought out that whereas 58 per cent of the doctors in urban areas had a medical degree, only 19 per cent of those in rural areas had such a qualification.
j) It is a matter of serious concern for the entire nation that about 5.2 million medical injuries are recorded in India, of which around 98,000 people lose their lives every year.
Approximately 3 million years of healthy life are lost in the country each year due to medical negligence, which is not acceptable at any cost.
k) Out-of-pocket expenditure on health because of the low insurance coverage and weak public health system is another key reason for poor health of Indians that ranks after Pakistan and Bangladesh with 57.57% out-of-pocket expenditure on health.
The draft of National Health Policy, 2015 takes note of the fact that over 63 million people are faced with poverty every year due to overburdening health care costs alone as there is no financial protection for the vast majority of health care needs.
We need the citizen of the country to be protected under national health insurance.
This is the high time to think not only to manage this crisis but prepare for the future. The right to health should be a fundamental right in Article 21 of the Constitution of India to change the scenario of public health in the country.
The right to health is not enshrined in the Constitution of India as a fundamental right, although, it was indirectly mentioned in different articles of the Constitution such as directive principles of state policy.
Dr Anamika Ray Memorial Trust urges to consider this demand of incorporating the right to health separately in Article 21 of the Constitution or a separate law to make healthcare system of the country transparent.
Dr Anamika Ray Memorial Trust takes this opportunity to salute those doctors and health workers and others, who have been serving the nation and humanity in this hour of health crisis and pay obeisance in the revered memory of those, who lost their lives in the line of duty.
(The author is the honorary managing trustee of Dr Anamika Ray Memorial Trust and Head of the Department of Communication and Journalism, Gauhati University)