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Uncomfortable question: More power to Centre, or empower States for Covid care?

By Mansee Bal Bhargava*

The responsibility of healthcare in the Corona time is hanging between the Centre and the States, with the virus as well as the masses being footballed by both the Centre and the States to put in the other’s court. The changing goalpost of who, what, when, how Covid care has gone too far, making things murkier to dump the matter in the waters.
In our Fridays with Future discussion/ dialogue/ debate series, we highlighted the possibility of Central/ National/ Union government having more power vis-à-vis the State governments being more empowered for the general and key sector administration such as the Covid (health) care of the citizens. There are the crucial panchayat/municipality scale governments that work at the helm of the Centre and/or the State for healthcare.
Then there are of course the private sector healthcare facilities that fill the gap in the society using the market mechanism based regulations and guidelines set by the Centre/ States. A combination of all run the healthcare system of the country.
Healthcare is a fundamental right of every citizen of the country based on the Right to Live. So, who must take care of my health? Of course, at the first place it is #Atmanirbhar Me (self-care) from the prevention to the cure and the care. Still, in the larger purview of the serious diseases in the society, the question is pertinent.
For serious diseases like, polio, malaria, pox, and others, the universal immunization through the vaccination programme is the duty of the Centre through the States/ Panchayats/ Municipalities/ private healthcare. Universal immunization must be available to every citizen at no additional cost as per the law of the land, and has been so until so far the case, for example, for polio vaccination.
The question then is, isn’t Covid-19 considered under the serious disease category or a national disaster? While the World Health Organisation (WHO) declared it as a pandemic since its emergence, most of the world is offering its vaccination free to its citizens. Initially, the Centre too declared free vaccination for all, then went on with the “jumla” of free vaccines in state elections if the BJP wins, but when the vaccines were out, suddenly, they got a price tag, that too different for the Centre, States and private facilities.
Surely, most healthcare is a State subject, but the catch for the States/ panchayats/ municipalities/ private operations lies in the way the Centre manoeuvres health polices and budgets. No doubt, in the Budget-2021-22, the Centre announced an increase in the allocation for health by 137% from the previous year's budget estimate with a separate budget allocation to fight Covid-19.
However, this health budget is way too less, if compared with the country’s defense budget – which is also conveniently used as a tool to tame the citizens of the country! It is brought up since it speaks of our priority of defense from the external threats of an internally sick nation, threatened by poor healthcare facilities, malnutrition, hunger, poor education facilitis, unemployment, domestic violence and communal violence.
Nevertheless, the question here is how did the Centre regulate (or did not) the budget given that we have a national disaster, how are the decisions made for the distribution of budget to the States, how are the vaccine production houses selected and discarded, how are the production houses funded for what quantity, etc., besides the export and import?
Alongside the fundamental right to healthcare, if the right to freedom of choosing the option for Centre/State or privately-served facilities, besides the vaccinating itself, is to be exercised, it is pertinent to ask whether it was right on the Centre’s part to discriminate healthcare policies in various ways as it did during the last year.
From the allocation of the Covid budget by the Centre to the approval of the vaccines, proposed oxygen/vaccine plants, current oxygen demand-supply, and other medical aid, the heavy hand of the Centre earlier, and then no hand of the Centre now, the State health infrastructures are left into a jeopardy.
Furthermore, the private sector was initially kept out of the Corona business for most part of the year since its advent/declaration in the country, and after they were allowed, there is a new Corona business blooming with sky-rocketing profits. Still, since their role is important in tackling the rising cases, their regulations need to be clarified and furthered by the Centre.

