Updated: Oct 7
Sahil Shrivastav(Associate Editor, Legit)
A lot of brainstorming has happened over the medical infrastructure since the nation witnessed its first-ever national lockdown. The Medical facilities in India have not been at par with the standards as compared to many other nations, at least the Government Hospitals. But never has any government, in the Independent India, been thoughtful of the Medical Infrastructure under such pressure. Although this is the time to stay strong, united and implement Co-operative federalism in its pure form, yet it is the time to hit the hot iron with the hard question and test its malleability.
With the rising number of Corona cases in India, the Government machinery has got a wake-up call to improve its medical facilities. COVID 19 has brought susceptible attention of everyone towards the Medical facilities in the nation. While writing this article, 6th July 2020 at 12.31 pm, the number of Corona cases in India are at 6,97,412 as per the Ministry of Health and Family Welfare. The total number of deaths reported is at 19,693, even though the mortality rate of the virus is indecent yet the death of every human individual is mournful. With the available data, the mortality rate of the virus is 2.82% in India, still, the recovery rate has proven that most of the deaths rather than all could have been prevented. But where did we go wrong? What was that one step which brought us into this maze trap? What could have prevented the life of around 19,000 people? all these questions are buzzing in everyone's head. While some believe that pointing out the deficiencies in the time of such pandemic is demotivating and unethical, still it has to be answered at this time before these ground issues get lost in the 'high profile issues' of politics.
WHERE DID IT ALL BEGIN?
The pandemic made its place in the world earlier this year, but the actual problem was present from a very long time, from the time we survived the dooming days of Spanish flu, to the struggle for eradication of polio in the developing nations and still not focusing on healthcare. The medical facilities have been given very less attention in most of the developing countries, the basic human needs that are food, clothing, shelter, itself, have made many governments careless of providing sound medical facilities. This was where it all began.
India began its journey, as an independent sovereign nation, with around 7000 hospitals throughout the nation in 1947 with a population of 361,088,090 to be served. But with the exponential growth in population at 135.3 crores, the number of hospitals which were 37,725proved insufficient to attain the objective with which we, India, started. There was and is humongous pressure on the healthcare industry in the time of this grave pandemic which has its reach to every nook and corner of India now. Thus, it makes it fairly significant to study the need of allocating Government funds to the healthcare industry without any delay.
HOW IS IT NOW?
As per the data by the World Health Organisation, for the year 2016 particularly, out of the total GDP of the nation, only 4.7% is spent on the health sector while many European or North American countries spend more than 10% of their GDP on health industry. Besides, as per the reports of WHO, India still lacks behind in the number of hospitals beds per 10,000 people, having only 7 beds per 10,000 people in 2011.
The Government of India in its budget for the Financial year 2020-21 allocated a huge amount of Rs.67,112 crores to the Ministry of Health and Family Welfare as compared to the highest allocation of Rs. 4,71,378 crores to the Ministry of Defence. while none of the sectors can be said to be of less importance still, there is a need to either curb the unwanted expenses or increase the budget, which in turn would lead to a higher deficit. then what can be done to create a better health facility without compromising the growth of any other sector?
As per the data presented in a press release by the Government of India in 2018, there were in total 37,725 hospitals serving a population of 135.3 crore in short, each hospital serving a massive 35,864 people.
WHAT CAN BE DONE?
It is a well-known fact that the State has to ensure that every human life within its sovereign territory has been endowed with the right to life and the same is safeguarded. Thus, the policies framed must have welfare and holistic growth at its centre. This makes it mandatory for every state to provide basic amenities for life which includes good food, good health, education and shelter.
But with the advent of the pandemic, the Healthcare industry of India has let down the expectations of its citizens. And hence it makes us question recent policies on which the State has been working rigorously and thereby analyze it through the lens of welfare and holistic growth.
The recent Citizenship Amendment Act (hereafter referred to as the Act) was an indication of prospective implementation of a Nationwide National Register for Citizens. The act and the NRC were in discussion for a reasonable period of time and had been questioned on various grounds, but very few or negligible questions involved at the core of it the economic impact. In the recent world of pandemic, this policy of Government has to be discussed before the severity of situation fades away.
"Assam is the only Indian state that has an NRC, a register that contains the list of all Indian citizens in Assam bearing their name, address and photograph. Assam has a high number of immigrants from Bangladesh (formerly East Pakistan). In 1951, the Ministry of Home Affairs created the NRC to distinguish citizens from illegal immigrants."India has only seen a single state implement NRC with an average cost of Rs.1600 crores which was not error-free and had both emotional and physical impact on the citizens of the state. With the Citizenship Amendment act coming into force and as per the statement given by Hon. Home Minister of India the state is planning to implement a nationwide NRC. But is it really a policy which the state should focus on? Does it have the welfare at its centre or is it a camouflage?
