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Opinion: Lack Of Investment In The Public Health System Is A Reason For The Deadly Second Wave

This post is a part of YKA’s dedicated coverage of the novel coronavirus outbreak and aims to present factual, reliable information. Read more.

Dr Ambedkar said in his final speech in the constituent assembly dated 25 November, 1949, “However good a Constitution may be, if those who are implementing it are not good, it will prove to be bad. However bad a Constitution may be, if those implementing it are good, it will prove to be good.”

It is substantive to review any problem that you have to know the past to understand the present. Why are we here? We, as Indians, took a pledge at midnight when the nation got independence. A historic speech was delivered by Jawaharlal Nehru, the first Prime Minister of India.

“Long years ago, we made a tryst with destiny, and now the time comes when we shall redeem our pledge, not wholly or in full measure, but very substantially. At the stroke of the midnight hour, when the world sleeps, India will awake to life and freedom. A moment comes, which comes but rarely in history when we step out from the old to the new when an age ends, and when the soul of a nation, long suppressed, finds utterance. 

“The ambition of the greatest man of our generation has been to wipe every tear from every eye. That may be beyond us, but so long as there are tears and suffering, so long our work will not be over. And so, we have to labour and to work, and work hard, to give reality to our dreams. Those dreams are for India, but they are also for the world.”

Covid-19 Oxygen
A patient wearing an oxygen mask sits outside Lok Nayak Jai Prakash Narayan Hospital (LNJP), one of India’s largest facilities for COVID-19 patients only, in New Delhi, India, April 22, 2021. (REUTERS/Adnan Abidi TPX IMAGES OF THE DAY, Source: flickr)

The above pledge has an almost 72-year long journey, but still, we don’t have an efficient public health structure in the country except for few states. Since independence, we have seen many Prime Ministers from two different political parties who have contributed as per their capacity and vision in the interest of the nation.

The Indian National Congress, the oldest party of India, governed for almost 54 years and 153 days as the Government of India and about 29 years continuously. Wherever we are standing at present, undoubtedly the major credit goes to the Congress party due to its long governing journey, whether achievements or failures. In the rational approach, I do believe that we could be happy for achievements, but it is essential to investigate the failures and reform them.

Despite being a welfare state, the earlier ruling Central Government, including the present NDA Government, never seriously dealt with India’s public health system. It has never been the prime objective of the political party’s manifesto, while many Indians are poor and completely depend on the public health system.

With reference to the Arjun Sengupta Committee report (2007), it was reported that 77% of India’s population is poor. It is very sorrowful to see India’s ranking in the Lancet Study (2016), where we rank 145 among 195 countries in terms of quality and accessibility of health care, behind its neighbours China, Sri Lanka, Bangladesh, and Bhutan. It’s an eye-opener that the government has failed to deliver and this ranking is not the result of a night. There is a long journey of various Governments till the present.

The persuasion of an inefficient health structure on the level of Primary Health Centre, Community Health Centre, District Hospitals and Medical Colleges led to open the parallel private hospital industry, which has become the major chunk of the health system in India. No doubt, it is the nexus of corporates and politicians. It is quite familiar to see a rash of alleged medical negligence and over-pricing by private hospitals. So far, a better public healthcare system for all in India is a dream.

Presently we have only seven AIIMS in-country and others are in line. It is well known for its finest health care services, but it is also inadequate to take over a load out of the capacity. AIIMS Delhi is an example of it. Many poor patients come from various states for treatment and wait for months. Some patients die without treatment due to a waiting period.

Being a federal structure in India, the state is also accountable to strengthen the public health system. Despite nationwide health programmes such as the National Health Mission, which was launched in the year 2005, it has not impacted significantly at the grassroots level due to improper execution of the various states

In 2019, NITI AAYOG issued the annual report of the Health Index. Kerala was the top performer among larger states for overall performance on health indicators, while Uttar Pradesh, Bihar, Odisha, Madhya Pradesh and Uttarakhand have been shown as the worst performers.

