Coronavirus has made us to listen to our common sense. It will recharge our commitments to our cultural, socio-economic and political worldviews, and transform the processes of society building approach. Two concepts of development based on fraternity and science will be celebrated. This approach calls for investing in Gandhian philosophy in our ways of life that should be based on wellbeing of humankind and fraternity as a pillar of society.
The second investment should be made in the field of medical science and technology. Covid-19 across the globe has shown that fraternity and medical science is crucial for a healthy society. Society adapting these two concepts of developmental approach can change the socioeconomic and political ways of life. This will also give importance to “civic federation” where village units or municipal units will become problem solving centres and will also expedite the processes of economic inclusion.
When we analyse the various countries on the parameter of investment in Medical Science we find that with 16.4 per cent USA, 7.5 per cent UK, 7.5 per cent Cuba, 6.5 per cent Italy, 11.2 per cent Germany, 11.2 per cent Norway, 11.2 per cent France, 11.2 per cent Australia, 10.9 per cent Japan; all spends approximately 10 per cent of their GDP on the health system. These nations have world’s best healthcare system but in spite of that, they witnessed huge casualties due to Covid-19. Just imagine if their health infrastructure would have not been good then casualties would have been multiplied many folds.
India which is the fifth largest economy of the world and aspires for becoming third largest economy by 2035 spends only 1.29 per cent of the total expenditure by the centre and state GDP (2019-20) on healthcare system. Moreover the 12 states spend less than 1 per cent of GSDP on the health infrastructure.
Even among BRICS countries India spends least when Brazil spends 9.2 per cent, South Africa 8.1 per cent, Russia 5.3 per cent and China 5 per cent of their GDP on healthcare. Moreover, when we analyse the Niti Aayog State wise health index, we find that since decades Bihar is in the only state which is at the bottom on health parameters for the last 15 years.
Under Nitish Kumar’s rule Bihar has not invested much on health infrastructure, therefore during this critical time of Covid-19 his government is facing an uphill task. After the relaxation in lockdown, the return of migrant workers from all parts of the country has added further strain on the crumbling healthcare system of Bihar. When we analyse the healthcare expenditure in Bihar, we find that the population of Bihar is approximately 12.5 crores but has only 148 Community Health Centre (CHC) instead of 800 CHC.
The people of Bihar need 622 Referral Hospitals but have only 70 Referral Hospitals, it needs 212 specialised Sub Divisional Hospital but has only 49 of such hospitals. To capitalise on talents, Bihar needs 40 medical colleges but has only 9 colleges, as per sanction post of doctors, Bihar should have 12,000 doctors but at present has only 2700 doctors. The ratio of people per doctor at national level is 1 doctor per 11000 people, whereas in Bihar there is only 1 doctor per 40788 people. As per WHO standards on 1100 people 1 doctor is required. If Bihar replicates WHO standard then it needs 1 lakh 20 thousand doctors.
On other hand when we look at the availability of beds than India ranks lowest globally with 0.9 beds per 1000 population which is far below the global average of 2.9 beds. Whereas Bihar has lowest hospital bed population ratio, for one lakh people only 4 beds are available. Moreover Bihar spends only rupees 495 per individual as compared to national average of rupees 1697 approximately on healthcare. Bihar hospitals are running with only 43 per cent of doctors, 29 per cent of nurses, and 28 per cent of technicians.
In Community Health Centres there is a shortage of 93 per cent of specialised doctors. The NSSO data gives us an idea that approximately 92 per cent of the population in the state is dependent on private healthcare system. The crumbling health infrastructure of Bihar has been exposed several times in recent years. Last year, due to Acute Encephalitis Syndrome (AES) known as ‘chamki’ fever, approximately 200 children in Muzaffarpur district of Bihar succumbed to the deadly brain disease.
Worst has come to reality for the health system of Bihar, when Coronavirus Quarantine were discovered functioning without proper protocol. The centres do not have basic facilities such as pharmaceutical rooms, restroom for doctors, nurses, and supporting staff. Moreover, the absence of clinical de-contamination rooms for doctors to monitor respiratory symptoms and non-existent biohazard precaution levels during this Covid-19 will surely shake the political as well as intelligence of Bihar in the context of health infrastructure in the upcoming Bihar assembly election due in November 2020.
On the other hand, to build better Bihar, investment in ways of life is required the most important is investing in human capability developmental approaches so that humanity can be celebrated. Inculcating the Gandhian philosophy is the way forward for Bihar. The implementation of Lord Cornwallis ‘permanent settlement’ gave birth to the zamindari system in Bihar which dragged Bihar into the vicious circle of divisiveness and a society based on hierarchy of castes which is still prevalent across the different walks of life in the state.
The whole idea of good governance is being dented due to historical misfortunes. When we introspect the post-independence Bihar, we find that caste has deeply divided the society. Thus, investment in the processes of democratic decentralisation has given impetus to Bihar. At this particular juncture Bihar is poised to take a giant leap forward even though there are constraints.
The prescription lies in evolving the idea of ‘fraternity’ and this should become the magic medicine for future Bihar. The principal plank of 1789 French Revolution, which is liberty, equality and fraternity, is celebrated across the world. In India also we have incorporated this idea in our constitution. Through Constitutional Provisions we can achieve liberty and equality but not fraternity.
Thus, to achieve fraternity, individual soul should guide the idea of self-sacrifice. Hence self-sacrifice will enhance the human capabilities of civil society in Bihar which will further replicate the whole idea of fraternity. If Bihar adopts the human developmental model based on investing in science and fraternity then Bihar can achieve top slot on development indications and Bihar will blossom again.
(The writer is an Assistant Professor at Department of Political Science, University of Delhi. He can be contacted on (M) +919313749124)