Health for all? UP development 'model' is deepening inequalities amidst Covid-19

Antonio Guterres

By Shobha Shukla, Bobby Ramakant, Sandeep Pandey*
“Covid-19 has exposed the lie that free markets can deliver healthcare for all, the fiction that unpaid care work isn't work, the delusion that we live in a post-racist world.We are all floating on the same sea, but some are in super-yachts and others clinging to drifting debris”, tweeted Antonio Guterres, United Nations Secretary General a few days back.
The Uttar Pradesh government in India, like some other states such as Delhi, Chandigarh and Punjab, has allowed paid hotel isolation facility for asymptomatic and mildly symptomatic Covid-19 patients. Prior to this, paid hotel quarantine facilities were offered for those with travel history to high burden areas.
For those who can pay, government health teams will be deputed in these hotels to monitor health of those isolating themselves there. But for those who cannot pay, appalling stories are piling in from public health facilities raising serious questions on food quality, toilet sanitation and hygiene, healthcare standards, among others.
However, there are some states like Kerala where everyone is getting quarantined in government facilities only (no paid hotel service) and Kerala is lauded globally for its response to the pandemic. Kerala health minister was the only Indian panelist on United Nations Public Service Day.
Covid-19 has made the world understand why health for all is so intrinsically linked to social security and economy. But our government response to the pandemic is not reflecting if we have taken these hard-learned lessons into account. Are we failing to learn one of these most important lessons?
These inequalities not only fail us in containing the pandemic but are also the root cause of perpetuating such calamities and putting most people at a heightened risk of avoidable human suffering and untimely deaths.
Only public health services can ensure health for all – rich and poor alike. Profiteering from illness must come to an end now. We must stop legitimizing profiteering from illness and misery. Also, efforts like paid-hotel-quarantine are validating profiteering from illness in so many ways and depleting public health resources because it is the government healthcare staff that is monitoring those who can pay in these hotels for care.
We have to bridge the gap, and not widen the chasm between those-who-can-pay and those who cannot. The UN chief also echoed this earlier: “Covid-19 has been likened to an X-ray, revealing fractures in the fragile skeleton of the societies we have built. It has reinforced the need for solidarity more strongly than ever.We belong to each other. We stand together, or we fall apart.”
If the intention was to increase healthcare capacity in terms of hospital beds and infrastructure, then converting hotels into isolation or quarantine facilities on a payment basis is not the right step. Government guest houses, hostels in educational institutions (with good mess services) which are mostly vacant as institutions have taken recourse to online classes could have been easily used just as railway coaches have been converted into Covid-19 hospitals. 

But the bureaucracy is enamoured with the idea of private so much so that hotels are used for meetings and stay increasingly, abandoning the government infrastructure.
If the intention was to provide a convenient way for those-who-can-pay to get healthcare in hotel facilities with proper toilet and sanitation and hygiene and other amenities they are comfortable with, and let the majority of our population deal with public health services and its limitations, then it is not only unfortunate but also is going to exacerbate the very inequalities that led us to this difficult situation.

Rainwater in a Covid ward in Bareilly, UP

It is also important to recognize that bad sanitation and hygiene, dirty or non-functional toilets, unsatisfactory healthcare standards and other concerns we associate public services with, are not new: they have ailed the public services for long but those-who-can-pay have conveniently made an alternate parallel system where they have services they are comfortable with.

For those who cannot pay, appalling stories are piling in from public health facilities raising serious questions on food quality, toilet sanitation and hygiene, healthcare standards

That is why we have a system that promotes airports, private hospitals, hotels, private transport, private schools, or privatization of railways for the convenience of those-who-can-pay.
Allahabad High Court Justice Sudhir Agarwal had passed orders in 2015 and 2018 making it mandatory for all those who receive government salary to ensure their children study in government schools and they receive healthcare from government hospitals, respectively.
Unless rich and poor alike will use same public services how will we ever begin to work towards a fair and equitable world, which is often referred to by the sustainable development agenda ‘where no one is left behind’?
For those who may question if the use of public services by those-who-can-pay will have any impact, may instead question why the world is paying attention to the Covid-19: Is it not because those-who-can-pay are also at risk? Is it not because it is essentially the public health services worldwide that are at the forefront of the pandemic response?
Now since those-who-can-pay have to use the same public services to save their lives then is it the time to find a convenient option like paid-hotel style healthcare or is it the time to fix the broken public system?
It is government’s responsibility to walk the talk on a very oft-quoted slogan of Health For All. Health for all, does not only mean clinics and hospitals but also includes preventive healthcare and healthy living “for all”. It is government’s primary responsibility to ensure that the populations do not suffer from preventable diseases or die untimely deaths.
This is also true for Covid-19 pandemic where it is the fundamental duty of the government to ensure that the infection is not spreading, and those who are infected get the best standards of healthcare and social support in a rights-based manner – regardless of their ability to pay.
If majority of our population is unable to do ‘safe distancing’ or have access to functional toilet or proper homes or nutrition or education, then is it not a failure of the development model our governments have been blindly chasing which serves the interest and coffers of only a handful few?
This is the same development model that deepens inequalities and injustices and makes us dangerously vulnerable to such pandemics and other humanitarian crises.
If we are to find a way out of the pandemic and avert such future crisis situations, the only path forward is in the direction of a fairer and equitable world. Some are not more equal than others.
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*Shobha Shukla is the founding head of Citizen News Service (CNS); Sandeep Pandey is Magsaysay award winning social activist and vice president, Socialist Party (India) (SPI); Bobby Ramakant is with CNS and SPI