Poor state of UP healthcare system: Manpower shortage, lack of health insurance, absence of political will to blame

A probe was recently ordered into reports claiming that 32 cataract patients were operated using a torch light for want of steady electricity supply at a state-run facility in Uttar Pradesh's Unnao. According to the reports, the operations were done at the community health centre (CHC) in Nawabganj on Monday in torch light as there was no electricity or power back-up there.

A video of the mass eye operation cost the top medical officer of the area his job. The patients had been brought to the government hospital in Unnao by a non-profit for free cataract removal surgery.

NDTV reported that such free camps are frequently held but in this case, while the outcome of the operations was not known, there were multiple violations of rules. The video of the operation that was recorded on a cellphone was widely circulated and featured a doctor operating on a patient by the light of a cellphone torch. Another patient was lying on the bed nearby.

 Poor state of UP healthcare system: Manpower shortage, lack of health insurance, absence of political will to blame

Acute manpower shortage, the fact that a vast majority of people do not have health insurance in a country where the public health system has collapsed and a lack of political will to fix the healthcare system has provided space for such tragedies to frequently resurface. Reuters

Nawabganj, like many rural areas of Uttar Pradesh, gets electricity for only 12 hours a day. A five-bed facility, the Nawabganj primary healthcare centre (PHC) took in 32 patients even though it is not equipped for eye surgeries, Hindustan Times reported. PHCs are the cornerstone of rural healthcare that typically have one physician and provide basic care. Reportedly, despite the bitter cold patients lay on the floor for more than six hours after the procedure and were provided blankets and mattresses only after the district magistrate rushed a team of medical officers to Nawabganj. Going against all medical norms, the patients were sent away the next morning. After cataract removal surgery, patients are not allowed to get out of bed for 24 hours. It was also not clear why the patients were operated upon at night — such operations are usually allowed only in the day. Reports said that the organisation, however, was supposed to bring its own generator to cover for any power cut. The Unnao incident, however shocking, is not the first in Uttar Pradesh. On 25 December, reports indicated that ambulances in Meerut were used to ferry liquor and in state-run Lala Lajpat Rai Medical College of Meerut, Russian belly dancers were called to entertain doctors. The incident came to light on Christmas Day, which also happened to be the silver jubilee function organised by the Old School Association which saw several eminent doctors from the 1992 batch in attendance at the college premises, reported The Times of India. A video clip showed an ambulance with registration number UP 15 CT 2860 loaded with cartons of liquor parked in the premises. Bar tenders, including women in Santa hats, are seen serving drinks to doctors. According to sources, Chief Minister Yogi Adityanath severely reprimanded the district magistrate and the chief medical officer. An inquiry has also been ordered to find out if the principal had any role in the incident and a few heads could roll, sources were quoted as saying.

Healthcare has been low on the priorities of successive Uttar Pradesh governments. An Indiaspend report said that the per capita expenditure on health in Uttar Pradesh increased from Rs 260 to Rs 372 over four years to 2010, according to the 2012 National Institute of Public Finance and Policy report, compared to Rs 356 to Rs 580 in Kerala and from Rs 299 to Rs 579 in Tamil Nadu over the same same period. Among the major states of India, Uttar Pradesh, Assam, Madhya Pradesh and Odisha account for the lowest life expectancy at birth, in contrast to the decade-long progress evident in most southern, western and eastern states. What are the reasons for Uttar Pradesh's poor healthcare record? A combination of several factors, such as a shortage of healthcare professionals, increasing cost of healthcare, the mushrooming of private healthcare and a lack of planning. A third of the rural population in the state has been deprived of primary healthcare infrastructure, according to the norms of the Indian Public Health Standards (IPHS), which sets infrastructural and human resource standards for public health institutions in India. Uttar Pradesh requires 31,037 sub centres, 5,172 PHCs and 1,293 CHCs to meet the healthcare demands of its population. But the state is 33 percent short of sub centres and PHCs and 40 percent short of CHCs, according to RHS-2015 data. This shortage of public healthcare institutions further impacts the implementation of centrally sponsored health programmes, which in turn, require an effective network of public health institutions. Successive state governments have failed to plan, prioritise and understand healthcare needs.  

Source:Rural Health Statistics (RHS), 2015

  Over the past nine years, Indiaspend reported, there has been almost no upgradation of institutions offering basic healthcare. No more than four of 773 CHCs are adequately staffed and serviced with drugs and supplies, according to this 2015-16 report of the National Rural Health Mission (NRHM); 467 CHCs did not have minimum infrastructure and staff. Medical and paramedical staff–in short supply across India, as IndiaSpend reported, are in particularly short supply in Uttar Pradesh, especially the rural areas.

Source: Compiled from Rural Health Statistics-2015


Gorakhpur tragedy taught UP nothing

In August this year, the Adityanath government was facing a major crises when more than 30 children died within a span of 48 hours at the government-run Baba Raghav Das (BRD) Medical College hospital in Gorakhpur. The tragedy took deaths due to shoddy healthcare in the state to 1,304 in 2017. College principal Dr PK Singh said, "On 31 August, 16 children died, while on 1 September, 19 others died in the NICU, general and encephalitis wards of the hospital."

Initial media reports had claimed that a disruption in oxygen supply led to the death of the children, however, the state government, as well as the district administration, have denied those reports.

According to Hindustan Times, the oxygen supply at the medical college was allegedly stopped after the suppliers’ bill of Rs 67 lakh was not cleared. The medical hospital is largest in the Gorakhpur region and also Adityanath's former parliamentary constituency.

The Indian Express reported that Gorakhpur has seen at least 114 deaths due to Acute Encephalitis Syndrome (AES) in 2017. The Chief Medical Officer (CMO) Gorakhpur, Ravindra Kumar was quoted as saying, "The Case Fatality Rate (CFR) last year was more than 20 percent and this year we have reduced it to 16 percent. In 2015, the CFR was somewhere near 30 percent.”

However, the deplorable condition of healthcare system in Uttar Pradesh is not about oxygen cylinders and unpaid bills. India's abysmally low public spending on healthcare is at the root of the problems. Livemint report said, "Public spending has increased but only marginally over the past two decades—from 1.1 percent of gross domestic product in 1995 to 1.4 percent in 2014. The infant mortality rate in India in 2015 was 38, according to the World Bank — far better than the 165 in 1960 but lagging comparable countries such as Bangladesh (31), Indonesia (23) and Sri Lanka (8). And the situation in even worse in some large states such as Uttar Pradesh, where around 50 out of every 1,000 children die before they reach the age of five."


Source: Compiled from Health in India, NSS 71st round (January to June 2014)


Acute manpower shortage, the fact that a vast majority of people do not have health insurance in a country where the public health system has collapsed and a lack of political will to fix the healthcare system has provided space for such tragedies to frequently resurface. In India, the private healthcare system now provides two-thirds of medical treatment, according to the April 2016 Health in India report from the Ministry of Statistics and Programme Implementation.

In Uttar Pradesh, private health providers — including unrecognised doctors and quacks — meet 85 percent of medical needs, according to the report. It appears that the people of Uttar Pradesh have two choices: An inadequate, inefficient public healthcare system and a private healthcare system offering low quality and expensive services.

Currently, the state relies on a public healthcare infrastructure that is two decades old. A fifth of the population deprived of healthcare cannot contribute to the social or economic growth of the country.

With inputs from Indiaspend and agencies

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Updated Date: Jan 12, 2018 14:06:45 IST