Where is the transparency in India’s health governance?

The management of COVID-19 outbreak in India has raised many governance questions. Frequently revised guidelines, unclear instructions and inadequate policy briefings have impacted the delivery of healthcare and containment of the disease. The hard work of frontline workers and the healthcare professionals in executing the containment measures at the ground level becomes ineffective in the absence of proper planning at the top level. The actions taken by the government need to be communicated to its citizens explicitly and need to be backed by strong and transparent public health laws, so that the COVID-19 crisis and the public health system at large, are better managed.

One of the issues with India’s health governance that has come to surface in the light of the COVID-19 crisis is the overlapping of functions of different institutions. As per the Indian Council of Medical Research’s response guide to COVID-19, it is responsible for approving, procuring and distributing testing kits. However, the mandate for these functions lies with the Central Drugs Standard Control Organisation. ICMR’s mandate states that it is also involved in the investigation of outbreaks and development of tools for prevention. These are public health functions which should not be the responsibilities of a biomedical research organisation and ideally, should be carried out by Integrated Disease Surveillance Program. There is no clarity provided by the government on why a biomedical research organisation is heading the management of a public health crisis whereas organisations like National Centre for Disease Control or IDSP are in the shadows.

Communication is one of the key aspects of transparency. In Taiwan, the health minister addressed the citizens daily through televised media briefings, during the initial period of the outbreak. The way New Zealand’s Prime Minister addressed its public is praised worldwide, as she was clear about what the situation is and why it demands a stringent lockdown. New Zealand’s government also kept its citizens updated regularly by disclosing what threat level they were at and what actions were taken at that level. India’s Kerala is also an example of good practices when it comes to crisis communication. After each evaluation meeting, Kerala’s health minister made media appearances notifying its people about the status of the situation and assured them so they do not panic. In India, when announcements for various versions of lockdowns were made at the national level, the information for each one of them was withheld till the last moment which led to panicking among citizens and businesses. Withholding information in crucial times can lead to confusion and result in lack of trust in the government.

Another issue that India’s health governance faces is the lack of strong laws that protect the health of the population. According to a study conducted by Monica Das Gupta and Manju Rani (2004), there is no transparency in auditing the implementation of public health laws, as the Indian government does little to include non-government stakeholders in the evaluation process. There is also no attempt to update the existing laws, to suit the evolving situation. For example, the Epidemic Diseases Act, 1897 is not at all comprehensive and does not even attempt to define the term ‘epidemic’. The Act places all the power in the hands of the Union Government without any accountability mechanisms, which can lead to misuse of the authority with no platform for others to question it. The shortcomings of the Epidemic Diseases Act, 1897 had to be compensated as states of India passed their own regulations to manage the COVID-19 outbreak.

India’s health governance needs a revamp that will address the above mentioned lacunae. Each of its organisations and departments needs a clearly defined mandate and it should be ensured that they do not overstep it. A biomedical research organisation like ICMR leading the fight against COVID-19, when there are public health agencies like NCDC and IDSP will lead to less focus on the public health agenda. The management of the public health crisis needs to be backed by strong laws and regulations. Lack of transparency and accountability mechanisms make it difficult for citizens to trust its government and actively participate in the management of crisis. Thus, it is essential for India to make some big changes to the way it addresses the public health issues through legal and executive framework.