After destroying cities in India, COVID-19 is now Raging The hinterland of the country.More than half of the country’s new infections and deaths are occurring Report From rural areas. For example, in the small village of Shertha in Gujarat State in western India, 64 people lost their lives in April this year, many of them because they did not get timely medical services and basic supplies such as oxygen. When villagers call an ambulance through the state-run hotline, it usually takes three days to arrive; sometimes, its sirens cannot be heard long after the patient’s death. “The situation in other villages in Gujarat is much worse, with as many as 100 deaths in each village,” Gulab Thakur, chairman of the Sherta Village Committee, told Scientific american Through the phone. “Every village here is facing the same destruction.”
Earlier this year, when an epidemic broke out again in India, even the hospital corridors in the capital Delhi usually provided residents with some of the best healthcare services in the country. Pack With patients.Multiple hospitals Drive the patient away,due to severely lacking Beds, oxygen, medicines, ventilators and other necessities.The funeral pyre is Erect In the park, parking lot, sidewalk And other empty spaces to keep up with the rapid death toll.Although the numbers seem to be declining now, it was only on August 15 that the country Report Approximately 33,000 new infections and 417 deaths-almost certain Count less.
Given these horrors, the spread of COVID-19 in rural India is particularly disturbing.The area has About two thirds Population, or 895 million people, but only Quarter The country’s health infrastructure, including hospitals and medical staff.This imbalance is largely the result of the privatization of India’s healthcare sector in the 1990s, when the country was Debt crisis, accept Structural adjustment loan From the World Bank and the International Monetary Fund (IMF), the government is a member of multilateral financial institutions. These loans are accompanied by mandatory “conditions” in fiscal and economic policies. These include financial and trade liberalization and sharp cuts in social spending—especially in healthcare and education.
The Structural Adjustment Program (SAP) has stimulated rapid economic growth, but it has also ensured that most of the proceeds will go to the rich, exacerbating social and economic inequality.In fact, international financial institutions Require India has lowered the standard of living of most people. Therefore, economic liberalization means that the poor and rural Indians are abandoned by market forces driven by competition, depriving them of affordable healthcare — while wealthy Indians have access to world-class healthcare. Policy prescriptions commoditize health services, Retrofit They become private goods rather than basic human rights.Public health expenditures are already very stingy 1.5% In the late 1980s, India’s GDP share fell to 0.6% in the 1990s.During the 2020-2021 fiscal year, despite the pandemic, India’s health budget remained at an alarming level 0.34% Its gross domestic product.
The decrease in public health expenditure means a shortage of funds for state-sponsored medical institutions.Many hospitals have been established in recent decades, but most of them are private and concentrated In urban areas.Therefore, rural India only has 3.2 There are government hospital beds per 10,000 people, while Indian cities 11.9 Beds per 10,000 people. Due to vacancies in government hospitals, the number of health care providers in rural India is also severely underrepresented, where wages are very low. Much lower than the private sector: Surgeons (83% shortage), obstetricians and gynecologists (76%), physicians (83%) and pediatricians (82%).
Government-run hospitals often lack the necessary equipment, such as ventilators, ambulances, pulse oximeters, medicines, and oxygen cylinders. For example, in a village in Uttar Pradesh in northern India, 45 Succumbed In the absence of medical support and oxygen, he contracted COVID-19 in April.In some areas of Maharashtra in western India, the death rate of government-run COVID-19 hospitals is 3.8 times Higher than private facilities.
Economic reforms also mean that the poor will have to pay for medicines, bandages and other supplies, even in publicly funded facilities. According to SAP’s conditions, the Indian government introduced “user fees” in public hospitals. The World Bank’s 1993 position statement on health care, “World Development Report: Investing in Health,” explained that people paying for their health care in the form of user fees and prepaid insurance plans have “become a real need” in some low-income countries, which can help improve the quality and reliability of services. But many rural poor people Can’t afford the usage fee, which makes Reduce Hospital admission rate.
