In the Indian political and public context, there are pertinent issues which are recurring in nature, and yet we fail to improvise and implement a solution that can stand the test of time. It is not the case of not knowing the nature of the problem at hand. The issue is the ability of power to maintain the status quo of keeping the problem at hand, to use it as a bargaining tool by offering a solution with the other hand.

For once, let us divert our attention to the flood situation in Assam  – a regular feature of the state since 1950s. The state is situated in a precarious position – with its vast network of rivers, glacial melting in Himalayas and flash floods during the same time make floods and the ensuing disaster, unique to Assam. However, the mitigation response has always been ad-hoc in nature. Building of embankments to control the flow of rivers, defined as hard engineering measures to control flooding aggravates the risk of flooding downstream, in those areas where there are no embankments. The failure of embankments to control flooding is visible, and yet, we keep the problem at hand, to maintain the status quo.

Similar is the situation with basic social infrastructure issues in our country – the problem is as clear as a day, there is a permanent solution, and yet, the problem continues, as a source of political rhetoric. Had it not been for the pandemic, would there have been any discussion on the state of health infrastructure in India? I doubt so. Citizens would have continued to access healthcare through out-of-pocket expenses, wherever possible, continue to pay premium due to low supply of healthcare professionals. To give a contrast of how abysmally low is the health infrastructure spending is, a comparison is drawn with military spending of our country.

According to the fact sheet released by Stockholm International Peace Research Institute (SIPRI) in April 2020, the five biggest spenders on military budget in the world in 2019 were the US, China, India, Russia, and Saudia Arabia, together accounting for 62% of global military spending. India moved one rank up from 2018, with a share of military budget at 2.4% of it’s GDP, making it the top spender in South Asia. In absolute terms, this amounted to 71.1 $bn, which was a rise of 6.8% y-o-y from 2018. In the last decade (2010 – 2019), it grew by 37%, however, as a share of GDF, fell only 2.7% (2010) to 2.4%.  In terms of comparison with other top spenders on military budget, among the top 15 military spenders in 2019, Japan had the lowest military burden: it devoted only 0.9 per cent of its GDP to military expenditure. Saudi Arabia had the highest, 8.0 per cent. Among the top 15, the military burdens of Israel (5.3 per cent), Russia (3.9 per cent), the USA (3.4 per cent), South Korea (2.7 per cent) and India (2.4 per cent) were also higher than the global military burden.

Together with Pakistan and China, the three nations spend about 342 bn on military budget, 65% of Asia’s and Oceania’s total spending in 2019 (Nan Tian 2020).

On the other hand, according to National Health Profile (2019) data, the spending on health by the government was 1.28% of GDP.  Even though the total per capita government spending on healthcare has doubled from ₹1,008 per person in FY15 to ₹1,944 in FY20, it’s still low. The total expenditure by the Centre and states for FY20 was ₹2.6 trillion, or 1.29% of GDP, including establishment expenditure comprising salaries, gross budgetary support to various institutions and hospitals and transfers to states under centrally sponsored schemes such as Ayushman Bharat. The rise in spending is primarily accounted for by rise in salary hikes of doctors and paramedical staff appointed at government hospitals (Mehra 2020).

India’s neighbours, such as Sri Lanka (1.68%), Indonesia (1.40%), Nepal (1.17%) and Myanmar (1.02%) are spending far more than India on healthcare, which could have an impact on its efforts to achieve Universal Health Coverage (Paul 2019).