Let us understand the effectiveness of this policy through an economic analysis of the monetary impact it will have and compare it with a policy which would emphasize on strengthening the medical infrastructure. The calculation below ascertains the approximate cost of implementing NRC in Assam per citizen;
Cost per person = Total Cost : CPP = Rs.1600 cr. = Rs. 52.28
Total Population 3.06 cr.
Now, ceteris paribus (other things being constant) after multiplying the CPP by the total population of India, we get an approximate figure which is the cost of implementation of Nationwide NRC;
Total Cost = CPP x Total Population :TC = Rs.52.28 x 136.6 cr. = Rs. 7.14 Lakh Cr.
Therefore, with this calculation, the total cost of implementing the NRC throughout India will cost around Rs.7.14 Lakh Cr.
Let us assume that this total cost is invested in the development of Hospitals in India resulting in the creation of quality hospitals and thereby reducing the burden per hospital. The average cost of constructing a fully functional hospital with world-class equipments is Rs.70 Lakhs/bed. Therefore, within the cost of nationwide NRC a total of 1,020 multispecialty hospital with 100 beds; or a total of 23,800 hospitals with 100 OPD & ICU beds.
Beyond this the Government can allow subsidies and many other compensatory benefits such as import of medical equipment’s at subsidized rates, leasing land at reasonable rents, providing taxation benefits to the hospitals or issuing competitive tenders. The canvas is huge and the colours are endless, what is needed is the artistic approach and a strong will.
The comparison made between policy for National safety and policy for sound Medical Infrastructure may seem vague but are of equal importance. The question here is not which one to implement? It rather is which one to implement first?
WHAT WILL IT BE IN FUTURE?
It is not about what the State keeps or discards? It is about, what has to be done now? &, what has to be done later? The state has to approach the calamities proactively in order to mitigate the impact. Being the pioneer of Surgical science (Sushrut Sanhita) and having introduced one of the most ancient and effective wings of medical science, The Ayurveda, India as a country cannot excuse its medical infrastructure. Having a population of 138.6 crores the country has to embrace itself for many more pandemics in future and not rely on special arrangements every time.
The nation wants to know ‘what’ is being served not ‘who’ is being served!
Government of India <https://www.mohfw.gov.in/>last accessed 6 July 2020  Supra 1  Mortality Rate (in %) = Total Number of Deaths / Total Patients infected * 100 By Mukul ‘How has the Indian healthcare sector evolved in the last 70 years?’ (January 29, 2019)<https://ehealth.eletsonline.com/2019/01/how-has-indian-healthcare-sector-evolved-in-last-70-years/#:~:text=At%20the%20time%20of%20independence,their%20caste%2C%20religion%20or%20occupation.> last accessed 6 July 2020 ‘Census of India’ (1951)<https://www.jstor.org/site/SAOA/SouthAsiaOpenArchivesSAOA/CensusReports-1951-26575929/> last accessed 6 July 2020 World Bank <https://data.worldbank.org/indicator/SP.POP.TOTL?locations=IN> last accessed 6 July 2020 Government of India <https://pib.gov.in/PressReleasePage.aspx?PRID=1539877> last accessed 6 July 2020 World Health Organisation<https://www.who.int/countries/ind/en/> last accessed 6 July 2020  World Health Organisation<https://apps.who.int/gho/data/node.country.country-IND?lang=en> last accessed 6 July 2020 Government of India <https://www.indiabudget.gov.in/doc/bh1.pdf> last accessed 6 July 2020 Supra 8 The Constitution of India 1950, art. 21 Supreme Court Observer<https://www.scobserver.in/court-case/assam-s-national-register-of-citizens> last accessed 6 July 2020 Priyaranjan Jha ‘Identifying illegal migrants through NRC process will be cumbersome, costs far outweigh benefits’ (January 3, 2020)<https://indianexpress.com/article/opinion/columns/nrcs-cost-benefit-analysis-caa-protests-6197030/> last accessed on 6 July 2020.; Rahul Pandey 19 December 2019 <https://www.nationalheraldindia.com/opinion/does-amit-shah-even-understand-what-nrc-will-cost> last accessed 6 July 2020. ZEPNUPhealth (April 22, 2019)<https://www.blog.zepnurhealth.com/post/the-pecuniary-plan-how-much-does-it-really-cost-to-set-up-a-hospital-in-india> last accessed 6 July 2020. Legit Originals, Volume 1, Issue 1 (September 2020)