Pandemic exposes the weakness of our social infrastructure

Vinayak Kishore/Ankur Sarin | Updated on May 22, 2020

Plugging holes in our essential public systems is the only feasible long-term response to the Covid challenge

As the challenge of the Covid 19 virus brings the world economy to a grinding halt, and severe pressures on public systems stare us right in the face, we are being forced to deal with issues which so far have been relegated to the realm of the idealists’ utopia.

The need for universal healthcare, secure employment, robust insurance mechanisms, a resilient rural economy, accessible and good quality education systems weren’t ‘immediate priorities’ for our political economy for a very long time. ‘Messy’, ‘costly’ and not as ‘sexy’ as issues of, say, identity politics, they have been practically missing from our social and political discourse. But, as the Covid crisis unfolds, we find that such public systems are the ground beneath our feet. Nothing else works, if they don't.

The Indian lockdown has been one of the strictest and longest in the world. The Epidemics Act is in force. On May 1, 2020, it was extended for another two weeks, amounting to a total duration of 50-plus days, and counting. Unprecedented, to say the least. Even the great Indian Railways, which remained operational during the two World Wars, has suspended passenger traffic. Policymakers have demanded its continuation week after week. There is a raging debate as to the extent of its success.

However, perhaps, an even more important question is: Was such a lockdown required in the first place? Why is it that even with hundreds of thousands of migrant labourers stuck across cities in appalling conditions and billions in revenue losses, policymakers appear clueless regarding any other policy alternative? The answer lies in the numbers.

Social sector data

India spends a total of 3.6 per cent of its GDP on healthcare (public and private included), faring worse than, inter alia, Turkey (4.2 per cent), China (5 per cent), Russia (5.3), Mexico (5.5) and Brazil (9.2 per cent).

We have an average availability of 0.55 hospital beds per 1,000 population, with States like Bihar with figures as low as 0.11 beds per 1,000 population. This figure compares highly unfavourably with countries like Japan (13.1), South Korea (12.3) and the US (2.8), and even middle-income countries like Indonesia (1), Russia (8.1) and Mexico (1.4) fare better than us.

In terms of availability of physicians, India at 0.8 doctors per 1,000 population compares unfavourably with China (1.8), Japan (2.4), Mexico (2.2) and Brazil (2.1). With 15 per cent of our population classified as undernourished, India lags behind China (9 per cent), Brazil (3 per cent), Russia (3 per cent) or Mexico (4 per cent).

We also have one of the lowest numbers of nursing and midwifery personnel per 10,000 population (17.27), again lagging behind China (26.62), Russia (85.43), Brazil (101.2) and Mexico (23.96). Even more alarmingly, it has been recently reported that 143 districts in India have no ICU beds.

In one of its strategic documents, NITI Aayog has categorically observed that more than 98 per cent of health providers in India function with 10 workers or less, leading to severe fragmentation and issues in quality of care being provided. It also observes that high level of out-of-pocket healthcare expenditure in India (64 per cent) implies that illnesses hit the poorest the hardest.

And such a trend is not limited to the health sector alone. India ranks 102 out of 117 countries in the Global Hunger Index, behind Myanmar, Nepal, Pakistan and Bangladesh. Eighty-two per cent of our rural households do not have access to piped water supply (a serious handicap in sanitation, washing hands). Twenty-four per cent of our urban population lives in slums (a very large number in absolute terms).

More than 80 per cent of our workforce is in the unorganised sector (implying fragile incomes). Close to 75 per cent of our population is not covered by any form of life insurance. Our cities rank abysmally low in terms of air-quality (14 out of 20 most polluted cities in the world are in India.

We can go on with the data across social sectors, and the picture will hardly be different. It is clear that we have had to resort to a complete suspension of the national economic engine because we lack some of the basic public systems, and therefore the confidence, on which a more measured response could be based.

Policy prescription

A complete, seemingly endless lockdown even as unemployment rates touch record high, is not the desired policy lever that one hopes to engage if such a crisis strikes, even though it might have its purpose in the short term. Building a resilient social infrastructure surely is.

It is not only about the Covid crisis. If and when we start inching back to normalcy, in getting our lives back on track, societies with more egalitarian and robust public systems will do so better, quicker and more sustainably. For instance, our skilled workforce stands at an extremely low figure of 4.7 per cent compared to 68 per cent in the UK, 80 per cent in Japan, 96 per cent in South Korea.

How do we plan on capitalising on the much talked about manufacturing exodus from China? If online businesses are set to rise in a post-Covid world, how do we plan to train our large unskilled workforce to ensure that we have enough jobs? It is clear that what matters the most has hitherto been on the periphery of our socio-political imagination.

This also means that equity needs to form the core concern of our policy debates. A creaking social infrastructure has implied that while the economically better-off sections have so far been availing themselves of such services through private providers of healthcare, education, transport, drinking water, housing, and even clean air, the poorer sections (who form the bulk of our country’s informal workforce) have had to make do with slums for housing, bad public transport, suboptimal health services and a poor education system for their children.

The pandemic has driven home the point, that we are only as secure as the weakest link in the chain. Even a single person devoid of access to basic public services can bring us back to square one. So no matter how many malls we build, how many brands we can choose from, it will always boil down to collective social security. We are always in the Noah’s Ark, and we always, swim and sink together.

Sarin is a faculty and Kishore is a Doctoral Scholar, at the Public Systems Group Area, IIM Ahmedabad

Published on May 22, 2020

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