On the 12th of May, the Prime Minister, while addressing the 95th annual plenary session of the Indian Chamber of Commerce stressed upon the need to create an Aatma Nirbhar Bharat a Self Reliant India. Atma Nirbhar Bharat (ANB) is conceptualized as a movement (Abhiyan) to drive the economy, infrastructure, system, vibrant demography, and demand. It is a consequential cumulative outcome of multi-level socio-economic paralysis that erupted out of CVOID-19. One of the focal areas of intervention envisaged in ANB is an increase in investment in the health sector. Indias health sector requires massive investments as resources to cure and care for 1.33 billion population are limited. However, India can turn this demographic burden into an advantage by superseding production over consumption of qualified health services. The article suggests that instead of being driven by disease, India with its demographic advantage can drive ANB by producing doctors and paramedics to fulfill the global and local demand. Bridging this universal demand of doctors and paramedics was a concern raised and realized during COVID-19. India urgently requires investment in medical education infrastructure and system.
No other country today is fortunate to possess a demographic advantage of 54 percent of its total population being under 25 years of age. By serving the aging global population with an everyday rising health crisis, doctors and paramedics will simultaneously promote a demographic dividend. Yet, with the current health infrastructure and medical education system, this window of opportunity is limited. If India wishes to reap this global advantage before it makes a demographic transition; it needs to use its strategically gifted demographic structure more diligently in the coming two decades. It requires reducing the gap between the MBBS aspirants and available seats in medical colleges. It needs to define the notion of vibrant demography as Aatma Nirbar as what once Pandit Deendayal Upadhyaya suggested -economic democracy. According to him, as vote stands for everyone in political democracy, work to everyone permeates economic democracy. The two remain the legs of vibrant demography and democracy that uphold the weight of the nation and help it in walking forward.
A pandemic like COVID-19 is a rare opportunity for policy formulation to promote self-reliance. Disasters are inevitable and are expected to rise with the increasing climate change challenges- what is important is to instill policy instruments that enable the nation to recover with minimum loss in a limited timeframe. Examples across the nation have changed the fortune of the city or the region after the disaster. New Zealand not only takes the lead in declaring a COVID-Free Nation, by doing so it has also reduced losses and regained economic momentum. It could achieve resilience in tackling disasters through the establishment of national integrated policy framework. According to a study conducted by Lincoln Institute of Land Policy; After Great Disaster, the report provides an analysis as to why China on May 12, 2008, after the Sichuan Province earthquake led to 69,226 deaths and another 17,923 reported missing. Whereas New Zealand reduced losses from the 20102011 Canterbury earthquake with a well-prepared recovery process. The resilience achieved in New Zealand is a consequence of two decades of policy preparedness. In the 1990s, the New Zealand national government developed an emergency management system that includes a framework for recovery management. It is one of the first countries in the world to offer government-backed insurance to earthquakes, volcanic eruptions, hydrothermal activity, tsunamis, forest fires, and landslides damage. Unlike New Zealand, in the absence of a national-resilience framework, most of the developed countries with one of the best health facilities failed to reduce losses due to COVID.
However, natural disasters and the COVID-19 crisis are fundamentally different in spread, speed, and surprise. What makes the COVID-19 crisis distinct from other disasters is the ‘element of surprise’? In a natural disaster, resilience is insured with timely international coordination and information sharing that allows national preparedness to reduce losses. In a market economy, information darkness in health disaster at its source also springs an opportunity for economic value creation by capturing the nascent market of medicine and vaccine. Response to global health crises, such as SARS, 2005; H1N1, 2009; Ebola, 2014-16, and the recent COVID-19 pandemic have failed to address the desired effectiveness of the International Health Regulations (IHR). In 1969, IHR was agreed as legally binding upon by all nations represented by WHO. The 1990s liberalization and globalization has rapidly expanded international trade, travel, and tourism, in this scenario failure of IHR has a severe economic impact. Though IHR was revised subsequently, the COVID-19 experience made it evident that International Health Regulations failed miserably to address its objective in controlling the health and economic threat of the Coronavirus.
With this paradigm of health and global governance challenges, nations are left with no option but to design a national-resilient framework. Barter or trade in a globalized world is inevitable; however, no relation based on asymmetric barter is sustainable. To protect and promote national interests with the rise of inequitable globalization, ANB is an effort towards this direction. The USD 265 billion economic package, approximately equivalent to 10% of India’s GDP is envisaged to address seven sectors under ANB Abhiyaan. These include MGNREGS to provide employment boost; increased investments in Public Health; technology Driven Education with Equity post-COVID; Ease of Doing Business; Decriminalization of Companies Act defaults; public Sector Enterprise Policy and increase borrowing limits of States from 3% to 5% for 2020-21 only & promoting State-level reforms.
Although livelihoods, education, business processes, and systems are important, the decision to spring investment in health infrastructure is critical in achieving ANB. COVID-19 has reinforced the need to solve the age-old wicked problem by promoting public health infrastructure and facilities in India. By doing so, it can gain global advantage and reduce domestic vulnerabilities caused due to a perpetual health burden. In 2011, a study by Ghatak and Madheswaran estimated 22 percent as an average annual household income loss due to health reasons. The 60th round NSSO, suggests 63 million people, approximately 12 million households fell into poverty due to health expenditures with an average of 6.2% of all households. In some of the states that are hard hit by COVID, such as Uttar Pradesh, Maharashtra, and West Bengal, over 8% of households were impoverished as a result of health expenditures ( World Bank 2010). And this figure is expected to double due to COVID-19.
While the government has realized the domestic losses due to poor health infrastructure and facilities, what is untenable is as to why India could not produce doctors and paramedics for the world? The current government has envisaged setting up 75 medical colleges by 2021-22. Currently, there are 353 medical colleges in India, out of which government-run medical colleges are 164. Government-run medical colleges cater to 31385 students out of a total of 91490 MBBS students. Preference for government medical colleges is primarily due to the opportunity of experiential learning with a high footfall of patients and low fees in comparison to private medical colleges. The limited colleges are unable to fulfill the irreversible global and local demand. This untapped potential is evident from the number of students who appeared in 2019, which was approximately 1.5 million. What if, India produces 1 million doctors every year? This demographic advantage for India is what the Prime Minister probably meant by vibrant demography in ANB that entails improving lives and livelihoods with limited recurring cost to the government.
What is distinct in ANB is the interrelatedness of health of the individual and wealth of the nation; local versus global consumption and production; and policy versus profit to promote a partnership that will bridge national agenda and social interests. It resonates with what Mahatma Gandhi once wrote in the Ideology of Charkha in 1951, when dependence becomes necessary to keep society in good order it is no longer dependent, but co-operation. Self- reliance or sufficiency does not mean narrowness. In a globalized world to be self-sufficient is not to be altogether self-contained. Further, what he meant while arguing for Charkha and Khadi is incorporated in ANB. Gandhi ji said,I want the concentration of wealth, not in the hands of a few, but the hands of all. Khadi and Charkha in the contemporary world are not products; it’s a process of the wheel that accelerates self-reliance – by creating a balance between production, consumption, and equitable benefits.
More importantly, ANB is a policy window to simultaneously release emotions and realize economic gain. However, to convert ANB into a reality, the government needs to reset its priority for the creation of long term sustainable assets by reducing ambiguity between the nation and the notion of self-reliance.
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