Forget failing government, citizens are making a difference. Are you?

State, Market, Society

From the beginning of the pandemic last year, it has been clear that the government cannot overcome the virus on its own. The people, too, must do their part. This is not merely about following the guidance from the government about social distancing, wearing masks, and so on. It’s more than that. Citizens have to help the public health system withstand the onslaught of the virus, and also help build long-term resilience in the healthcare system.

During the course of the last two weeks, as #CovidRuralResponse has run the largest volunteer network for relief in the country, a lot of people have asked me three questions repeatedly. Isn’t the government supposed to do all this? Can citizens really make a difference? When will it all end? Let’s look at each of those.

Yes, the government is supposed to do a lot of this. But there is a long history of governments not doing things they should, and the people have not really held them accountable for that. Imagining that things are going to be magically different because of the current situation is just wishful. If anything, we should be telling ourselves that we, too, have failed.

There is simply not enough capacity in government to tackle this. It’s partly because it’s a very large problem, one that has severely tested even some very prepared governments. But it’s partly because we have not invested enough in healthcare for decades. That has left us with very little armour in the war against the contagion.

Yes, citizens can make a difference. The first significant supplies of non-governmental aid in the state came from citizens. The donor agencies are large and move through ‘implementation partners’ who are very good peacetime heroes. But this is war, and the speed of the intervention needs to be much greater. Who can act most nimbly and without hesitation? We, the people.

Every little bit helps. Some contribute money, yes. Some contribute time and skills. These are equally important. And no one is too young to help. Yesterday, the youngest volunteer in the group, a 10th standard student in Ranchi, helped compile a dataset of hospitals in Gujarat. She did it in less than a day and was eager to do more. I spoke with her mother briefly, and the pride in her voice was evident.

When will it end? That depends on what we mean by ‘it’. If you’re looking for a lower caseload and deaths being reported daily in the press, that could happen reasonably soon. But that’s not credible. There is simply too much data, from too many sources, that contradicts the official counts. Plus, the media and health personnel are not everywhere. The unseen is vastly greater than the seen.

The end has to be much more than this. It has to be a staff-to-bed ratio that can provide accessible care to everyone. It has to be a cost of care that is affordable to everyone. It has to be a commitment to year after year of higher budgetary expenditure on healthcare. It has to be about science research, without prejudice or fear about what we might find. It has to be about transparent data and public discussion of our problems. I made a list of things that will be needed in a comprehensive response and came up with about 20 things. There must be many more.

At the Public Health Centres (PHC) in the rural areas, it is a catastrophe, at many places in the country. The district hospitals could get to some level of manageable suffering by mid-June. The taluk hospitals might get to that stage in August. But the PHCs are another story -- no one can assess this with any confidence. And so many of them have caseloads you don’t want to hear the numbers. It’s scary.

As if all this were not bad enough, we must also endure the tussle between governments at different levels. Things that should be decentralised are command-controlled, and things that should be centralised are left to lots of others to do. The virus is having a field day (a field year, actually) while we spend time trying to sort out blame, credit, responsibility, authority, etc. The end, really, is not about time. This suffering will end when we commit to politics and governance that will tackle all this. And not before then.

Anyone who is ‘assuring’ us of a larger picture of getting this under control with a ‘plan’ is simply lying. There is no such plan. Only a race to fill in the holes created by decades of denying accessible and affordable healthcare to the majority of the people. Every PHC will need lakhs of rupees to get through this. Karnataka has more than 2000 PHCs. And even if the money can be found, getting the manpower and equipment needed to make these resilient is months away.

We need to get involved, stay involved and care deeply about the quality of care that others receive. Ours will be alright automatically.

(The author is social technologist and entrepreneur, founder of Mapunity and co-founder, Lithium, wakes up with hope for the city and society, goes to bed with a sigh, repeats cycle @ashwinmahesh)