Understanding the Context of Global Health Policies: Their Post-Colonial

The systemic inadequacies of models of health systems propagated by the advocates of global health policies (GHPs) have fragmented health service systems, particularly in middle- and lower-income countries. GHPs are underpinned by economic interests and the need for control by the global elite, irrespective of people's health needs. The COVID-19 pandemic challenged the advocates of GHPs, leading to calls for a movement for "decolonisation” of global health. Much of this narrative on the "decolonisation” of GHPs critiques its northern knowledge base, and the power derived from it at individual, institutional and national levels. This, it argues, has led to an unequal exchange of knowledge, making it impossible to end decades of oppressive hegemony and to prevent inappropriate decision-making on GHPs. Despite these legitimate concerns, little in the literature on the decolonisation of GHPs extends beyond epistemological critiques. This article offers a radically different perspective. It is based on an understanding of the role of transnational capital in extracting wealth from the economies of low- and middle-income countries resulting in influencing and shaping public health policy and practice, including interactions between the environment and health. It mobilises historical evidence of distorted priorities underpinning GHPs and the damaging consequences for health services throughout the world.

COVID’s Effect on India’s Health Services: A Commentary

Using a comprehensive framework (the state’s will to deliver, its institutional strength and its legitimacy), this article assesses the impact of the COVID-19 pandemic on public sector healthcare services in India. The power to deliver was explicit when the interventions were harsh, increasing the burden of death and disease on health services. But when it came to healthcare by the public sector we find a worsening of achievements of non-COVID ailments during the pandemic and an inability to tackle the second wave due to gaps in the nation's infrastructure, a centralised control undermining state authority;and visible results of a flawed policy that pushed further the agenda of making healthcare a profitable business.

COVID-19: Beyond Biological Dynamics

In the absence of specific drugs and vaccines, precautions at the personal level (hygiene, maintaining physical distancing and so on), people?s participation in population-level interventions (such as sharing scientific information, case-tracking and strategic area-specific lockdowns) and health service system preparedness are three key available measures against the COVID-19 pandemic. However, the necessary ingredients for these three measures are missing? induced by poverty and structural inequality;lack of people?s trust and a crippled public sector in health with a low resource base;shrinking, fragmented and weakened infrastructure that has lost on inter-institutional referral links and monitoring and surveillance systems. Not only has an ill-planned lockdown crippled an already struggling economy and depleted health systems and overshadowed containment efforts but the time has not been utilised to strengthen primary health care (PHC) services and secondary and tertiary public sector healthcare infrastructure. A phased relaxation of the lockdown with a comprehensive fiscal stimulus to jump-start the economy, coupled with the strengthening of health systems that put the needs of the poor at the forefront, is suggested.