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Kota Shows Pitfalls In Healthcare

Kota Shows Pitfalls In Healthcare

The death of over 100 infants at the Government run JK Lon Hospital in Kota, Rajasthan is a cause for serious concern.

While a high-level central team from Delhi will assess the infrastructural gaps and suggest remedial measures to be taken for preventing further deaths, a preliminary probe seems to suggest that besides paucity of staff, over 70 per cent of the essential equipment in the hospital like infusion pumps, warmers, oxymeters, nebulisers -- all meant for new-borns -- were not in a working condition.

Amidst political backlash, according to State Government figures, child casualties in Rajasthan have reduced to 963 in 2019 from 1,260 in 2015 and 1,193 in 2016.
It is not just in Rajasthan, last June, the death of over 90 children within a month in Bihar’s Muzaffarpur’s government-run Sri Krishna Medical College and Hospital due to encephalopathy which according to health practitioners could have easily been prevented with some foresight and early care.

Similarly, deaths of a large number of children in Uttar Pradesh due to acute encephalitis syndrome between August 10 and 11, 2017 at the Baba Raghav Das Medical College, a major referral hospital in Gorakhpur, had jolted the conscience of the nation.

India has one of the largest public health systems in the world and the history of health services development takes its roots to the Bhore Committee, set up in 1943 by the Viceroy of British India to assess the health conditions of the population and to come up with a blueprint for health service development. Accordingly, a three-tier structure consisting of primary, secondary and tertiary levels of care came into existence. Each of these levels had a specified role for health service provisioning and would support each other through a referral system.

There is much debate about the current status of India’s healthcare, which is a State subject. Reportedly there is one government allopathic doctor for every 10,189 people, one government hospital bed for every 2046 people and one state-run hospital for every 90,343 people.

According to an official statement published in the August 8, 2019 Times of India, “there is a huge skew in the distribution of doctors between urban and rural areas with the urban to rural doctor ratio being 3.8:1. Consequently, most rural and poor population is denied good quality care leaving them in the clutches of quacks.”

The existing health is by and large in pathetic condition. Despite budgetary allocations and purchase of equipment, many of them are not properly maintained.
Government hospitals often face the problem of lack of resources and infrastructure. There is inadequate number of beds, rooms and medicines. It is rather appalling that deaths of many a new born has been reported even in the neonatal ICU. Primary health centres are supposed to work round-the-clock; but how many of them really do so? In several places, there is only one special care new born unit to treat sick infants for an entire District.

Also, many patients who can be treated and cured at PHCs and secondary clinics are routinely sent to bigger hospitals leading to avoidable overcrowding. Due to this reason, it is not uncommon for more than one patient to share a bed. To overcome shortage of staff, adoption of knee-jerk measures often compounds the situation.
For instance, in some government hospitals, with posts of paediatrics remaining unfilled, doctors are posted from medical colleges on an adhoc basis, while support staff like nurses and pharmacists are appointed by the health department, leading to a lack of coordination.

Survey after survey has pointed out that underage mothers stand less chance of carrying their babies to full term. Also, a leading cause of infant mortality is due to complications arising from premature birth, which makes babies more susceptible to infections. The 2018 Economic Survey put the number of “unwanted girls” born to parents trying to have boys in India at 21 million. The trend of weaning them off earlier so that their mothers can have children again has to be broken.

More so because the country’s population is expected to exceed that of China’s by 2027 and it is projected that nearly 273 million people will be added between 2019 and 2050. The need to get cracking is all the more important because the Government is struggling under a health care burden and a whopping 25 per cent of our people are living on less than Rs 143 a day. Although the role of private players is increasing in healthcare sector, simultaneously healthcare facilities are also getting costly making it beyond the reach of the poor.

A comprehensive strategy is essential to deal with healthcare challenges. As infrastructure is the basic support for the delivery of public health activities, it is important to adopt an integrated approach to strengthen the health infrastructure in the right earnest. Besides a skilled workforce, developing a real time health information system, reduction of medication errors and improvement of clinical effectiveness is equally important.

(Published on 06th January 2020, Volume XXXII, Issue 02)