COVID Spike: How Will Our States Manage? Here’s What They Can Do
States must focus on strengthening healthcare systems. Their model should remain decentralised and low cost.
Why did we ever get confused about the powers and functions of the union government and the states as far as the health sector is concerned? The Seventh Schedule of the Constitution very clearly lists, defines, and specifies the allocation of duties, powers and function of Item 6 in List II, and is crystal clear on this issue. It says that public health and sanitation, hospitals and dispensaries are categorically state subjects. This issue unfortunately got obfuscated when the union government took over the COVID-19 crisis under the Disaster Management Act of 2005, and edged out the states.
With Onus Back On States, Accountability To Citizens May Increase
The level of centralisation was such that the states were not allowed to even tone down the lockdown provisions, even when some of them did not need a complete shutdown of economic activity. Exactly a year ago, when the state of Kerala had decided to open up some activity in districts where the COVID-19 infection rates were minimal, the Ministry of Home Affairs wrote a stern letter asking the state government to not dilute the provision of the MHA order issued on 15 April 2020.
On vaccine purchases, the centre set up the National Expert Group on Vaccine Administration (NEGVAC) that clearly warned states against buying vaccines directly.
In a major reform measure, the Centre has now decided to give back to states the authority that the Constitution provided them with in the Seventh Schedule. Such a move would allow states to make their own decisions based on local knowledge, numbers, and the capacity of the healthcare system, to cope with the pandemic.
It will also make state governments accountable to the citizenry that is now confused on who to reach out to amidst the chaos that reigns. As voters, we have grown up in a democratic tradition where the Centre is responsible for foreign affairs, cross-border issues, banking, trade and monetary policies. The states however, must answer for the quality of law & order, healthcare, and education.
Sudden Decentralisation of COVID Efforts Will Further Burden States
While the return to a decentralised structure is indeed welcome and reformist, it’s the suddenness and the manner in which this step has been taken that has left states confused, and in conflict with one other. Some states have broken healthcare systems, some do not have adequate doctors or healthcare staff, and almost all do not have the funds to procure vaccines suddenly.
However, given the level of distress in at least the 10 top states that are bearing 80 percent of the COVID-19 burden, there is no choice but to buy at whatever price available.
It is now clear that one of the biggest reasons for the mortality rates during the second wave is not so much the disease as the absence of ventilators, oxygen capacities, ICU beds and vaccines.
There has been much criticism over the way the Centre has suddenly abdicated its responsibility at a time when the numbers are at a historical and international high. Even the US did not reach the figure of 3,00,000 new infections a day during the worst of times last year. We had 314,000 cases on Wednesday, 21 April 2021, and the number is only likely to keep rising for several days to come. This when less than 8 percent have got one dose and less than 2 percent have received both the doses of the vaccines.
Now with vaccinations coming to a temporary halt, the situation is dire and states must gear up without any notice to handle this unprecedented crisis.
What Is The Way Forward? What Should Individual States Do?
What then are the solutions? What should individual states do? First, they must quickly get vaccine stocks, from anywhere and at any price. There is enough competition now with several vaccine manufacturers ready to supply, and while some of them will still scurry to make steep profits, most will look for sustained orders over the next 12 months or so.
The mistake the central government made, by way of losing precious time, while negotiating with the two approved vaccine manufacturers, is now coming back to haunt us by way of increased morbidity and mortality. The states should not make the same mistake. The money will be found eventually — now it is important for all those in the 18+ category to get vaccinated twice.
Secondly, states must focus on building their healthcare systems. The model that they must use should remain decentralised and low cost, and one that uses technology and mobile networks to build efficiency in the supply chain.
It is so frustrating to see in a developing country such as ours — with so many poor and illiterate — that instead of building a robust public health system that works from the PHC upwards, we are encouraging — and inexplicably investing in — the private sector amidst a total abdication of public health norms.
We have brought the COVID tragedy upon ourselves. The states must correct this and immediately start building back their healthcare systems.
States Must Strengthen Healthcare Systems, Upgrade Supply Chains & Tech
As Usha Titus, one of our most respected officers, who recently retired as Additional Secretary, Government of India says, on the issue of the strengthening of the health system, all we need are First Line COVID Care Centres for every person with mild symptoms like fever and cough, in every panchayat in this country. All that is required here are sampling kiosks, pulse oximeters, thermometers, beds, fluids, food and toilets.
Patients whose conditions get worse can then be shifted to other medical facilities using software that maps beds, ambulances, oxygen cylinders, ventilators and personnel, in the state and private sectors so that ambulances can carry patients to the appropriate facility. This has been operationalised only in Kochi, Kerala, and can be replicated across the country, she emphasises.
Thirdly, states must upgrade their existing supply chains, warehouses and health centres that carry out routine immunisation in any case, to be able to vaccinate the entire adult population urgently.
We cannot go on at the current pace, that would take at least a year for even two-thirds of the population to get covered. The data on vaccination must be published in real time, with enough information and communication material that would remove all vaccine hesitancy. It will be up to the leadership to convey strong and firm messages that would remove any confusion in the minds of people suspecting the efficacy of vaccines and relying on alternate, untested, and often dangerous remedies.
Should Other States Follow UP Model and Offer Free Vaccines?
Finally, what each state should try and do is emulate the UP Chief Minister who was first off the blocks in announcing free vaccines for the people of his state. He is, despite the mounting fiscal deficit, confident of raising the resources to do for his 200 million people. Other states have a minuscule population as compared to UP.
Vaccines against dangerous pandemics are pure public goods, that must be provided to everyone free of cost. Those who choose to may still buy them from private hospitals, but the end game should be to ensure that 70 percent of the population gets immunity within the next six months.
(Dr Amir Ullah Khan is Research Director at the Centre for Development Policy and Practice. This is an opinion piece, and the views expressed above are the author’s own. The Quint neither endorses nor is responsible for them.)
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