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India needs strong policy reforms, not symbolic gestures

June 17, 2020

On March 22nd (Sunday), Indians responded to their Prime Minister’s call to pay respect to the front line workers who are “working 24/7 so that our nation becomes free from COVID-19. #JantaCurfew.” People clapped from their balconies to show solidarity with the corona warriors. The event was hailed as united India standing to thank their brave souls. While such spectacles are useful tools to lift the morale of a nation in these unprecedented times, the event should not be seen in isolation from the policy reform/initiatives undertaken by our government. As a concerned citizen, we need to be vigilant if such events are used as a smokescreen to hide the systemic failures.

We need to inquire that beyond the talis (claps), what have we done to protect our frontline workers from the infection, why are these warriors facing backlash at raising genuine issues. What has been done to protect them from social stigmatisation and harassment at the hands of their society/flat owners. The delayed response/ no response to many of these questions makes it feel like we are trying to instill a false pride among our corona warriors in order to silence them. If we really respect our corona warriors, we need to ask some very tough questions to our political leaders (across party lines) to stop the systemic exploitation. The government needs to do more than symbolic gestures, if they are really serious in protecting their citizens and respecting frontline workers.

India lags behind in Social Spending

The government’s timid response to corona was not only because they were caught off guard by this pandemic. The mess we are in now has been planned and implemented across decades. Multiple governments in India have spent a meager percentage of their GDP on social infrastructure. Despite multiple researches advocating social sector spending to boost the economy, successive governments have just paid lip service to social development and poverty alleviation. The policy responses have lacked adequate financial assistance. The Economic Survey 2017-18 reported that India’s social spending as a percentage of gross domestic product (GDP) had remained in the range of 6% during 2012-13 to 2014-15”. The central bank of India (RBI) found India’s social sector expenditure as “woefully below peers”. Within the social spending expenditure, India spends only 1.02% of the GDP on public healthcare. While some of the neighboring countries spend way higher than us (Maldives spends 9.4%, Sri Lanka 1.6%, Bhutan 2.5%, and Thailand about 2.9%.) Sri Lanka’s per capita expenditure on health is about four times as much as ours. In 2020, India spent less than Rs. 200 per person on public healthcare. 12 states have spent under 1% of GSDP on healthcare. Kerala, a small state in southern India, held a mirror to the federal government on how social spending could have helped avert the pathetic situation we are into.

Do we really care? - Erosion for social protection schemes disadvantaged

On December 20th, 2017, 60 development economists wrote to the Finance Ministry highlighting the "extraordinarily stingy" contribution of the central government towards social security pensions which hasn’t increased beyond measly Rs. 200 since 2006. The scheme covers more than 2.4 crores of pensioners. Such lacking schemes have left our elderlies with no means to fight the tough times during this pandemic.

Apart from the extremely low healthcare budget, India has appalling deficits in providing public healthcare facilities. Fraught with weak infrastructure and poor quality medical services, India’s healthcare system was already in a critical condition. Banking

on the private sector, India promoted informalisation in the health sector leading to massive rise in contractual employment. The private sector in turn intensified the exploitation of medical professionals (especially care givers). The income disparities of medical professionals working in the USA, Canada and the UAE are huge when compared to their Indian counterparts. The resulting international migration has led to the shortage of Human Resources for Health (HRH) in India. Wichterich (2020) states that India has a shortage of around 2 million nurses. Compared to WHO recommendation of 1:4 nurse-patient ratio, India has 1:40. The situation in rural areas and primary health care centers is even worse.

In a response to this crisis, the government started promoting volunteerism. Asha workers were hired on contractual basis to support the rural healthcare system. They receive meager payments for their community service (the government does not identify them as working professionals). Asha workers across various states have protested time and again to make their position permanent and increase their wages. Many of these workers are the sole breadwinner for their family. Their requests have fallen to deaf ears over the time. The healthcare workers also face other forms of harassment and the grievance redressal mechanism for such complaints is broken.

“The ideology of honour which is attributed to voluntarism does not pay off in money or recognition. The imagined culture of honour leads to a bizarre situation that the dignity and labour rights of women are violated by a ‘state without honour’ as highlighted by Sreerekha (2017).

It took decades for India to strip their healthcare workers of all dignity and expose them to systemic exploitation in the spirit of a noble cause. The Corona crisis has unearthed the rot that prevailed in our healthcare policy. It will take decades to fix this. That will happen only if we recognise the problem and set our priorities right. We can start with increasing our social sector spending, providing policy support to our health workers with a better wage, social security, protection against harassment of any kind. Public healthcare system should be strengthened and not destroyed to give way for the private sector.

Ashish Ranjan, Assistant Professor, Unitedworld School of Business (UWSB)

Disclaimer: The opinions / views expressed in this article are solely of the author in his / her individual capacity. They do not purport to reflect the opinions and/or views of the College and/or University or its members.

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