In my opinion, without strengthening the basic public health system like PHC, CHC and District hospitals, we can never build a substantial public health infrastructure in India. In fact, we left the rural periphery alone in the cycle of urban development that originated regional disparities in the country. A larger population remains deprived of better health services and has been facing a livelihood crisis for a long time. This is why from every corner of the state, many poor people migrate to the urban areas for two-time meals.

Keeping in the painful experience of the COVID-19 pandemic since 2020, it has been noticed that our public health system is very weak to deal with the pandemic. We faced many serious challenges such as insufficient beds in hospitals, lack of medical staffs, lack of basic precautional equipment for medical and paramedical staff, ventilator and oxygen shortage, etc.

Last year, the NDA Government announced the nationwide lockdown for medical preparation to fight with the invisible enemy (COVID-19). But they could not sense the major crunch of the lockdown decision, which occurred in terms of the hunger crisis. The daily wage earners/labourers started to go back home on foot with their families due to financial problems and the administration’s failure.

It was a distressing scene again after the partition. Many people died and were injured during this tragic journey. In this serious condition of the Nation, NGOs and Individuals came forward and helped migrants by providing food, water and transport. The Supreme Court also acclaimed the noble initiative of NGOs.

Gradually, we recovered from the first wave of coronavirus but lost many precious lives due to inadequate health services and the hunger crisis in many states of India. The Covid-19 pandemic has added a layer to the malnutrition issue of the country.

According to a UNICEF report titled State of the World’s Children 2019, the statistics show that India reported the highest number of deaths of children below 5 years in 2018 with 8,82,000 deaths, and malnutrition caused 69% of it. Apart from this, India ranked 94 among 107 nations in the Global Hunger Index 2020 and is in the “serious” hunger category.

The nationwide lockdown did shrink the GDP. In the effect of the economy, many small industries closed and the lockdown damaged the unorganised sector. As per the recent data of the Centre for Monitoring Indian Economy (CMIE), the unemployment rate of India is 8.2% which was at a high of 23.52% in April 2020.

Once again, the present unemployment rate may high due to the lockdown. In April 2021, Haryana stands at a 35.1% unemployment rate which is the highest rate in the country; after that, Rajasthan with 28.0% and Delhi recorded 27.3%.

From December 2020 to March 2021, the graph of COVID-19 positivity started to lower. Meanwhile, the vaccine was prepared. When the positive cases were low and life slowly came on track, our government and people forgot one thing, India crossed the first wave of coronavirus, but the second wave was still remaining like other countries.

On a serious note, we could fill the gaps before the second deadly wave and we had time. Firstly, we should have aggressively covered the larger population for the vaccination drive, and second, we needed to improvise on previous mistakes. But alas, nothing was taken as seriously by the Central Government and the many States of India. 

Amit Shah Bengal Rally
Amit Shah during a roadshow in support of Suvendu Adhikari (L), the BJP candidate for Nandigram constituency, at Nandigram on March 30, 2021. (Photo by Samir Jana/Hindustan Times via Getty Images)

Unfortunately, we forgot and moved on and the propaganda of celebration started in India, which the government led. But we, the people of India, did not learn from other countries that faced a devastating second wave of the pandemic. The government was in urgency to get credit and the message conveyed in the public domain was that we had won the war against COVID-19.

People became careless with respect to wearing a mask and physical distancing. Meantime, the Election commission declared five states’ assembly elections, including West Bengal. Our senior ruling and opposition political leaders, including Mr Prime Minister and Home Minister, rapidly started the election campaign. The crowded political rallies were seen in the campaign, specifically in West Bengal, and all COVID-19 protocol have been neglected.

In April, the same ignorance was seen in the Kumbh Mela of Haridwar, Uttar Pradesh, and the Ugadi festival celebration in Andhra Pradesh. Recently, thousands of people gathered for a religious leader’s funeral in UP’s Badaun on 9 May. They flouted all COVID-19 protocol.

The negligent behaviour of the government and society invited the deadly second wave of coronavirus with new strain and the triple mutant variant of the COVID-19. In April, the most affected states that recorded the highest rates of COVID-19 positive cases in the country amid oxygen shortage were Maharashtra, Gujrat, Uttar Pradesh, Kerala, Karnataka, Rajasthan, Punjab, Chhattisgarh, Bihar, Andhra Pradesh, West Bengal, Tamil Nadu, Madhya Pradesh and Delhi.

