Data updated by the Ministry of Health and Family Welfare on the evening of April 7 indicated that the fatality rate due to COVID-19 in Gujarat is the highest among all states and union territories of India.

The total number of infected persons reported in Gujarat was at 165, with 13 deaths. Thus the fatality rate in Gujarat is 7.88%. The fatality rate of COVID-19 in India as a whole is 2.87%.

The high fatality rate in Gujarat perhaps reflect the alarming conditions of the public health system in the state. There is a need to understand this, particularly since Gujarat has been projected as the model state in the past for India to follow.

It was only after the total lockdown was imposed throughout India that the Gujarat government started the process of reserving hospitals for treating patients with COVID-19 exclusively, procuring 156 ventilators and training its 9,000 health workers to manage ventilators. This lack of urgency reflects the poor condition of public healthcare in Gujarat.

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Gujarat has a legacy of a bad public healthcare system. The four terms of Narendra Modi as chief minister of the state played an important role in creating this legacy.

Modi became the prime minister while flaunting the Gujarat Model of Development (GMD) in 2014. He had been the chief minister (CM) of Gujarat for almost 13 years between 2001 to 2014. Modi’s achievements as chief minister of Gujarat in the field of public healthcare may reflect on his healthcare policy at the Centre, and help us understand his response to the coronavirus pandemic.

Currently, Gujarat has 0.33 hospital beds per 1,000 population. There is only one state that has smaller ration – Bihar. The national average is 0.55 beds per 1,000 population. This disparity between Gujarat and the national average needs to be understood. According to the World Health Organisation, India had 0.70 hospital beds per 1,000 of population in 2011.

Gujarat was ranked 17 among the 18 largest states in India by the Reserve Banks of India in terms of social sector spending. Gujarat was spending only 31.6% of its total budgetary expenditure on the social sector.

In terms of per capita health expenditure, Gujarat’s rank slipped from fourth in 1999-2000 to 11th position in 2009-10. During the same period, Assam improved from the 12th to the third position and Uttar Pradesh from the 15th to ninth position. In 1999-2000, Gujarat was spending 4.39% of its total state expenditure on health, but by 2009-10 this came down to 0.77%.

In terms of health expenditure as a share of NSDP, Gujarat went down from 0.87% to 0.73% between 1999-00 and 2009-10, while the average of major states increased from 0.95% to 1.04% during the same period. Tamil Nadu and Assam almost doubled their expenditures during the same period. This indicates the increasing disinterest of the Gujarat government in public health services.

In 2004-05, when the United Progressive Alliance came to power in the Centre, public expenditure on health as a percentage to GDP was 0.84%. It went up to 1.41% by 2008-09 before being reduced again to 0.98% by the new National Democratic Alliance government (Modi’s first term) in 2014-15. In the current financial year (2020-21), it was set at 1.28%.

Also read: While the World Fights COVID-19, Indians are Busy Communalising It

In Gujarat, Out of Pocket Expenditure on Healthcare (Hospitalisation) in government hospitals is higher than the national average and higher than even states like Bihar. This means those visiting government hospitals in Gujarat have to spend more money from their own pockets than the people in Bihar have to. In terms of per capita spending on medicine, Gujarat ranked 25th in 2009-10.

In 2001, when Modi became the chief minister of Gujarat, the state had a total of 1,001 primary health centres, 244 community health centres and 7,274 sub-centres. In 2011-12, while the number of the primary health centres and community health centres marginally increased to 1,158 and 318, the number of sub-centres remained the same. Even today the total number of primary health centres in Gujarat is less than even Bihar. The total number of public rural hospitals in Bihar is almost three times of the total number of rural public hospitals in Gujarat.

Also read: The Pandemic Should Serve as a Wake up Call to Revamp Public Healthcare

While the world is dealing with the current pandemic, countries across the globe are estimating their strengths and weaknesses, capacity and potential, and deciding on policy accordingly. It is important to identify and understand our vulnerabilities amidst this crisis. India currently has only around 7,13,986 hospital beds and 20,000 ventilators. According to an estimate, around 5 % of those infected from COVID-19 will need ventilator support.

Under these conditions, the moment the total number of infected persons in India crosses four lakh, India will not have enough ventilators for =critical patients. According to an estimate, by May 15, the total number of infected people could reach up to 22 lakh. The estimate from Indian Council of Medical Research and IndiaSim is even higher.

While the situation is scary across the countries, we have to question the model of development we have chosen and where that has left us in times of crisis. And we may have to think about a more sustainable model of development in the days ahead.

Sanjeev Kumar is a senior researcher at Tata Institute of Social Science. He can be reached at subaltern1@gmail.com