At 5 pm on 29 March the union health ministry’s website said that India had 869 positive COVID-19 cases, spread over 26 states and union territories. Seven days earlier, Prime Minister Narendra Modi had announced his main attempt to halt the spread of the pandemic: an unanticipated 21-day nationwide lockdown. Amid rising concerns of shortage of essential equipment and services in public hospitals for front-line staff dealing with the epidemic, the sudden lockdown exposed other faultlines. It forced thousands of migrant labourers to walk hundreds of kilometres back to their hometowns and villages. In the preceding days, several reports had emerged of private hospitals having turned away patients showing symptoms of COVID-19, including the first victim of the disease in the country. Though the union health ministry issued an advisory that no suspected COVID-19 patient could be refused, such reports, of private hospitals denying patients care, continued to emerge. Experts I spoke to have raised concerns about another worrying aspect: India’s shift towards a privatised model of health insurance in the past few decades, they said, could mean that many, especially the poor, will be left without access to free healthcare in the pandemic.
Dr T Sundararaman is a former dean of the School of Health Systems Studies at the Tata Institute of Social Sciences and a global coordinator of the Peoples’ Health Movement—a global network of grassroots health activists. He said, “India’s weakened public health infrastructure is unprepared for the COVID-19 pandemic.” Sundararaman said that the lack of supplies illustrates how “the neglect of a robust public-health system in favour of privatised, insurance-led healthcare has weakened India’s ability to deal with a national health emergency.”