In some states, there was a chaotic situation. Most of the states mentioned above are still critically facing the crisis of bed, ventilator and shortage of oxygen cylinder, which are the reason for continuous deaths. The condition is very terrible and shocking. COVID-19 positive patients are being treated in the open area of the hospitals due to the unavailability of beds.

Those who cannot get a bed and oxygen cylinder are wandering here and there and many positive patients are dying without treatment. Many people are being arrested for black-marketing of remdesivir injections and oxygen cylinders amid high demand. Medical and paramedical staff are helpless. It is a fact that Central Government has failed to allocate oxygen to the affected states on time and also noticed that the government was more concerned to export the vaccine, not for its citizens. 

In the second deadly wave of the COVID-19, many positive cases are also being reported in the rural part of India. The surges of positive cases in the villages may be most dangerous because they don’t have adequate health facilities. Even now, a larger population of rural India depends on the network of the quack clinics, which is subject to concern in the pandemic.

Oxygen Covid
Representative Image. Source: flickr

If we still don’t work aggressively on the vaccination drive and awareness of the precautional measures to fight the pandemic, then the third devastating Coronavirus Wave is inevitable in the nation.

Due to the governance failure of the concerning states on the pandemic, on 12 April, the Gujarat High Court pulled up the state government over the Covid-19 situation in the state and problems being faced by citizens, saying the reality is contrary to what the government claims. “People now think that they are at God’s mercy,” the bench observed.

On 19 April, Allahabad High Court directed Uttar Pradesh Government to take harsh steps in the larger public interest. “If people die of the pandemic in a large number due to paucity of sufficient medical aid it would be the governments to blame which failed to counter the pandemic even after one long year of experience and learning. One would only laugh at us that we have enough to spend on elections and very little to spend on public health,” they noted.

They added, “It is a shame that while the Government knew of the magnitude of the second wave it never planned things in advance.” In addition to the above comments, the Delhi High court asked the Centre why the government was waiting till 22 April to implement the order “when the needy are dying due to shortage of oxygen”. The capital has suffered a lot due to oxygen shortage.

On 23 April, in the meeting of CMs of the most affected states from Covid-19 with the Prime Minister, Chief Minister of Delhi raised the issue of shortage of oxygen in the hospitals of capital because of which many COVID-19 patients died.

On 26 April, the Madras High Court slammed the Election Commission of India for the COVID-19 surge and said, “It is the most irresponsible institution in the country who have done nothing to prevent political parties from breaching Covid-19 protocol. Were you on another planet during the political rallies?”

In many places, cemeteries and crematoriums are filled with Coronavirus positive dead bodies and people are waiting in queues for many hours.

Due to the emergent need for funeral sites, the administration prepared temporarily, but still many Coronavirus positive dead bodies were found in the holy river of Ganga in Uttar Pradesh and Bihar. This is completely terrible and taints humanity. Even the government is reportedly not giving the right statistics of COVID-19 positive deaths.

Due to the deadly second wave of the Coronavirus in India, many states announced either a complete lockdown or weekend lockdown for controlling the devastating situation. Considering the earlier painful experience of nationwide lockdown, the migrant labourers started to go back home, especially from states like Maharashtra, Gujrat, Delhi, and Haryana.

Notwithstanding the critical situation of the deadly second wave in many states of India, few states such as Kerala and Tamil Nadu learned from past experiences. The respective states prepared themselves to tackle the second wave of pandemic specifically for the oxygen cylinder and adequate beds. They also supplied oxygen to neighbouring southern states.

Once again, many NGOs and individuals have also come forward to help the needy amid the high demand for the oxygen cylinder. The COVID-19 Pandemic has been a painful lesson to both the Government and society of India.

Why should a nation strengthen the public health system on priority? Because every human life matters. Hyper-nationalism, appeasement and symbolic politics can never fill this gap.