First and second wave Corona

In the first wave, the Centre was remote controlling the prescriptions and instructions of Corona care during the lockdown. This continued till the approval of two companies for vaccine production. Meanwhile, it refused permission to import vaccines. It signaled to States its power to do this.
By the end of the 2020, the Centre also self-proclaimed victory over Corona without substantial research and development, to the extent that in beginning of 2021, when the country produced nearly half of the world vaccines, it cleared for export (sell, not free) nearly 90% of production to several countries as part of its vaccine diplomacy.
The Centre took similar decisions to export most of the medical oxygen in February. The exports seemed like an ambitious plan of the Centre to achieve the 5 trillion economy by 2024 from the business of pandemic. This “apda mei avsar” may be tagged as the Gujarat model.
Making the patenting/IPR clause stringent and disallowing more companies to produce the vaccines, thus disallowing the vaccine rights to its own people, will go down in the history of the country as the biggest mistake by the Centre. Ironically, while the Centre at the WTO seeks patent rights waiver, it argues against a waiver in the Supreme Court.
The Centre has been discriminatory in the allocation of the vaccines and other medical aides to the States. Else, how did the Centre decide to export the country’s vaccine and medical oxygen, depriving the citizens its rights? What was the administrative and participatory governance process involved? Did the Centre ask the States, or did it enquire into requirements of the States before taking the decision to export vaccines and medical oxygen?
Ironically, the parliamentary sessions are not conducted for a while in the disguise of Corona care, and there are absolutely no discussions/ dialogues/ debates whatsoever between the Centre and the State, except the one-way communication from the PM to the CMs. If the things go this way, the monologue may also slim with the Corona impact getting graver, as is happening in the second wave.
Further, the Centre has been discriminative to the citizens on who will be vaccinated, thereby completely failing and shunning the universal ummunization approach. In the digital India where there are messages reaching every phone, there are fake news going everywhere every moment. Yet, we hear only Mann ki Baat. One wonders why didn’t the Centre run a survey with citizens asking who should be vaccinated, when and how. It may not provide a clear picture; however, it may provide a sense of participatory governance.
The Centre then suddenly put the States on the #Atmanirbhar mode after the situation got out of its control. It bypassed Universal Immunization Act for vaccinating people amidst uncertainty of procurement of vaccines from international market.
In fact, the Centre sought vaccines from the international market too late. It had already exported India-made vaccines. Now it has left to the States to import the vaccines on their own. Besides, the Centre made the States to decide on which vaccine to procure, from where to procure, when to receive, way too late when there were long orders pending internationally.
When the vaccination is now opened for larger populace from this month, the production nationally even if expedited is insufficient. How did the Centre plan to vaccinate majority populace without substantial vaccine in production plan?
Since several States of India are ruled by different parties, other than the party at the Centre, the discriminative voices and difficulties in Centre-State relations have turned louder. Amidst the second wave, when Delhi was gasping for oxygen, the Centre refused to oblige, and the same happened with Maharashtra, which is among the worst affected states. It is also true that the same party governed States like the Gujarat, Madhya Pradesh and Karnataka are equally in distress, yet they are not noising, even though they are found to be misreporting data.
The private vaccine producers’ stance of different pricing for the Centre and the States and the private hospitals was ridiculous, yet, ironically, it was supported by the Centre. With profit as a priori, the private producers are obviously tempted to export more than sell it in the internal market, given the price they are able to fetch internationally. This certainly resonates with the typical Gujarat model of “apda mei avsar” that has been also promoted by the Centre.
Why isn’t the Centre regulating the pricing on the humanitarian grounds under the universal immunization law? If vaccine is life saving and if it is not a rocket science that other pharma companies cannot produce, why isn’t the Centre allowing and supporting other pharma companies into vaccine production by removing the IPR clause?
Now, when the States are made to take care of themselves, it is natural for them to reach out to the production houses everywhere to order for their vaccine-oxygen-medical requirements. At the same time, it is also natural for a State like Maharashtra that houses one of the approved vaccine production plants to demand from the producer to reserve 50% vaccine for the State. This happened even as the Centre has imposed curbs on the States from producing and procuring vaccines from elsewhere.
Why didn’t the Centre decentralize the Corona care strategies to State level right from the beginning (as it was demanded by Delhi and Maharashtra), so that they were better prepared for the second wave? If it had done so, the States could have also allowed the PSUs to engage in vaccine production, besides having more time to strategize urban-rural healthcare facilities.
Despite States now being turned into relatively more autonomous in Corona care, the permission for medical oxygen, vaccine distribution, etc. remains a matter of clearance from the Centre. This gets murkier when the world is coming to the rescue of the country. Relief materials will obviously land on the laps of the Centre. How does the Centre plan to justify sharing or not sharing international aid with States? The same true is with PM CARES funds. How States getting as their share?
The Centre is not behaving like a democratically elected government, but instead like a Royal/Honorary set-up as in many developed countries, including our colonizer England, and their close aides like Japan and Netherlands. This can only be tagged as authoritarian, as has been referred to of late on more than one occasion.
When the country is fighting with the pandemic, the Centre is evading its responsibilities to the States. In fact, it is taking wrong decisions insisting that it has more rights than the States. Meanwhile, it refuses to hold parliamentary debates, even as continuing to focus on winning elections.
Worse, the Centre boasts on the making of the Central Vista as an essential good at a time when the Delhi government declared a lockdown, signaling an indifferent mode to the massacre happening in the Delhi NCR. Those ruling the Centre seem to forget and forgo the entire constitutional process in order to build castles, as if it is going to be theirs forever. It is important to alarm this distancing of the Centre from the country’s priorities. The distancing of the Centre vis-a-vis States is evident all across the country irrespective of political party rule.
Since the Centre is slowly slipping into this royalty mode by projecting more as Presidential form of government, it is pertinent to ask, can India afford one more royal position as Prime Minister like the President of the country, or are they going to be eventually one position in future?

