(This is Part-II of a three-part series by (retd) IAS officer and public health expert Ms Shailaja Chandra, to mark the first ‘anniversary’ of India’s COVID-induced lockdown. You can access Part-I here and Part-III here.)
The COVID-19 pandemic that was declared about a year ago, brought with it myriad challenges. Chief among these hurdles being the added pressure on the global healthcare system and equitable access to resources. In India, an already stretched healthcare system found itself overwhelmed as the COVID numbers continued to rise, and what helped the state and central governments meet this challenge was the involvement of the private sector.
However, the private sector too is not without its own issues.
Different assessments found that there were cases of overcharging by private hospitals. Although charges associated with COVID treatment had been capped by the central or the state governments, this (cases of overcharging) mostly applied to cash-paying patients and those covered under insurance. Reports of overcharging were received at various places.
The possible reasons could be that instead of having a blanket price on all COVID treatment, with strict protocols, some hospitals continued their own line of treatment which left scope for variation in protocols for diagnosis, medication (especially the choice of expensive antibiotics).
Indian Govt’s Commendable Response to COVID-19 Crisis
Despite the availability of designated COVID beds in government hospitals, people began crowding the private hospitals, and some managements used the unusual spike in demand to charge exorbitant advance deposits.
The establishment of steering committees with representatives from both the public and private sector helped. The private hospitals appreciated the uniformity in communication and instructions given by the state and central governments as well as the ICMR.
Which other country in the world has this structure, such ubiquitous systems which combine local knowledge with enormous authority? Where else was this authority reinforced by the invocation of the National Disaster Management Act 2005? How else could facilities and manpower be galvanised from a situation when there was virtually nothing on the ground?
Which other country could electrify a single line of authority to start performing, flowing from the centre to the states to the districts — and down to the entire medical and health formations across megapolises like Delhi and Mumbai, the state capitals and cities, spreading to 730 districts and 5000 blocks?
The Rs 50 lakh insurance for dying in harness was announced by the prime minister early enough, and the Epidemic Diseases Act 1897 was amended through an Ordinance, which gave overriding protection to health workers.
Indeed, these measures stopped troublemakers who had begun to pelt stones at health workers. A 7-year punishment ensured that no one would take chances.
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The positive outcome of the lockdown was that it helped slow down and delay the transmission of the coronavirus within and among multitudes of people for a couple of months. It also gave the state governments time to prepare for the upcoming wave of COVID transmission.
The revving up of a sleepy state health apparatus was done with amazing speed and dexterity. A gargantuan effort was needed to mobilise health workers, ancillary staff and the police to respond to an unknown disease.
The health workers were required to wear special protective gear which was not available for the love of money.
The district magistrates were required to plan and execute the requisitioning of hotels, resorts and dharamshalas for isolating and quarantining patients. The testing capacity was non-existent in some states and highly deficient in others. Initially, states like Chhattisgarh did not have a single RT-PCR laboratory nor sufficient private hospital capacity for treating patients, particularly those needing ICU and ventilator support.
Until early March 2020, India’s production capacity in terms of PPE kits, N95 masks, ventilators and testing kits etc was deficient, and in the initial phases, the country had to import many supplies — even for its healthcare workers — from other nations including China, UK, Malaysia and Korea.
India has since joined the global platform and is today one of the top manufacturers and innovators for these products. All of these items are now also being exported in substantial numbers.
(Shailaja Chandra (IAS retd) has over 45 years experience of public administration focusing on governance, health management, population stabilisation and women’s empowerment. She was Secretary of the Department of Indian Systems of Medicine & Homeopathy, Ministry of Health & Family Welfare (1999-2002) and following that the Chief Secretary Delhi until 2004. She tweets at @over2shailaja. This is an opinion piece and the views expressed are the author’s own. The Quint neither endorses nor is responsible for them.)
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