It is very disappointing to see that in India, those who are more accountable deliberately abused the COVID-19 protocol during their political rallies, and now many lives are in danger. On the other side, we have the finest example of Norway’s prime minister Erna Solberg. She has been fined 20,000 kroner (₹1,76,961) after breaking coronavirus social-distancing rules when organising a family gathering to celebrate her birthday.

In the Indian context, it is still a dream to have an accountable system. Wherever we are standing at present, ultimately, we the people of India are responsible because we forgot Nehru’s midnight pledge.

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An ambassador and trained facilitator under Eco Femme (a social enterprise working towards menstrual health in south India), Sanjina is also an active member of the MHM Collective- India and Menstrual Health Alliance- India. She has conducted Menstrual Health sessions in multiple government schools adopted by Rotary District 3240 as part of their WinS project in rural Bengal. She has also delivered training of trainers on SRHR, gender, sexuality and Menstruation for Tomorrow’s Foundation, Vikramshila Education Resource Society, Nirdhan trust and Micro Finance, Tollygunj Women In Need, Paint It Red in Kolkata.

Now as an MH Fellow with YKA, she’s expanding her impressive scope of work further by launching a campaign to facilitate the process of ensuring better menstrual health and SRH services for women residing in correctional homes in West Bengal. The campaign will entail an independent study to take stalk of the present conditions of MHM in correctional homes across the state and use its findings to build public support and political will to take the necessary action.

Saurabh has been associated with YKA as a user and has consistently been writing on the issue MHM and its intersectionality with other issues in the society. Now as an MHM Fellow with YKA, he’s launched the Right to Period campaign, which aims to ensure proper execution of MHM guidelines in Delhi’s schools.

The long-term aim of the campaign is to develop an open culture where menstruation is not treated as a taboo. The campaign also seeks to hold the schools accountable for their responsibilities as an important component in the implementation of MHM policies by making adequate sanitation infrastructure and knowledge of MHM available in school premises.

Read more about his campaign.

Harshita is a psychologist and works to support people with mental health issues, particularly adolescents who are survivors of violence. Associated with the Azadi Foundation in UP, Harshita became an MHM Fellow with YKA, with the aim of promoting better menstrual health.

Her campaign #MeriMarzi aims to promote menstrual health and wellness, hygiene and facilities for female sex workers in UP. She says, “Knowledge about natural body processes is a very basic human right. And for individuals whose occupation is providing sexual services, it becomes even more important.”

Meri Marzi aims to ensure sensitised, non-discriminatory health workers for the needs of female sex workers in the Suraksha Clinics under the UPSACS (Uttar Pradesh State AIDS Control Society) program by creating more dialogues and garnering public support for the cause of sex workers’ menstrual rights. The campaign will also ensure interventions with sex workers to clear misconceptions around overall hygiene management to ensure that results flow both ways.

Read more about her campaign.

MH Fellow Sabna comes with significant experience working with a range of development issues. A co-founder of Project Sakhi Saheli, which aims to combat period poverty and break menstrual taboos, Sabna has, in the past, worked on the issue of menstruation in urban slums of Delhi with women and adolescent girls. She and her team also released MenstraBook, with menstrastories and organised Menstra Tlk in the Delhi School of Social Work to create more conversations on menstruation.

With YKA MHM Fellow Vineet, Sabna launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society. As a start, the campaign aims to begin conversations on menstrual health with five hundred adolescents and youth in Delhi through offline platforms, and through this community mobilise support to create Period Friendly Institutions out of educational institutes in the city.

Read more about her campaign. 

A student from Delhi School of Social work, Vineet is a part of Project Sakhi Saheli, an initiative by the students of Delhi school of Social Work to create awareness on Menstrual Health and combat Period Poverty. Along with MHM Action Fellow Sabna, Vineet launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society.

As a start, the campaign aims to begin conversations on menstrual health with five hundred adolescents and youth in Delhi through offline platforms, and through this community mobilise support to create Period Friendly Institutions out of educational institutes in the city.

Find out more about the campaign here.

A native of Bhagalpur district – Bihar, Shalini Jha believes in equal rights for all genders and wants to work for a gender-equal and just society. In the past she’s had a year-long association as a community leader with Haiyya: Organise for Action’s Health Over Stigma campaign. She’s pursuing a Master’s in Literature with Ambedkar University, Delhi and as an MHM Fellow with YKA, recently launched ‘Project अल्हड़ (Alharh)’.

