State Health Response During COVID-19: Why We Need A Coordinated Approach ?

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It’s really disappointing to see how our state governments are fighting, or in some cases struggling, in these difficult circumstances. Many things are propping up in the media—like how all states are managing PPE or others things on their own, and there are even reports that our central government is also providing some support. But, why is there no coordination?

Here is the catch: some states are managing this crisis with full capacity. But most of the states don’t have the medical capacity to handle the crisis. How will these states fight the pandemic?

I hope our central and respective states administration would have coordination to assess the situation and prepare accordingly. Most of the Hindi-speaking states fall in the category, where they don’t have infrastructure or human resources in the first place. Some of you might remember Gorakhpur, UP, where in September 2017, hundreds of children had died at the hospital because of Acute Encephalitis Syndrome (AES). Doctors could have saved those life, but there was insufficient supply of oxygen. That happened during the normal times, before this pandemic.

The condition of health facilities is almost the same in my native state of Bihar. The governance and state health infrastructure are not up to par, let alone the preparations of the state to handle a crisis like this pandemic. One can understand this through the case of the recent outbreak of Acute encephalitis syndrome (AES) in Bihar in June 2019, where around 37 child lost their life, or rather, I would say, the health system of Bihar did not have the capacity to prevent the situation. This was palpable from the reports coming from the ground; and only functional institutions at the ground-level could have averted the grim situation. Furthermore, according to Nation health portal (NHP) 2018, in Bihar, one doctor serves a total population of 28,391.

Here, there is no need to explain the condition of bigger states like MP, where Shivraj Singh was chief minister for 13 years, and the BJP has been running the show for 15 years. Even after losing in the recent assembly election in the state, the BJP entered from the back door. Shivraj Singh again formed the government in March 2020. Almost the entire health department of state government including top officials are being infected or gone for quarantine.

If we turn to Kerala, the performance of the state government in to managing the whole crisis is unsurprising. One cannot handle such a huge crisis like the coronavirus with a short time of preparation; you must have proper existing infrastructure and resources beforehand, only then can you plan well in advance. Whatever news is coming from Kerala, that is the result of implementation of a robust plan. Here, everybody in the state is contributing. Of course, the team leader has to play a bigger role, and Chief Minister Pinarayi Vijayan has been acting like a true statesman as always. We have seen his leadership recently in the devastating flood as well.

The entire state functionaries are on the emergency duty. Here, the local governance has been a playing crucial role in helping others during this difficult time. We cannot finish the Kerala story without mentioning the name of its health minister K.K. Shailaja. She has been on the frontlines to assist all officials. Every day, she stays in the office till every one has gone home; she is the one who leaves her office last.

Recently K.K. Shailaja told The Washington Post, “We hoped for the best but planned for the worst. Now, the curve has flattened, but we cannot predict what will happen next week.” Shailaja claimed six states had sought advice from Kerala.

I am more worried for a few states which, historically, have had a good track record of health infrastructure and taking care of their peoples. Here, I am talking about two state: Maharashtra and Tamil Nadu. These states were pioneers for development initiatives, especially in the health infrastructure, even during colonial times. But, for quite some time now, due to bad governance or lack of a visionary leader, those infrastructures have not been upgraded, or in many cases, due to low public investment in the health sector, are no longer viable to help in a crisis like this pandemic. Maharashtra alone would have helped at least four to five states in this crisis if they had functional institutions. But, at this point, at least Chief Minister Uddhav Thackeray is showing his leadership to fight the pandemic.

There are faults lined in the health sector or politics of health, because health is a state subject as per our Constitution. State governments don’t have autonomy on resources; they have to depend on the central government for resources. But most of the time, our Central government is busy planning for health while sitting far away in Delhi, and all the burden smoothly goes to the state government.

After liberalization in India, Central government stopped putting money for building infrastructure and started withdrawing funds to create human resource in the government; instead they pushed towards the private service providers. The government started giving insurance schemes to the people without thinking who will be provided the service. As we know, even private health providers are very limited in numbers and their reach is not beyond the big cities. Government cannot wash their hands by giving money to insurance companies.

It’s high time for our government to invest more in public sectors. I would recommend that India adopt universal health care where everyone should have an equal access to health services. We can learn from many countries. Some of them, like Cuba, even in difficult circumstances, developed the capacity of the nation health sector far beyond the so-called developed countries. For this, the Central government would have to give financial autonomy to the state.