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Every Body Counts


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Medical professionals in India, as elsewhere, defended their communities with their bodies. With only reused and often ill-fitting masks, and without the protection of vaccines for the first twelve months, nurses and doctors reported to work every morning, risking their own lives and the lives of the families they returned home to. This commitment to their vocation could not compensate for decades of neglect and poor public sector investments in health. 

In 2020, India’s health expenditure ranked 179th among all countries, at 2.96 percent of its GDP. Poor infrastructure, lack of accountability, and a fragmented healthcare system with little oversight, resulted in gross mismanagement, with wanton prescription of drugs unwarranted for COVID-19 care. Several academic and state institutions failed the profession by continuing to promote, and even distribute en masse, deworming medications, spice mixes and expensive drug regimens that most Indians could ill afford. 

The overwhelming majority of Indians (with a median age of 32.4 years in 2020) would require no treatment for COVID-19 except for supportive care. The stigmatization created by the public identification of COVID-19 positive households, the fear of being whisked away to hospitals and quarantine centers, and the terror of watching patients lie on sidewalks desperate for hospital beds led to mass panic. Those with means inadvertently drove up prices for drugs and beds, created shortages, and risked financial ruin for the masses. In our survey, healthcare expenses were the second most common reason (after food) for people to use up their savings or sell assets. 

The public health profession has long recognized that social determinants drive health outcomes. In the United States, race, poverty and age are key mediators. The differential access to care in India across class and caste divides could not be obliterated by the herculean mobilization of oxygen cylinders and the rushed building of new hospitals and ICUs. SEWA’s five-decade long investments in their communities allowed them to mount a response on multiple fronts to protect their members. 

In 2020, in response to the lockdown SEWA launched a telemedicine consulting service free of charge for all their members. A massive awareness campaign was launched to educate members about physical distancing, masking, and hand hygiene. SEWA leaders would go to the dairies, milk collection centers and street markets where their members worked to help enforce physical distancing and masking. They partnered with Yale University researchers to test the efficacy of their masking awareness programs. In 2021, SEWA converted 11 of their existing community centers to COVID-19 Care Centers to provide members - most of whom lived in dense housing -  safe and trusted spaces to quarantine.


















Karthik Garish (Visualization)
Kartikeya Bhatotia (Research)