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Times of COVID – Health and Equity

A lot will also depend on using new forms of capital that blend grants, equity, and debt. The timing and reasons are right; all we need is the Will to take it through.

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It has been an unprecedented year. A year that has seen lockdowns, fear, migrant's crisis, employment loss, economic recovery, vaccine, indifference, and we again stand at the cliff-edge – crossing 100k per day – a step further can mean a repeat cycle.

COVID has brought to light and peeled-off, layer-by-layer, the inefficiencies that mar our health systems. The initial months saw diminishing service levels for critical preventive healthcare services (pre-and ante-natal care, immunization, geriatric care, etc.). As cases increased, our emergency health systems were exposed and struggled to cope with the pandemic's pressures and needs. All energies focused on COVID, and other emergency life-threatening care needs took a backseat. As things started to improve, the other services saw a pull; however, as we entered the second wave, the dilemma again strikes, to continue everything or focus on COVID care.

What also came to the fore were the inequities in our healthcare systems. Then whether these were because of geography (urban vs. rural; tier1 vs. tier 2 and 3 cities), age (young vs. adults vs. seniors), financial (rich vs. poor; insured vs. uninsured), or gender, it became amply clear that we live in a privileged country, where our social standing defines what we get or don't get.

The government tried its best to address some of these inequities. Whether it was regulating the cost of hospitalization, COVID diagnostics, allowability of COVID treatment under government/private insurances, or now subsidizing the cost of vaccination, the Government of India's efforts must be commended. However, most of these were and remained quick-fix reactions and short-term solutions to an emergency, and not systematic changes that can have a long-lasting impact. The sector continued to face financial challenges. Without easy availability of suitable forms of capital, little was spent on infrastructure improvement that could reap long-term benefits.

A pandemic is once in a lifetime event, and like the financial crisis of the early '90s, it should encourage brave steps for structural changes that are long-lasting. The National Digital Health Mission and Aatmanirbhar Swastha Bharat Yojana's launch in this year's budget seem to step in the right direction. However, with limited budget allocation, how far they can address some of the sector's inequities will depend on how well these are designed and implemented. A lot will also depend on using new forms of capital that blend grants, equity, and debt. The timing and reasons are right; all we need is the Will to take it through.

Disclaimer: The views expressed in the article above are those of the authors' and do not necessarily represent or reflect the views of this publishing house. Unless otherwise noted, the author is writing in his/her personal capacity. They are not intended and should not be thought to represent official ideas, attitudes, or policies of any agency or institution.

Himanshu Sikka

Health Expert, IPE Global

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