On August 4, the Principal Director, Department of Health & Family Welfare, issued an Advisory, published in all local newspapers on August 5, which sounds very good benevolent on the face of it. However, what happens when healthcare workers of Government designated COVID Hospitals do not follow the Advisory ~ as there are several instances when people have lost their lives due to such refusals? In fact, why this Advisory so late in the day? Clearly, it has been issued after several instances of people losing their lives due to refusals to admit and/or treat them ~ as published in local newspapers. So, this Advisory once again reiterates how terribly unprepared our Government healthcare delivery system is to fight the Coronavirus pandemic. Indubitably, it was never a matter of the state Department of Health & Family Welfare losing the plot ~ right from the beginning, it had no plot.
This Advisory basically says: “No serious patients should be turned away for want of COVID test report” ~ “subject to availability of beds”. Now, if a serious/critical patient is turned away from any health institutions (public and private) on grounds of unavailability of beds, on what basis can the patient’s family assume it to be a fact? However unpalatable, it is also undeniable that the credibility of the Department ~ particularly in Dimapur ~ has descended to an all-time low particularly after the detection of positive cases in late May. Not without reasons though ~ the very fact that the Advisory doesn’t address the numerous complaints of refusal to test and of failure to issue the test reports, if a person is tested, says volumes. Then there are numerous instances of people stuck in quarantine centres for almost two months, or more, because their tests have not been done or the failure to issue their test reports. Reportedly, swabs have also been misplaced. The efficiency of this Department then definitely comes into question.
In the Advisory, the Principal Director also cautioned: If there is any denial of treatment to any patient for want of COVID test report, appropriate action would be taken against healthcare worker(s) or hospital(s) as per the law. So, what investigations and “appropriate action” have been initiated against healthcare worker(s) or hospital(s) that have denied treatment to patients for want of COVID test report so far? Two deaths at Dimapur have already been widely publicized for denial of treatment recently. Yes, Dimapur’s CMO and Civil Hospital’s MS have been transferred. But that’s neither here nor there because transfers and postings are a part of Government service and we don’t know why these two health officers have been transferred. Transfer can also hardly be called “appropriate action”. Dimapur’s Deputy Commissioner has been transferred recently too. It’s no big deal because no Government servant can expect to be posted in one place forever ~ although there are innumerable instances of that happening ~ reportedly including in the Civil Hospital, Dimapur. The issue here is it’s no point “cautioning”, if that is not made good. Government “cautioning” its employees or anyone without making good its word is a decades-old stale joke. So much for accountability!
Talking of accountability ~ it should start with the Health Minister. The very fact that particularly in Dimapur the Government healthcare delivery system has been working in an undisciplined manner ~ to put it mildly ~ speaks for how much in control, or not in control, our Health Minister is of the very vital Department he heads. The thing about heading/leading a Department or any agency or institution is that he must not only take the bouquets but also the brickbats. The buck must stop with him. Responsibility always accompanies power. In fact, in governance, power is delegated to shoulder responsibility ~ not for the pelf it is associated with. So, our Health Minister must take responsibility for the almost broken down Government healthcare system in Dimapur and directly speak to the public on the matter, instead of delegating Government employees, irrespective of ranks, to do that ~ especially because majority of the public aren’t on Twitter.
Now, I also like the Principal Director’s not-so-subtle attempt to co-opt private health facilities when he addresses the Advisory to “COVID Hospitals and all health institutions (public and private)” ~ however late in the day. I particularly like the “(public and private)” part because it appears to be the state Government’s oblique way of finally co-opting private health facilities in Nagaland’s fight against the pandemic. See, it’s like this ~ from the start, our Government didn’t include our private health facilities in the COVID “war room”, literally and figuratively. Our Government’s focus was on specific Government Hospitals, which were designated as COVID Hospitals ~ and which had very limited ICUs, number of beds, ventilators and other requisites in them. Now with the number of positive cases increasing, and worse still deaths due to its failure to admit and treat COVID-suspected cases, the Government has no option but to co-opt private health facilities. Besides, our Government healthcare delivery system has only this many health workers and quite a few of them are reportedly either under quarantine or COVID treatment. Moreover, a good number of them also have to be assigned for non-COVID health issues of the public.
Somehow, it appears that our Government failed to take into account the probability and possibility of a high number of COVID cases in ratio to and commensuration with its healthcare delivery system’s capacities and capabilities. It probably hoped for the best but didn’t prepare for the worst. So, now our private health facilities have to be co-opted to fight the pandemic. But there is the issue of funds. Our private health facilities also have only limited financial strength ~ especially in terms of purchasing COVID-testing equipment, setting up ICUs, isolation wards and the requisite paraphernalia, as also the technicalities and legalities involved, besides COVID-specific trained human resources. If right from the beginning, our Government had faced the fact of its woefully inadequate health delivery system and human resources and had co-opted our private health facilities, especially in terms of sharing and allotting the Central funds meant specifically for the pandemic, by now Nagaland would have been confidently on our way to a robust public and private healthcare system to fight the pandemic ~ and probably no lives would have been lost. But for whatever reasons, our Government seemed to believe it could deal with the pandemic all on its own by over-estimating its capacities and competence and in the process lost precious time and human lives. As for funds, we don’t know whether they too are lost or have found their way to some “protected” pockets.
While any Government has the mandate to regulate, advice, instruct, direct or order private health or education or any other private facilities, enterprises, agencies, institutions, etc., it is difficult for the private health sector to unthinkingly follow Government advisories willy-nilly at the drop of the hat in the middle of a pandemic. The private sector, in any field, doesn’t work and operate in the ways of Governments. Moreover, the whole thing once again underscores the reasons for the growth of a vibrant private health sector in a small state like Nagaland, which has seen no dearth of Central funds for our Government healthcare delivery system. This, by no means, is the last word on the issue. Meanwhile, it would serve our Government well to contemplate on why a lot of our Government doctors also have one leg firmly in the private health sector. And, the Government’s contemplation on this is crucial ~ pandemic or no pandemic ~ because it also boils down to the issue of Central funds for public health in Nagaland ~ an issue uppermost in the people’s mind. Tied to this issue is also the circular issued by the recently-transferred former MS of Dimapur’s COVID Hospital on July 30 last, entitling health workers on COVID duty only Rs 300 per day for diet, which Nagaland Page had highlighted on August 3. If the Dimapur’s COVID Hospital and by extension the state Health & Family Welfare Department does not take care of its own, would it take care of the public? If the Department doesn’t allot funds for its own workers, would it expand funds for the public and public health?