Why India needs an NHS-like healthcare model

Swati Narayan writes: Even after the pandemic, the Indian government continues to budget less than 1 per cent of GDP for healthcare, one of the lowest in the world.

Early this month, the Uttar Pradesh government informed the Allahabad High Court that the order for a re-inquiry against Dr Kafeel Khan had been withdrawn. But the doctor remains under suspension due to disciplinary proceedings in another case instituted by the state health department.

On the night of the tragedy in August 2017, the good doctor had moved mountains to procure oxygen cylinders for his encephalitis patients, whose lives hung by a thread. But 63 innocent toddlers suffocated when the government hospital in Gorakhpur ran out of oxygen. If only the government had carefully listened to, instead of arresting, Dr Khan, maybe, the chronic oxygen crisis plaguing Indian hospitals would have been resolved before the pandemic.

Now the health ministry has claimed in Parliament that only Punjab has reported four “suspected” deaths during the second Covid-19 wave due to lack of oxygen. This contradicts every news report. Patients gasping for breath on stretchers, testimonies of relatives running from pillar to post for oxygen refills, gurdwaras installing oxygen langars, televised SOS pleas of hospitals, appeals from state governments, overcrowded crematoriums and bodies floating on the Ganges. But in Delhi, the Lieutenant Governor has twice rejected proposals by the state government to commission committees to investigate oxygen deaths. Instead, the volunteer-run “Oxygen Shortage Deaths” group has documented at least 629 oxygen-related deaths since May 2021 nationwide.

Even before the pandemic, similarly horrific healthcare tragedies occurred every single year. In 2017, 800 children died in Jharkhand of suspected encephalitis. In 2015, 18 patients died in a Chennai hospital, due to power failure after the floods. In 2014, 13 women died after illegal sterilisation at an overcrowded government health camp in Chhattisgarh. These tragedies recur, but the sorry state of healthcare persists.

On a personal note, across the oceans, my sister has been battling encephalitis for the last two years. But though she is on a delicate road to recovery, there is no doubt that Britain’s National Health Service (NHS) government hospitals have saved her life repeatedly.

Every year, Britain’s legendary health network cures 15 million patients with chronic ailments, at a fraction of the cost spent by the US. The NHS funded by direct taxes is also the fifth largest employer in the world, after McDonalds and Walmart. One of every 20 British workers is employed as doctor, nurse, catering and technical personnel. As true successors of Florence Nightingale, the compassionate nurses after the pandemic have been hailed as superheroes by graffiti artist Banksy. After all, in a rapidly ageing society, for Britons, “the NHS is the closest thing to religion”.

On the other hand, in India, hospitals are beleaguered with absentee staff. As per a Niti Aayog database, in the worst state of Bihar in 2017-18, positions for 60 per cent of midwives, 50 per cent of staff nurses, 34 per cent of medical officers and 60 per cent of specialist doctors were vacant. Those on the job, despite being handsomely paid, are chronically overworked.

Even after the pandemic, the Indian government continues to budget less than 1 per cent of GDP for healthcare, one of the lowest in the world. In contrast, China invests around 3 per cent, Britain 7 per cent and the United States 17 per cent of GDP. So, 62 per cent of health expenses in India are paid for by patients themselves — one of the main reasons for families falling into poverty especially during the pandemic.

The Covid-19 oxygen crisis could certainly have been prevented. But the central government delayed by eight months a Rs 200-crore tender to build oxygen plants across 150 district hospitals. In contrast, prescient district collector Dr Rajendra Bharud set up multiple oxygen units in Maharashtra’s Nandurbar before the second wave. Kerala, the only oxygen-surplus state, also increased production capacity in 2020 in anticipation of a demand surge.

Before the NHS was established, George Orwell in his stinging 1946 essay How the Poor Die painted a tragic portrait of state-run hospitals with, “a seeming lack of any perception that the patients were human beings”.

In the 21st century, not much has improved in India’s public hospitals. Still, in India doctors are often equated with gods. But, without basic medicines, equipment and oxygen, can even Dr Khan be expected to perform miracles?

This column first appeared in the print edition on August 25, 2021 under the title ‘Lessons from pandemic’. The writer is with NIAS

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