COVID 19: After the virus, a wake up call to invest in Primary Health Care

This was written on the 8th of March.

After the death of 463 patients, the Government of Italy has announced a lockdown for the country, hoping it would stem the rise of coronavirus cases. There are cancelled weddings, funerals, and public gatherings. Theatres, movie halls, restaurants will be shut, as will be schools and universities. Just one day earlier Italy had put the region of Lombardy under lockdown.

As COVID-19 inches its way around the globe – 115 countries have reported cases – it is leaving behind panicked populations.  Between the breathless TV coverage of the death rate, the science coverage on digital media that is often contradictory, well intentioned WhatsApp forwards, and lockdowns of entire regions – people have gone into panic buying and hoarding of food, toilet paper, OTC medicines, hand sanitisers and bathroom cleaners.

While products like Dettol and Clorox , anti-flu tablets, and paracetamol are seeing a spike in sales, and services like Zoom (teleconferencing) are being more used – there is a negative impact on the rest of the economy. The starting point of this economic crisis is the quarantine that China had to impose in various parts of the country to prevent the spread of the virus. While this could mean work from home options for the service sector, it meant a shut down of factories in much of China. A recent satellite image released by NASA, shows the collateral benefit of the shut down due to the Coronavirus – a dissipation of the pollution – but it also gives you an indication of the kind of slowdown that is to come, if the spread of the virus is not stemmed.


Source : NASA

While China with its one party system, and a disciplined population used to following orders, is more or less successful in imposing a lockdown and isolating those with the virus, the question is how do nations that are chaotic democracies do the same thing? How do you force people to stay isolated? How do you provide care for them? What about those who are daily wage workers?  Who compensates for these? And what does a democratically elected government do to its citizens who want to step out for a walk?   

If you look at India, it has been miraculously spared the kind of outbreak and spread that is being seen in China, Iran, and Italy. As a nation we need to understand that for miracles to work best, they need help. And, the system in India is woefully underprepared to help. From a point of view of spending – the most vulnerable states – those with the highest levels of poverty and malnutrition – have cut spending on health. Bihar’s cut its health spend by 15% in 2017-18, spending just a shade over Rs. 6600 crores compared to the previous year’s Rs.7800 crores. Uttar Pradesh’s health spending went down by 2% in the same period. In contrast the North Eastern States, and the developed states like Kerala, Tamil Nadu and Maharashtra have boosted their spending on health.

There are 50+ cases in India spread across the states. Kerala has the most detected infections,  over a 1000 people have been put under observation – and it is contemplating a lockdown. The CM of the state has announced a state of  high alert, with all public programmes suspended till the end of March. Schools have been shut, and the government is undertaking a mass information campaign. Of all the states in India, Kerala probably has the best primary health care system, with secondary and tertiary care built atop a strong foundation of community health and treatment. It coped effectively with the Nipa virus and brought it under control, and it is likely to do the same this time around. It can do so because of its health infrastructure, and a highly educated people who understand the need for caution.

If you turn to states like Uttar Pradesh or Bihar, this model may just about break down. Their health systems are creaking – in many cases they don’t even exist.  And compounding this, is a general state of not following the law and/or government instructions. How would the system fight a virus, for which no cure has been found yet, in states that exist slightly above anarchy? 

In most democracies, public health systems are already overburdened and creaking under the weight of increased health care demand, and consistent funding cuts since the last economic downturn of 2008. Most are woefully unprepared for a pandemic like this. At a time when fiscal discipline is at a premium, nations need to revaluate their priorities. At the top of these priorities needs to be robust public healthcare, at the core of which is an integrated primary health care system that functions. With zoonotic transmissions on the rise, we are going to be confronted with many new viruses for which there is no cure yet. And, to combat these we need to be prepared. This enemy is not going to be fought with supersonic jets, and high precision rockets. It is going to be fought with highly trained medical and para medical teams who are able to identify, isolate, and fix the problem. And, put in place protocols that train the general population on what to do at times like this.  And a larger part of our tax money ought to go in improving this system. The alternative is too scary to contemplate.

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