The health sector needs public investment. Is Mandaviya as health minster a correct choice given Covid 19?
After the recent cabinet reshuffle we have a new union Minister of health and family welfare Mansukh L Mandaviya. Honourable Minister Mansukh Mandaviya is also a Rajya Sabha member from Gujarat who has completed a certificate course in veterinary livestock inspector from Gujarat agriculture University. He also has an MA in political science from Bhavnagar University. Honourable Minister Mansukh Mandaviya is also Minister of chemicals and fertilisers.
The country does not doubt the capabilities of the new minister but the minister has no educational background in medicine, healthcare, hospital, diagnosis or health sciences. To be honest, he does not have any degree in healthcare, be it animal healthcare. He has done a certificate course in livestock inspection which is far more different and narrow than the ministerial portfolio given to him.
We all know the difference between degree programmes, diplomas and certificate courses and how narrow or broad their syllabus is. Degree courses are stretched over three to four years where the vast and extensive syllabus is covered, a diploma is relatively less broad and certificate courses can range from six months to a year. Whenever a person chooses a doctor he always sees how many degrees he has, and everyone avoids going to a doctor who only has a diploma.
So how can Indians rest peacefully knowing that their health minister has a done certificate course in livestock inspection? Since India has poor literacy rate talent and intellect cannot be judged based on educational qualifications or the number of degrees. But few areas which demand in-depth academic expertise like technology, medicine and nuclear sciences also demand learned and trained professionals as heads.
A person can only understand the working of an organisation when he has either worked extensively in that field or has academic expertise. The current minister has none because he was minister of road and transport, shipping, chemicals and fertilisers and agro-industries. He has never laid a foot inside an operation theatre, diagnosed a patient with an illness, managed a hospital or read books on medicine. He has a masters degree in political science which will not help him understand the human body.
A person who does not know chemistry, theoretic physics or rocket science cannot be made as to the head of the Indian Space Research Organisation ISRO. This is where the comparison between the presidential form of government and the Parliamentary form of government comes in. A Parliamentary form of government is called a government of amateurs and a presidential form of government is called a government of professionals.
In the United States, it is impossible for a Livestock inspector Health Minister. In the Parliamentary form of government, the prime minister chooses his cabinet members from the pool of elected members. These elected members got appointed because of their people skills and political capacity. Whereas in the presidential form of government the President chooses his cabinet members according to the checks and balances and confirmation of the legislature.
The choice is not subjective to public constraints. This system is similar to the corporate world where the CEO Appoints his/her team to run the company who are experts in their areas. India provides civil servants, special advisers and other qualified bureaucrats to assist the minister but if a person does not know the portfolio she/he is heading even Einstein cannot guide him/her. Apart from ministerial choices India needs a revamp in the healthcare system after the deadly second wave of COVID-19. To prevent such mishaps in the future India has to prepare before the onset of the third wave which is due soon.
While Kerala fared better on COVID-19 care and Maharashtra didn’t?
Maharashtra and Kerala have similar gross state domestic products but a patient with Coronavirus in Maharashtra was four times likely to die than a patient in Kerala. The reason behind such stark contrast is the effectiveness of the public health system. Kerala has two and a half times more government doctors per capita than Maharashtra. Kerala also has a higher proportion of government hospital beds per capita as compared to Maharashtra. It allows one and a half times more funds on public health per capita than Maharashtra does.
Kerala indulged in timely testing, early case detection, national treatment of Covid patients and an effective outreach system that reduced Covid 19 fatality rates. Maharashtra has a robust private healthcare system but at the time of the pandemic, everything was crippled because the private sector works on the law of demand. The moral of the story is the state needs private health care but it needs a robust public healthcare system on priority.
Refocus on national health Mission NHM-
The government expenditure on National Health Mission has declined in real terms which pose problems for important activities like immunisation and systematic delivery of COVID-19 vaccination. If 20,000 crore rupees allocated for Central Vista were directed towards 25,000 government hospitals more lives could have been saved.
The condition of the National Urban Health Mission is devastating because it allows Rs 2 per month on every urban Indian. The government needs to allocate 1.6 lakh crore rupees for public health in the current year so that National Health Policy can reach its targets. The government also needs to double the health budget so that healthcare services across India are strengthened.
The private sector in health care needs to be tightened-
It was long after the private sector started overcharging for CT scans the government stepped in and capped the price at 3000 rupees. The private sector does not work for the welfare of the people, it works for profit maximisation. Therefore the government needs to step in and decide rates for healthcare services. Newspapers are filled with clippings about massive hospital bills of three lakhs per week and unnecessary charges. Remdesivir Panic rendered many people dead and indebted.
Black fungus outbreak owes itself to unnecessary use of steroids especially on diabetic patients for more money. The government needs to implement the Clinical Establishment Registration and Regulation Act CEA which was passed in 2010.A central minimum standard must be decided to develop a regulatory framework for rates. 15 state governments had to invoke disaster-related provisions to regulate prices of the private sector for COVID-19 treatment. But initiatives and regulations are still inadequate.
Reduce privatisation of healthcare
Providing healthcare, water, sanitation is the responsibility of the government. India has one of the most privatised healthcare systems in the world. Investment opportunities in India’s healthcare sector a report published by Niti Aayog will only promote privatisation of healthcare. The second wave of COVID-19 in India has shown us that the government cannot rely on the private sector to provide healthcare.
The private sector which works on the law of demand hikes prices as the demand goes up which cost people their lives. India cannot look after its people via public healthcare because of poor capacity, it should at least prioritise regulation of the private sector by capping the rates of goods and services. The investment opportunity report by Niti Aayog celebrates COVID-19 and asks the world to come and invest in India which is horrible and insensitive on so many levels.
In a recent Mann ki Baat, the Prime Minister Narendra Modi shared his ideas of privatising loss bearing public sector units. As per the Washington Consensus, it believes that the market will sort everything out on its own. Fact check – it will not. Every time the market was let loose it resulted in crisis that the state government had to solve like the Latin American crisis, Argentinian crisis, 2008 crisis et cetera. The Modi government who is in love with the idea of privatising everything should take a few steps back and think about whether the private sector will work for the welfare of the public?
Because it will not.
