Nitish Mohan
Up until April 6, the position of Gujarat stood well below 10 in the list of states with the most number of COVID-19 cases in the country. However, the situation now has taken a somersault with a sudden rise in the numbers. As of April 28, the state stands second with 3774 positive cases. It was clear from the beginning that Gujarat did not have a concrete plan to fight this unprecedented outbreak, when the first case was reported on March 19. It simply shows the negligent and apathetic attitude of the state administration which only swung into action after the imposition of lockdown by the Prime Minister.
At the same time, Kerala formed its high level action committee to combat the pandemic as early as January 25, and it was on January 30 that the southern state saw its first positive case. Kerala, which was swaying between first and second positions with the most number of COVID-19 cases till the end of March, has now managed to go down to the 13th position on the list. It was on January 30th itself that the WHO Director General, Dr. Tedros Adhanom, declared the situation a global emergency. The same day, 82 cases were reported outside China, of which 10 cases were in Europe, but no cases from either Latin America or Africa.
Gujarat’s state government was slow and delinquent to act in the face of this looming disaster. The state assembly saw its annual budget being presented on February 26, without a word about the fast spreading virus. PM Narendra Modi himself visited Ahmedabad to receive US President Donald Trump on February 24. The number of people who participated in the event was approximately 1.25 lakh people. The crowd consisted mainly of school students, factory labourers, government employees, teachers, scheme workers, etc. Taking the occasion as a matter of pride, the BJP state government ensured that they left no stone unturned to achieve this figure. The density was so high that mobile towers were installed overnight. Thus, all these show that the basic preventive measures that are taken during such health emergencies were not even on the platter.
Highest Fatality Rate and Lowest Recovery Rate in India
The so-called “shining Gujarat model” of development has surprisingly failed to show any bright recovery rate as far as managing the pandemic is concerned. The recovery rate of positive patients in Gujarat is only a mere 6.3%, very low in comparison to the national average of 19% (data as of April 22), and even that of Kerala’s, which has a recovery rate of 75%. Fatality rate in Gujarat is astronomically high, standing at a 4.79% with 181 people having succumbed to death so far. Again, it is above the national average of 3.2%. Kerala at the same time, has a fatality rate of just 0.8%. (Figures as of April 28).
The data given above shows us the plight of the public health sector in Gujarat and its sheer inability to fight the pandemic. It was last month that the Deputy Chief Minister Nitin Patel had revealed the detailed data on infant mortality rate in the state. According to this, 15013 out of the 72000 newborns who were admitted in the SNC units of government hospitals across Gujarat had succumbed to death. The maximum of new-born deaths (4322) were reported from government hospitals of Ahmedabad and it stood at 34.2%. Today, Ahmedabad district tops with the most number of COVID-19 cases, which is 67% of the total number of cases in Gujarat.
A video of around 25 COVID-19 patients from Ahmedabad waiting for admission at the Civil Hospital went ‘viral’ on social media. They were seen addressing the camera, complaining to the Chief Minister and Prime Minister about the ill behaviour of the staff (the only one seen registering the patient details) and their concerns about the treatment. The Ahmedabad Civil Hospital is the largest Public Hospital in Asia and a similar report had come out a couple of days before about the same hospital, of in-patients complaining about the food they received there.
Any hospital administration would be expected, during such crises, to keep the spirits of their patients high. Since no vaccine has been discovered so far, anti-bodies of recovered patients are the most significant medicine that can be utilised, and this can only be fetched through amicable behaviour and daily updates by hospital staff. Such measures, in turn, will yield a lower fatality rate. The positive impact of the immense care taken by hospital administrations in Kerala can be seen in the case of an aged couple of 93 and 88 years-old having successfully recovered after their battle against COVID-19.
Public Health Sector: Heart and Soul of the Nation
The Directive Principles of the Indian Constitution, in its Article 41, give the provision of Right to Public Assistance, in cases of old age, sickness, and disablement. Similarly, Article 47 mentions that it is the primary duty of the state to raise the level of nutrition, standard of living, and to improve public health. The central and state governments must invest in the public health sector if these rights are taken into consideration.
According to budget insights provided by leading economist Prof. Hemankumar Shah, public health expenditure by state and central governments during 2017-18 was Rs. 1580, which was only 1.28% of the total GDP. The same was 1.3% of the total GDP during 2008-15. The National Health Policy of 2017 suggests a minimum 8% of the GDP for this and that it be invested in part by each state government. India’s per capita annual expenditure of health during 2015 was Rs. 5775, and this was the lowest amid all BRICS nations. We would really get to know our pathetic scenario if we compare it to other nations such as China, which is Rs. 32,340 and Brazil, Rs 72,919. The question is not about expenditure alone, but also about who is spending. In India, 30% of health expenditure is by the government and the rest 70% by citizens. This broadly means that those unable to spend this have to live in misery.
Sanjeev Kumar, a researcher at the Tata Institute of Social Sciences (TISS), writes on The Wire:
Currently, Gujarat has 0.33 hospital beds per 1,000 population. There is only one state that has a smaller ratio – Bihar. The national average is 0.55 beds per 1,000 population. This disparity between Gujarat and the national average needs to be understood. According to the World Health Organisation, India had 0.70 hospital beds per 1,000 of population in 2011.Gujarat was ranked 17 among the 18 largest states in India by the Reserve Bank of India in terms of social sector spending. Gujarat was spending only 31.6% of its total budgetary expenditure on the social sector.
In terms of per capita health expenditure, Gujarat’s rank slipped from fourth in 1999-2000 to 11th position in 2009-10. During the same period, Assam improved from the 12th to the third position and Uttar Pradesh from the 15th to ninth position. In 1999-2000, Gujarat was spending 4.39% of its total state expenditure on health, but by 2009-10 this came down to 0.77%.
Open Loot by Private Hospitals Even Amid a Pandemic
The corporate sector’s motive to commercialise health has not come down once even during the global pandemic. The Gujarat state government has announced that private hospitals across the state would provide COVID-19 treatment free of cost, but out of the three Ahmedabad Municipal Corporation (AMC) enlisted hospitals, Sterling Hospital levies a deposit of 8.5 lakh from patients and an another hospital named HCG asks for a minimum of 5 to 7 lakhs. In fact, a patient in Surat had to pay around 5.88 lakhs for treatment. These came to light when the patient’s relative Tweeted an image of the bill from Metas Hospital, where the patient was admitted. The AMC’s decision to start a paid COVID-19 care centre at a five-star hotel has also taken place in such a context.
When it comes to the private health sector, humans are treated as commodities and means to gain maximum profit with. This health sector has always been treated as a profit-oriented business, be it hospitals, pharmaceutical companies, insurance companies, testing labs, or pharma shops.
Extensive testing, contact tracing, mitigation and treatment are the only measures to save the state from the pandemic. Gujarat must follow the steps taken by the Kerala Government to combat the COVID-19, which is being celebrated internationally as a role model to the entire world.
Nitish Mohan is the Convenor of the Gujarat State Organising Committee of the Students’ Federation of India (SFI).
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