Post Mortem

Health is a justice issue: Lessons from COVID-19

By Nagaland Post | Publish Date: 5/4/2020 1:23:07 PM IST

 COVID-19 is a wake-up call to healthcare systems all over the world because no country was medically equipped to face this pandemic. Nations spend more money on defence, military procurements of arms and ammunitions, warships and jet planes and on nuclear weapons but far too less on health care and life-saving facilities. As per the latest report, India is 3rd on the list of countries with the highest defence expenditure in the world, next only to the USA and China. This current year (2020) India’s defence budget is INR 4,71,378 Crores – which is 15.49% of the total budget (USD 65.86 billion). In comparison, our healthcare budget is only INR 67,484 crores for the entire nation. According to the report, the government of India spent about 1.3% of the total GDP on healthcare in 2018 and for this year’s budget, healthcare forms 1.6% of the total GDP which is one of the lowest in the world. More money is spent on security and defence – for killing, but for saving lives a paltry amount is allocated each year which is unjustifiable. 

How much does the government of Nagaland allocate as healthcare budget each year? It may be too negligible an amount for an essential sector like public healthcare. COVID-19 should be a turning point to invest seriously on healthcare facilities and policies. 

It is evident that the preparedness and mobilization of resources in our state, Nagaland, to combat COVID-19 is not satisfactory. Negligence on the part of the government to procure, on time, testing tools and other medical kits, setting up labs and equipments necessary for dealing with the corona virus are all salient issues which demands serious and immediate attention. Nagaland does not have a single medical college whereas other neighbouring states like Assam have 7 medical colleges. The maintenance of the government run hospitals and dispensaries in most of the districts in Nagaland are very poor. Apart from a lack of hygiene, there are problems of infrastructure, shortage of equipments and medical supply. 

In the midst of this reality, who is at fault? It is the collective negligence and failures of the successive ruling governments in the State. There is a sharp disparity between rural and urban areas concerning the healthcare system. The distribution of healthcare resources in the rural villages is very pathetic. Along with a lack of proper infrastructure, absence of medical staff is another problem because many healthcare workers do not want to go to rural places which are often referred to as “outposts” or “remote areas”! In this day and age, many people with treatable diseases die pitifully in the villages due to lack of healthcare facilities and even first-aid medicines. Poor healthcare system is indicative of acute corruption and state-mismanagement by the politicians and the government bureaucrats. The COVID-19 crisis and the utter helplessness of governments and healthcare systems should give rise to critical questioning on the slackness of public healthcare system in our State.

An aspect of healthcare is that it is highly commercialised and urban-centric and therefore, it is not accessible to and affordable for rural people. Decent hospitals are located in Dimapur and Kohima that are government run as well as private hospitals, including Christian hospitals. There is a mushrooming of private hospitals and nursing homes, largely in Dimapur and Kohima, which is a good sign but we should also be aware that healthcare is one of the fastest growing industries in the world.  It is not patient-friendly but money-oriented that the value of a human life is no longer important. Many poor villagers lack the necessary means or cannot afford to travel to Dimapur and Kohima for treatment. For medical treatment, the rich and elites can go to big metro hospitals in India or even abroad. This shows that there is a sharp division in healthcare systems in our society between the rich and the poor and between the urban and the rural. Health disparities affect the physical illness, the psycho-social and emotional well-being of persons in the community. We also need to acknowledge that socio-economic structures, political and environment systems have also caused us to incur serious health issues, which may not all be physical, but this area has never been addressed as a health care problem in the past. There may not be positive COVID-19 cases in Nagaland thus far, but it has created “phobia” or fear psychosis among the people and many are suffering emotionally and psychologically. This fear psychosis is equally dangerous for the well being of persons in the community. Hence, healthcare and its systems should have a holistic approach and focus for the upliftment and well being of all persons in our society.

The Constitution of India states that right to health is a “Fundamental Right” of all citizens. It is about equal distribution of healthcare facilities, made accessible and affordable for all. Nevertheless, the public health care and sanitation systems are poorly implemented, and health care is inaccessible to the vast majority of the population in Nagaland. The most affected are the economically poor rural people. Health disparities are due to human-made, unjust social systems and structures pervaded with corruption and mismanagement. This can also be prevented or eliminated through human intervention, by developing honesty, sincerity, transparency and good governance. COVID-19 should be a lesson to transform health care systems in Nagaland.

Better healthcare system demands not just efficient planning, implementation and monitoring by the government but also political will.  Allocation of sufficient budget is necessary. A sufficient amount should be earmarked for public healthcare facilities for both rural and urban areas. The establishment of a medical college and hospital in the State is long overdue. Fair distribution system for the welfare of the community should be promoted. Medicines for rural primary health centres do not reach the target people and even if they do, it is often of sub-standard quality!

The well-being of a person in community can be measured by life-span expectancy, low infant mortality, good maternal and child health care, clean environment, food security, access to safe drinking water, adequate sanitation facilities and good transport and communication. 

These are the pressing needs for the good health of a community. Unfortunately, we are failing in almost all these primary public healthcare areas. COVID-19 should be a wake-up call for us to restructure and rejuvenate our healthcare system.

Dr. Limatula Longkumer Serampore

 

Launched on December 3,1990. Nagaland Post is the first and highest circulated newspaper of Nagaland state. Nagaland Post is also the first newspaper in Nagaland to be published in multi-colour.

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