Economist and the US Ambassador to India John Kenneth Galbraith had once called India ‘a functioning anarchy’, way back in 1958. He wanted to attribute the salient journey of the country not to the government but to the common people. Since then, a lot of water has flown down the Ganges, however, the observation of Galbraith is still worth examining vis-à-vis Indian governments and institutions, particularly when the country is facing its worst health crisis post-Independence.
The massive second wave of COVID-19 in April-May has proved to be devastating for the entire country. The frequent observations of different high courts and the Supreme Court on the functioning of union and state governments, seeking details of the nitty-gritty of COVID management, revealed stunning and astonishing facts. The Delhi High Court while issuing scathing remarks over dealing of the COVID situation and shortage of oxygen said—“You can put your head in sand like an Ostrich, we’ll not.” Delhi government further got an earful from the high court, which observed that the existing medical infrastructure in Delhi is in “complete shambles” and exposed when put to test. The stories of mishandling and mismanagement of the COVID situation by governments are numerous. The causes of failure to pre-empt and prepare for this catastrophe are numerous too. But, above all, the complacency and lackadaisical attitude of the state governments in ramping up medical infrastructure seems to be the root-cause for the loss of countless lives.
The federal structure is one of the basic features of the Indian Constitution. The provision of a separate state list, under 7th Schedule of the Constitution, has strengthened the case for federalism. Entry 6 in List-II of the 7th Schedule gives exclusive jurisdiction to states over “public health and sanitation; hospitals and dispensaries.” Thus, providing health facilities—hospitals, dispensaries and health centres—is one of the primary responsibilities of the state governments. The current crisis and mismanagement show abysmal failure of the state governments to handle the pandemic. Challenges and shortcomings have persisted in almost every state. It seems that either the state governments have miserably failed to cope with the crisis, or they did not show keen interest in visualizing the impact of the pandemic on people.
During the second wave, the demand for medical oxygen multiplied manifold. The acute shortage of hospital beds for patients has exposed governments’ preparedness. In the national capital itself, patients and their kin have been desperately looking for hospital beds during the peak of the second wave. Medical-grade oxygen is directly under the control of central governments, but state governments failed to envisage the actual requirement of this life-saving commodity. Instead, they tried passing the buck to the central government to cover-up their inefficiency and mismanagement.
There was neither sufficient number of cryogenic oxygen tankers to transport the allotted medical-grade oxygen from the eastern and western parts of the country nor sufficient storage capacity in several states. The paucity of oxygen cylinders was another remarkable shortfall, resulting in large-scale hoarding and black marketing. The legal battle between the central and state governments in Delhi High Court over availability and responsibility to provide oxygen to Delhi is nothing but a cop-out by the latter from its constitutional responsibility. The government in Delhi has failed to set up even a single oxygen plant of the eight sanctioned by the central government under the PM Cares fund since December 2020. The demand for oxygen by the Delhi government kept fluctuating from 700 MT to 900 MT and finally came down to 582 MT when the Supreme Court constituted a high-level audit committee to scrutinize the actual requirement of oxygen in Delhi.
The pinch of shortage of basic medicines like paracetamol, vitamin tablets, fabiflu, favipiravir and injections like Remdesivir were felt by the common people in Delhi and other states. The black-marketing and hoarding of Remdisivir, oxygen cylinders and oxygen concentrators became common. A number of black marketeers and hoarders have been arrested. The arrest of restaurant chain Khan Chacha’s owner, Navneet Kalra, in Delhi for hoarding and black-marketing oxygen concentrators is just the tip of the iceberg. States governments have performed poorly to stop these vultures and black-marketeers from profiteering in these difficult times.
A shortage of ventilators was pre-empted and the union government allocated ventilators to states and Union Territories under the PM Cares funds. The union health ministry has tripled the availability of critical care machines in government hospitals from mere 16,000 in pre-COVID period to around 60,000 now. Almost 43,800 ventilators were delivered to the states and UTs in the last one year. However, some states like Punjab, Rajasthan, Bihar, Uttarakhand, Karnataka, Uttar Pradesh and Odisha couldn’t fully utilize these live-saving machines in the hour of crisis. Punjab and Rajasthan complained that the machines were faulty. In Punjab, 285 of 320, in Rajasthan 1,400 out of 1900, in Karnataka around 1,600 out of 2,025, in Bihar 47 out of 109 ventilators were non-functional because of excuses like lack of trained manpower, shortage of medical consumables and fear of malfunction. The dilly-dallying approach of these state governments can only re-confirm the sheer failure of the institutional machinery of the state governments.
It is easier to lay one’s own inaction, inefficiency and fecklessness at the door of the central government, but under the constitutional provisions, the accountability of state governments to people’s health is inexcusable. Blame-game is not the solution. The constant intervention by the judiciary, the outcry by media and the enraged public opinion are enough to support the view that ‘functional anarchy’ still prevails. The only panacea for the pandemic is—follow the principle of Nation First.