At the time of the pandemic, there was an estimated 19-lakh hospital beds, 95,000 intensive care units (ICU), and 48,000 ventilator supported ICUs available. Most of the beds and ventilators in India, are concentrated in seven States – Uttar Pradesh (14.8%), Karnataka (13.8%), Maharashtra (12.2%), Tamil Nadu (8.1%), West Bengal (5.9%), Telangana (5.2%) and Kerala (5.2%), based on data from 75th round of NSS (2019) and NHP (2019) (Geetanjali Kapoor 2020). To put the number into perspective, it implies that there is roughly one bed for every 5000 individuals. Another indicator of healthcare infrastructure is the doctor to population ratio. The recommended standard ratio by World Health Organization (WHO) is 1:1000. As per Medical Council of India (MCI), there were a total of 1,1 54,686 doctors in India, giving a ratio of one allopathic doctor (registered with MCI) for 10,926 persons. This national average, of course does not reveal the urban-rural divide and the concentration of doctors in the southern states. In Bihar, one government doctor serves 28,391 people. Uttar Pradesh is ranked second with 19,962 patients per doctor, which is followed by Jharkhand (18,518), Madhya Pradesh (16,996), Chhattisgarh (15,916) and Karnataka (13,556). The most severely short-staffed medical facilities are the Primary Health Centres (PHCs) that form the frontline of medical access for large swath of rural population. These government health facilities are in want of at least 3,000 doctors ((DTE) 2020).

The rhetoric being fed is that the lockdown is used to contain the spread of the virus, and reduce the rate of increase of cases. However, that is just one part of the story. The imposed lockdown was used to prepare the state machinery to deal with this situation, which otherwise, would have collapsed, given the inadequacy of resources. The images of large number of beds being set up, flashing across news channels and print media, that image could have been avoided, had those beds been installed and hospitals been set up in a normal situation. The lack of doctors and paramedical staff has never been more urgently felt as in this time of crisis – local governing bodies are hiring medical staff at double the standard salaries. All this expenditure, at the cost of the taxpayer. The cherry on the cake is the cost of treatment for a Covid-19 carrier – which on an average, without ventilator and other life-support equipments costs ₹ 20,000 – 25,000 per day. In other words, a 14-day institutional quarantine can cost you three (3) – lakhs. The apprehension goes beyond the health scare, and is more of the financial stress that will befall, if an individual undergoes treatment. The impact is compounded by the decrease in real income. Again, all of these impacts on general life are coming to light is due to this situation. Had it been a normal, we would have continued with our day, after paying taxes.

The role of power to subvert/divert rhetoric cannot be more emphasized than now. The large-scale reverse migration of labourers induced by lack of economic safety of work in cities (it wasn’t because of the virus, the exodus was caused by fear of negligence in cities due to the virus) will in due course of time, be forgotten in public memory. Maybe a proportion of that work force will migrate back to cities. However, the emerging discussion will be on occupying the space left by migrant labour by local labour, citing regionalism, and using local vs outsider as political agenda.

The relief package announced during May to jump start the economy relies ultimately on consumer demand. If there is no consumer demand of final products, then capital consumption and investment in capital for boosting production will go in vain. Based on National Sample Survey (NSS) data on consumption, according to 2018 prices average rural consumption expenditure declined from ₹1,587 per person per month (ppm) in 2014 to ₹1,524 ppm in 2017-18. The decline in urban areas was from ₹2,926 ppm in 2014 to ₹2,909 ppm in 2017-18 (Jacob 2019). By this indicator, the purchasing power of people is reducing y-o-y, and if the purchasing power is falling, how can supply side measures take effect. Our economy’s growth forecast was already on the downside, and the pandemic situation has simply exacerbated the already negative sentiments existing in consumer mindset. Again, the role of power came to rescue – the rhetoric of “Atmanirbhar Bharat” was created that guided us in envisioning a situation that economic growth is just around the corner.

The issue at hand is not new; the use (misuse) of power to create an agenda that does not exist is an existential problem. The new element is the lack of independence of media to adhere to reality, and falling back on tropes of “creating” news. We have reached a state where citizens are told not to believe what is reported as news, and the loudness of “truth”. It is time for the society at large to challenge the rhetoric, to play our role in democratic system.

DISCLAIMER: The author is solely responsible for the views expressed in this article. The author carries the responsibility for citing and/or licensing of images utilized within the text.