“If the officials had disclosed information about the epidemic earlier, I think it would have been a lot better. There should be more openness and transparency” – Dr. Li Wenliang (1986- 2020) in an interview to New York Times

Gopichandran and Subramaniam in their editorial in IJME have appreciated the intensive Chinese efforts to contain the Covid-19 outbreak and wondered if other “weak” and developing health systems will be able to do the same (1). In a section of their editorial, “Strengthening health governance and law”, they appreciate the efforts of authoritarian state China to make mass quarantine possible. They go on to write, “A mass quarantine of the proportions seen in China is very difficult to achieve in India”. While everybody should get appreciation when it is due, if we don’t distinguish between different components of a system, our conclusions may not be correct. Here we need to distinguish between China’s authorities and its healthcare workers.

The WHO Chief praised Chinese authorities at the end of January (2) and that may have inspired the authors to note it in their editorial. But we need to realise that that claim has been questioned by many (3, 4). Moreover, the memory of Dr Li Wenliang should haunt us if we believe such claims. The brave doctor tried to raise awareness about an emerging infectious disease in his closed group to warn others to protect themselves. In response, he was silenced by the authoritarian State (5), after which he kept on working in hospital, contracted the same infection and then succumbed to it. All of us need to draw some courage and inspiration from his heroism. Besides, a careful analysis of the situation may bring us some new and useful insights

Healthcare reforms introduced in China since 2008 have transformed its delivery system (6). Scholars at the Harvard School of Public Health emphasise China’s efforts to make extensive primary care system available to the masses. A World Bank graph depicting rising life expectancy at birth of the Chinese population shows a steady improvement in this century (7). A plateau in the latter part of the last century is attributed to the government’s efforts then to privatise the healthcare system before that. Hence it would be preferable to appreciate authorities only when it is deserved. The irony is that while China is reaping the rich dividends of its early and substantial investment in public health, our Government is privatising its public services at a rapid pace. Right now, it is planning to give its district hospitals into private hands (8). Hence we need to introspect and carry out a course correction here. We earnestly urge our policy makers to learn from China on how, by expanding Universal Health Care, one can achieve a healthy population─ and healthy workers─ who can fuel the economy by providing a strong labour force.

The authors of the editorial also discuss the issue of strengthening human resources in healthcare. Although we agree with what they suggest here, something which is of more importance is the regularisation of the workforce. At present, the National Health Mission, the backbone of our system, runs on contractual employees as described by Bahadur in this journal (9). As permanent employees don’t attend their duties regularly, our government plans to hire contractual employees. But that is not a fair solution and will throw up other challenges which need proper redressal. Our former RBI Governor Raghuram Rajan has suggested a solution. As contractual workers live under the constant threat of termination, he advises longer term contracts and increased severance pay (10). We believe that the ASHA workers– serving in remote rural areas — deserve a much better deal from our system (11).

Covid 19, like MERS, Ebola, SARS, bird flu, and swine flu, may appear like an effervescence, and then rapidly disappear. But it has made an indelible impression on our collective consciousness. Therefore, we need to appreciate the shortcomings of an authoritarian regime, along with its strengths, if any. We should also bow to our unsung and unknown heroes; defend the interests of our workforce, and at the same time, be ready to accept our faults, in order to make a rapid course correction. These are times when humility, truthfulness, the courage to speak truth to power, and the generating of a feeling of global fraternity are the best virtues.