Even while cutting public health spending, the Indian government has promoted privatization in the following ways-this is another condition of the World Bank and the International Monetary Fund- supply Many subsidies are provided in the form of land and reduced import taxes to encourage the expansion of private medical facilities.Reforms have stimulated the rapid growth of the private sector, which currently accounts for 62% India’s health infrastructure.In addition, nearly 60% of hospitals, 80% of doctors and 75% of pharmacies are in lie in In urban areas, people who can afford these services live.Even before the pandemic, this difference had already shortened the lifespan of the villagers Four to five years Compared with city counterparts.
The privatization of health care in India has not only had an overall impact on the health of rural Indians; if members get sick or injured, it also means economic disaster for many poor and lower-middle-class families. As (mostly) private facilities that provide effective health care flourish, even if public facilities decline, 72% Indians from rural areas and 79% People from urban areas use private hospitals and other private medical services.
But private health care costs Four times It’s not just public health care in India. Only in the 2011-2012 fiscal year, 55 million Because of out-of-pocket expenses, Indians fell below the poverty line.To make matters worse, economic reforms have penetrated into the pharmaceutical industry Drug Price Control Order After 1994, most drugs were not subject to legal price control, resulting in rapidly increase In terms of drug prices. From 2011-12, 38 million Indians fell into poverty in medicine spending aloneIn summary, according to a 2017 survey of 184 countries, Indians’ private expenditure on healthcare accounted for 65.6% sixth It is one of the largest out-of-pocket health consumers in the world.This, despite the fact that around twenty two% Of Indians still live below the dollar poverty line $1.90 per day.
It is not just poor Indians that are affected by the health effects of the neoliberal economic diet. Between 1980 and 2014, 109 out of 137 developing countries in the world Enter At least one SAP authorized by the International Monetary Fund and the World Bank in exchange for loans. Like India, these policy changes have adversely affected the healthcare systems of disadvantaged groups in many of these countries.Almost all experienced Wages have fallen, income inequality has increased, infant and maternal mortality rates have increased, and malnutrition has increased. A 2016 Review The restructuring of 16 West African countries found that such conditions “hinder progress in achieving universal health coverage”.
exist ZimbabweAfter the introduction of user fees, the maternal mortality rate rose from 90 per 100,000 live births in 1990 to 168 per 100,000 live births in 1993. MexicoWith a loan from the World Bank in 1997 to privatize its social security system, public sector organizations faced budget cuts, which eroded health care services and left millions without insurance.The weakening of health systems in West African countries is mainly a consequence of structural adjustments. Blocked Their response to the Ebola outbreak.
The impact of SAPs on the world’s poor has only intensified in the past few decades. The ongoing pandemic has exposed the deadliest fault lines in these policies, and these fault lines have also hindered their fight against COVID-19 with their enduring legacy. For example, in Cameroon, structural adjustment has exacerbated poverty, 37.5% Its population now lives below the national poverty line.Here is Hinder The country’s response to COVID-19 is that low-income people cannot take measures such as social distancing and are forced to leave their homes to support their families.exist EcuadorAt the same time, the austerity policy promoted by the IMF has become the “vehicle of the health, economic and social crisis” of COVID-19.
If international agencies had promoted the health guidelines set out in the health guidelines, the world, especially developing countries, could have better dealt with this epidemic. Almaty Declaration In 1978, instead of focusing on the free market system. The declaration recognizes that health is a basic human right. The declaration noted the “severe inequality” in the health of citizens between developed and developing countries, insisted on vigorously deploying world resources, and bridging the gap in health equity by allocating appropriate funds to primary health care.
“All governments should formulate national policies, strategies and action plans as part of a comprehensive national health system and coordinate with other departments to initiate and maintain primary health care,” stated the declaration signed by 134 national government members of WHO.. “To this end, it is necessary to exert political will, mobilize national resources, and make rational use of available external resources.”
However, the World Bank-International Monetary Fund approach seems to ignore the primary health care system advocated by the Almaty Declaration and instead supports free market principles. The impact of this fatal rebuttal is now evident in villages like Shertha. According to Thakur, the village chief, there are about 18 private hospitals around his village, and only one government-run hospital. “Although medical expenses are expensive, villagers trust private hospitals more. However, most people cannot afford it,” Thakur told me. “Those who cannot afford private hospitals either give up medical treatment or try to heal themselves at home. Or yield.”
This is an opinion and analysis article; the views expressed by the author or author are not necessarily Scientific american.