She says, “Bihar is ranked the lowest in India’s SDG Index 2019 for India. Hygienic and comfortable menstruation is a basic human right and sustainable development cannot be ensured if menstruators are deprived of their basic rights.” Project अल्हड़ (Alharh) aims to create a robust sensitised community in Bhagalpur to collectively spread awareness, break the taboo, debunk myths and initiate fearless conversations around menstruation. The campaign aims to reach at least 6000 adolescent girls from government and private schools in Baghalpur district in 2020.

Read more about the campaign here.

A psychologist and co-founder of a mental health NGO called Customize Cognition, Ritika forayed into the space of menstrual health and hygiene, sexual and reproductive healthcare and rights and gender equality as an MHM Fellow with YKA. She says, “The experience of working on MHM/SRHR and gender equality has been an enriching and eye-opening experience. I have learned what’s beneath the surface of the issue, be it awareness, lack of resources or disregard for trans men, who also menstruate.”

The Transmen-ses campaign aims to tackle the issue of silence and disregard for trans men’s menstruation needs, by mobilising gender sensitive health professionals and gender neutral restrooms in Lucknow.

Read more about the campaign here.

A Computer Science engineer by education, Nitisha started her career in the corporate sector, before realising she wanted to work in the development and social justice space. Since then, she has worked with Teach For India and Care India and is from the founding batch of Indian School of Development Management (ISDM), a one of its kind organisation creating leaders for the development sector through its experiential learning post graduate program.

As a Youth Ki Awaaz Menstrual Health Fellow, Nitisha has started Let’s Talk Period, a campaign to mobilise young people to switch to sustainable period products. She says, “80 lakh women in Delhi use non-biodegradable sanitary products, generate 3000 tonnes of menstrual waste, that takes 500-800 years to decompose; which in turn contributes to the health issues of all menstruators, increased burden of waste management on the city and harmful living environment for all citizens.

Let’s Talk Period aims to change this by

Find out more about her campaign here.

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A former Assistant Secretary with the Ministry of Women and Child Development in West Bengal for three months, Lakshmi Bhavya has been championing the cause of menstrual hygiene in her district. By associating herself with the Lalana Campaign, a holistic menstrual hygiene awareness campaign which is conducted by the Anahat NGO, Lakshmi has been slowly breaking taboos when it comes to periods and menstrual hygiene.

A Gender Rights Activist working with the tribal and marginalized communities in india, Srilekha is a PhD scholar working on understanding body and sexuality among tribal girls, to fill the gaps in research around indigenous women and their stories. Srilekha has worked extensively at the grassroots level with community based organisations, through several advocacy initiatives around Gender, Mental Health, Menstrual Hygiene and Sexual and Reproductive Health Rights (SRHR) for the indigenous in Jharkhand, over the last 6 years.

Srilekha has also contributed to sustainable livelihood projects and legal aid programs for survivors of sex trafficking. She has been conducting research based programs on maternal health, mental health, gender based violence, sex and sexuality. Her interest lies in conducting workshops for young people on life skills, feminism, gender and sexuality, trauma, resilience and interpersonal relationships.

A Guwahati-based college student pursuing her Masters in Tata Institute of Social Sciences, Bidisha started the #BleedwithDignity campaign on the technology platform Change.org, demanding that the Government of Assam install
biodegradable sanitary pad vending machines in all government schools across the state. Her petition on Change.org has already gathered support from over 90000 people and continues to grow.

Bidisha was selected in Change.org’s flagship program ‘She Creates Change’ having run successful online advocacy
campaigns, which were widely recognised. Through the #BleedwithDignity campaign; she organised and celebrated World Menstrual Hygiene Day, 2019 in Guwahati, Assam by hosting a wall mural by collaborating with local organisations. The initiative was widely covered by national and local media, and the mural was later inaugurated by the event’s chief guest Commissioner of Guwahati Municipal Corporation (GMC) Debeswar Malakar, IAS.

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