Covid opens wide India’s precarious health and sanitation structures – 08/05/2021 – World

In September 2019, Indian Prime Minister Narendra Modi received an award from the Bill and Melinda Gates Foundation in New York City for his government’s clean-up campaign, the Clean India Mission.

On the same day, two Dalit children, members of the country’s lowest caste, were beaten to death in the village of Bhavkhedi, Madhya Pradesh state, for defecating outdoors. Indian government documents claimed that all houses in the village had toilets and therefore the village was classified as “open defecation free”.

But the children – aged 10 and 12 – were killed for not having a toilet at home and for defecating in a field near an area belonging to an upper caste Yadav community. Two men hit the children on the head with a stick and killed them instantly.

The government says that since the campaign was launched in October 2014, more than 100 million bathrooms have been built in India, making the whole country a “open defecation free” zone.

The murder of the two children, however, highlighted the contrast between reality and official statements, highlighting the structural deficiencies in India’s health and sanitation system.

A similar scenario repeated itself in January of this year, when Covid cases in the country declined and, at the World Economic Forum, Modi declared victory by claiming that India had saved humanity from disaster. major “for actually containing the coronavirus”. Five months later, however, figures from the health crisis show a scenario of chaos: in the past 15 days, the country has set daily world records for new cases, and the rise in infections is driven by the emergence. of a variant that has completely overloaded the health system, health care and burial places in the country.

The drop in the number of deaths and cases of Covid earlier this year is still a puzzle. Criticized by scientists for hiding data, authorities blamed the setback on natural immunity Indians would have from exposure to other viruses. This thesis created the idea of ​​a kind of exceptionality and was taken up by the highest levels of government up to the state administrations.

In March, tens of thousands of people watched cricket matches at Narendra Modi Stadium in Gujarat. The event bolstered national pride, despite warnings that Covid contamination was on the rise. Huge Hindu religious rallies and gatherings were also held in several regions, and the prime minister himself led huge political events in which the majority did not wear masks. India therefore now finds itself fighting a very tough battle against the pandemic.

The 414,188 new cases of Covid recorded only Thursday (6) brought the total in the country to more than 21.4 million, behind only the cumulative in the United States. On the same day, the Indian Ministry of Health also reported 3,915 more deaths, bringing the number of Covid deaths in India to 234,083.

With the dramatic second wave of the pandemic hitting the country, people are dying on the streets, not only from the virus, but because the country’s healthcare system has collapsed. There is a lack of oxygen and intensive care beds in hospitals, and funeral homes lack space, resulting in a build-up of bodies.

In the 2019 Global Health Security Index, a ranking that lists countries’ preparedness for a pandemic, India ranked 57th, behind Brazil, at 22nd. In terms of investments, the country devotes only 1.3% of its GDP to the health sector, a figure once again lower than that of Brazil (9.5%) and that of the other countries ranked among the most poor of the world.

The government, however, is making up the numbers to try and show that health spending was higher. To this end, it adds to the health budget a one-time expenditure of US $ 6.5 billion (R $ 33.97 billion) for Covid vaccines and US $ 18.29 billion (R $ 95.59 billion). reais) for nutrition, water and sanitation.

Earlier this month, US consultancy firm Fitch Solutions said the persistent lack of funding for healthcare infrastructure had led the Indian system to collapse under Wave 2. “In addition, the growing needs of the population are not being met due to the inefficiency, dysfunction and acute scarcity of health care delivery systems in the public sector.”

Add to this the fact that, according to Fitch, 80% of Indians do not have significant health coverage and that around 68% of residents have limited or no access to essential medicines. Thus, the pandemic has highlighted the critical importance of the public sector in the provision of health care.

Sanitist Asif Wani argues that India should increase its spending on public health, especially in rural posts, which serve more than 65% of India’s population. In February 2020, the proportion of doctors across the country was 1 per 1,404 inhabitants, an index lower than the ratio considered ideal by the World Health Organization (1 per 1,000 inhabitants). In rural areas, this figure is much worse and reaches 1 in 10,926, according to the National Health Profile of 2019. For comparison, in Brazil this rate is 1 doctor per 417 inhabitants, according to data from the Federal Council of Medicine.

“There is a lack of access to basic medical tools, equipment and adequate funds,” says Wani. “In addition, we must focus on preventive care at the primary and secondary levels of the health system, in order to face any eventuality. “The health official says that health professionals who work in the communities do not participate in decision-making processes and do not have access to more recent research. For this reason, he argues, the country must open its system medical to international partnerships, so that students can have hands-on contact with the most recent advancements in medical science.

India’s structural health problem is circulating in numbers: nearly 5.8 million people die from non-communicable diseases (NCDs) in the country each year, meaning one in four Indians is at risk of dying from NCDs before reach the age of 70, and at least 33 out of every 1,000 children born this month will die before their first birthday.

On the other hand, even if many Indians still do not have access, for example, to drinking water, several indicators have improved in the country since 1980. That year, basic health coverage in the zone rural was estimated at 1% – in 2018 it reached 95%. Just a few years ago, in 2015, almost half of the country’s population, or around 568 million people, suffered from the indignity of defecating in fields, forests, rivers or other public spaces. due to lack of access to toilets.

India alone made up 90% of South Asia’s population and half of the 1.2 billion people worldwide who defecate outdoors. In 2019, according to official data, however, the number of residents without access to a toilet decreased significantly, falling by 450 million people.

Change is essential, as experts point to the lack of basic sanitation as a generator of a ripple effect, hampering the development of the country as workers fall ill and have shorter lives, without being able to pay for the education of their children nor guarantee. their a stable future.

According to an article published in the scientific journal The Lancet, the lack of water, sanitation and hygiene services in health facilities in India contributes to the high rate of neonatal mortality, which today stands at 24 deaths per thousand children born alive.

Sepsis, a potentially serious reaction that spreads throughout the body to infection and spreads primarily in healthcare settings, accounts for up to 15% of total neonatal mortality and 11% of maternal deaths. And the risks don’t end when babies are brought home to communities that don’t have toilets.

Reports also indicate that 22% of schools in the country do not have appropriate toilets for girls, 58% of preschools do not have a bathroom and 56% of preschools do not have water on site.

Arguably, a tragedy is needed to sensitize people to the adverse effects of India’s historic trend of declining public health spending. Professor of epidemiology Madhukar Pai, of McGill University in Canada, said India is a story that should serve as a warning to the world. “If we declare victory ahead of time, open it all, give up investing in public health and don’t get vaccinated quickly, the new variants can be devastating,” he wrote on Twitter.

Health numbers in India

0.53

hospital beds per 1,000 people have India, according to World Bank; in Brazil, the proportion is 2.09 per 1000 inhabitants

1.3%
of Indian GDP is invested in health, less than a seventh than in Brazil

1,404
people for each doctor in India, while in Brazil the rate is 1 professional per 417 inhabitants

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