Barely a day before India celebrated 70 years of its Independence, every Indian was shocked to hear about the sudden death of more than 70 children in Gorakhpur in Uttar Pradesh. There were reports that the children died because oxygen supply was stopped by the vendor as the government had not paid its dues.
Some other media reports suggested that the children were suffering from brain fever or encephalitis, a kind of fever caused by bacterial infection. Of course, politicians, especially from the Opposition, came down heavily upon the government. State health minister Sidharth Nath, instead of finding out the reasons and springing into action, came out with figures labelling the incident as normal in UP.
“Seven deaths on an average per day in this hospital is normal. This is after all a major hospital in Gorakhpur, so obviously people from all over, and from the primary centres, land up here on referrals. Hence numbers of deaths are normally in this range,” he said. The minister might have thought that the figures he quoted might act as a face-saver for the government that announced the formation of a high-level committee to investigate the matter, thinking that people and media would spare it.
There were heroic stories about a doctor who supplied oxygen when the hospital had no supply. The messiah soon turned out to be a villain when it was revealed that the doctor was having a private clinic from where he sourced the life-saving gas. While all this melodrama continued, children kept on dying. The government suspended the medical college chief. What else could it do to comfort the agitating parents and their relatives?
The high-level committee submitted its report on August 22 and it found six officials, including the college principal, responsible for the tragedy. The government said that cases shall be filed against those found guilty under Section 304 (culpable homicide not amounting to murder) of the Indian Penal Code (IPC). Hopefully, the court will do justice. But will this put an end to the horrifying tale?
Studies reveal that UP has the highest infant mortality rate (probability of a child dying against 1000 live births) of 64. The under-five mortality rate is 78. During the last 15 years, the population of the state increased by 25 per cent and the core health facilities for the general public fell by 8 per cent. A recent study conducted by a Tata Trust and the Poorest Areas Civil Society shows that the age of a new-born child in UP is four years less than the neighbouring state of Bihar, five years less than Haryana and seven years less than Himachal Pradesh.
Leave UP, the country, as a whole, has no different tale to tell. No doubt, it has come a long way over the last 70 years but we are the worst amongst BRIC nations in terms of under-five child mortality rate. A report shows that we lost 1.08 million children below the age of five in 2015. On an average, it comes to 2959 deaths a day or two each in a minute.
Child mortality is considered to be the index of health of a nation. When the economy registered the highest growth in the last five years during 2015-16, India still had a child mortality rate of 43. And the reason for these deaths remains the same even after 70 years of freedom. Fifty-three per cent of the neonatal deaths took place due to pneumonia, diarrhoeal diseases, measles etc. More than two-thirds of these deaths take place in the very first month of a child’s birth.
While India flaunts its state-of-the-art health facilities and “cutting-edge” technology for not only treatment of diseases but also diagnosis, it has one of the worst health-care facilities in the rural areas. It is a pity that while a US national came to India for weight-loss surgery, children in UP died a silent death struggling to get the last ounce of life-saving oxygen. Another lady from Poland started walking 24 hours after her spine surgery in India but the UP government could not control child-deaths after the first 23 children died on August 10.
The World Bank estimates India’s expenditure on health at Rs. 37061.55 crore which is only 30 per cent of what China spends. The out of pocket expenses (OPE) on healthcare by citizens is one of the highest in the world. The high-level expert group formed for the purpose of reviewing Indian healthcare facilities has emphasised that the country must increase public expenditure on health from 1.2 per cent of its GDP to at least 3 per cent by 2022.
The world health organisation (WHO) has stated that while every country has financial constraints to increase expenditure on health, every nation can do more with the existing resources. In other words, the current resources that are deployed in the health sector need to be utilised efficiently. The Centre for disease control, Atlanta, says that around 50 per cent of the antibiotics are prescribed unnecessarily or are used inappropriately.
A substantial part of the budget allocated under the National Rural Health Mission (NRHM) is either not drawn by the state governments or is not used efficiently resulting in high OPE, increasing financial stress on the common man. As far as medical insurance is concerned, China has covered more than 95 per cent of its population. The National Health Assurance Mission (NHAM), aimed at providing health insurance to everyone, has not been rolled out till now. And it has been in the news since 2014. Hopefully, it will be functional or at least formed by 2019 when the government would want people to vote again for Modi sarkar.
A recent study conducted by the Tata Institute of Social Sciences (TISS) estimated that only 5 per cent of the households in India are covered under some kind of health insurance. The biggest service provider is Employees State Insurance Scheme. More than 90 per cent of the Indian workforce is deployed in the informal sector.
As facilities like insurance is given to those who work in the formal sector, a majority of the households remain out of its purview. Inadequate health care facilities, coupled with a highly privatised health sector, further worsen the financial status of the poor and marginalised groups. In other words, OPE on health is one of the prime reasons that push a major chunk of the population below poverty.
The existing health insurance, mostly provided by private players, only takes care of the hospital expenses, that too in certain cases and for certain diseases. It also depends on the kind of premium a person has paid. Certain facilities are available only if a person has spent more than Rs. 2000 a month on premium, which certainly a low-income family cannot afford. Family health insurance is way too expensive.
In a country where pizza gets delivered in guaranteed 30 minutes, there is no guarantee that the patient, who is on the verge of death, would reach the hospital in time. Even if he/she is able to reach the hospital, there is no guarantee that person will get a bed and proper treatment! It is a pity that it took 15 years for the government to announce a national health policy. And it took more than six decades to think that the country must have a national health insurance.
Modi did mention about the Gorakhpur incident in his address to the nation on August 15 and mollified people by saying that the entire nation was with the aggrieved families. Yes, every Indian shares their grief but is the government really with us? Or is it with a few elite, who can afford the world-class health services in the cities?
(The writer is a company secretary and director communication, deepalaya and can be reached at firstname.lastname@example.org)(Published on 28th August 2017, Volume XXIX, Issue 35)