Historically speaking

The heavy and invisible hand of the Centre needs to be understood historically to move forward in resolving Centre-State tensions.
Citing/clarifying Centre-States relations from the legislative perspectives, Article 1 of the Constitution of India states that “India, that is Bharat, shall be a union of states.” We refer to India as a quasi-federal system since Independence, with federal in the form and unitary in the spirit. Interestingly, the word “federal” is nowhere used in the Constitution of India; however, the nature of Indian federal system is clarified by Dr BR Ambedkar as:
“...it established a dual polity with the union at the centre and the state in the periphery, each endowed with sovereign powers to be exercised in the field, assigned to them by the constitution. The union is not a league of states, united in a loose relationship; nor are the states the agencies of the Union, deriving powers from it. Both the Union and the states are created by the constitution. The one is not subordinate to the other in its own field; the authority of one is not subordinate to the other in its own field; the authority of one is co–ordinate with that of the other.”
The Centre-State relations are based on
i. Legislative relation,
ii. Executive and administrative relationship, and
iii. Financial relationship.
Despite the above words in the Constitution, it is a fact that the Constitution intended to establish a stronger Centre to preserve the unity and integrity of States. The intention is clear with the centralizing tendencies imbibed in the Constitution itself for some key sectors like defense, but then pandemic is also a national matter, like it was the Emergency of 1975-77. We are no less than in the state of Emergency both democratically as well as pandemically, wondering why is the Centre not declaring it an Emergency?
It is also a fact that the States did not and do not feel their autonomy threatened or compromised when the same party was at the Centre and the State. When it is different parties in the Centre and the State, the tensions are evident. Since 1967 when in eight States non-Congress governments came in power to today when more than half the States are non-BJP governments, Centre-States tension are exposed in these difficult times.
It was in 1967 and thereafter that the issue of preservation of autonomy of the States have been raised. The Maharashtra CM has sought decentralization of power and decision making for Corona care, while the Delhi CM has been noising about the snatching of autonomy of the Capital city-state.
This appears understandable, given the time when the Constitution was written during the distress of partition; however, it is important now to reflect upon the Centre-States arrangement given that we are more likely to have different parties in power in the Centre and majority of States. One party government gave way to UPA/NDA coalition governments, but now the Modi (person) government is seeking to signal scrapping of the democratic process itself.

Way forward

It is a matter of concern that all the noise around Centre-State relations until recently was mostly for the urban populace, where the media is usually active. However, now half the country’s rural-town population in the dire situation of the virus spread. The panchayats-municipalities are poorly equipped with healthcare awareness and facilities with too little too late support from the Centre.
If the panchayats are not empowered now, the rural India may perish, and if that happens, India will perish. The question is, as a citizen of this country, whether urban or rural, should it matter who provides the healthcare aka Corona care as long as it arrives to the right place at the right time?
The Centre-States tension is here to stay and may get murkier in the days to come. They are a black hole, but there is also a silver lining to it. The silver lining is that this is the right time to question the dual polity legislation and evolve a more robust system with the Union of the States in line with the Constitution’s true meaning. After nearly 75 years of Independence, it is crucial to look into the matter.
The situation may get worsened because of the inherent healthcare challenges of the country that votes more for temples than for hospitals. Further, because the Centre is advocating One Nation, One Election, One GST, and implicitly even One Religion, etc., we must learn to live with pandemics now, as the climate change impacts, that call for more local sustainable actions.
We don’t have to live with Centre-States tensions, but instead evolve from the administrative-legislative arrangements when Indian became independent and when the circumstances were different. It is now crucial that the States rise and reclaim their sovereignty more than ever to look for local solutions to local global problems.
If healthcare is a State matter, let the States be more self-sustainable and open to all kinds of business. Going beyond healthcare, other sectors, including defense, must be also looked through for States to be more sovereign. Let the panchayats and the States be the leading governments with a Committee of Ministers representing Centre (India-Bharat).
Let us rethink the positions of the Prime Minister-President chosen and rotating lead from States. This also means decentralizing the Capital to multi-capitals, like in the Netherlands, Germany or Australia, making necessary administrative-legislative changes. We can certainly look at what countries like the United States on what not to do, and the European Union as to what can be a possibility.
---
*Entrepreneur, researcher, educator, water enthusiast, governance scholar, keen political observer. Click here for more about Mansee

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