UP healthcare crisis Part 1: Chronic shortage of doctors, overdose of apathy have left govt hospitals comatose

Editor’s note: Uttar Pradesh had been in the grips of a healthcare crisis long before Gorakhpur and Farrukhabad put the spotlight on the state’s ailing public health system. The state’s infant mortality rate is comparable to that of strife-torn African nations. There is one doctor for every 19,000 people; according to WHO, there should be one for every 1,000. This is the first of a four-part series that explores the state’s policy-paralysis and places it against the larger backdrop of a systematic public health failure.

Lucknow: At the government hospital in Uttar Pradesh’s Deoband, there is only one gynaecologist for the 200-odd deliveries that take place every month. If you think that is bad, think again. Ram Manohar Lohia (RML) Hospital in Fatehganj, Farrukhabad district, has a lone paediatrician even though it witnesses about 600 childbirths every month.

Across Uttar Pradesh, government hospitals are understaffed and overburdened. It reflects on the state’s healthcare index. According to the  National Family Health Survey , infant mortality rate (IMR) in the state in 2015-16 was 64 deaths per 1,000 live births. This figure is comparable to that of strife-torn African nation Mauritania, whose IMR is 65.

A  report  published by data journalism portal  IndiaSpend  earlier this year highlighted how Uttar Pradesh’s per capita expenditure on health in 2013-14, at a mere Rs 452, is 70 percent of India’s national average.

The country’s most populous state is ailing from a chronic shortage of doctors, medical colleges and apparently an overdose of apathy.

“There is no use of writing a letter to the higher authorities. Nothing will be done and nothing has been done in the last two years. The posts are lying vacant and they will remain vacant till unfortunate incidents like Gorakhpur, Farrukhabad or Saharanpur (happen),” said P Kumar, chief medical superintendent of Banda district hospital.

This hospital is 19 physicians short. Further, Banda’s chief medical officer Santosh Kumar informed that more than 60 posts are vacant in Community Health Centres (CHCs) and Primary Health Centres (PHCs) in Banda.

According to Rural Health Statistics (RHS) data available with Firstpost, there was a shortage of 1,288 medical professionals at the PHC level in Uttar Pradesh as of 31 March, 2015. At the CHC level, the state was 2,608 doctors short. The report also mentioned that there was a health infrastructure shortfall of 34 percent at the sub-centre level, 33 percent at the PHC level and 40 percent at the CHC level.

As of October 2016, India had 422 medical colleges with 57,000 seats. However, 60 percent of these medical colleges are concentrated in six states and a Union territory (Maharashtra, Karnataka, Andhra Pradesh, Tamil Nadu, Kerala, Gujarat and Pondicherry), according to  government data .

Severe shortage

As per a government report, Uttar Pradesh has only one doctor for every 19,000 people. According to the World Health Organisation (WHO), there should be one doctor for every thousand people.

Deoband medical chief Dr Indrajeet Singh told Firstpost that there are only six doctors in their district hospital and they go on leave whenever they want. The number of patients that visit the hospital every day ranges from 1,000 to 1,200. He said the hospital is not equipped to admit serious patients and is forced to refer them to other hospitals. He said they have requested the health department to assign more doctors.

Dr BB Pushkar, the chief medical superintendent of RML Hospital, said their hospital has had an acute shortage of doctors for long but the government has done nothing to fill this gap.

“It has been six years in a row now I have been writing to the (health) department and the government,” he said. He informed that their hospital is supposed to have 29 doctors but has only 13, including him.

Dr Ved Prakash, the spokesperson of Lucknow’s King George’s Medical University, told Firstpost that there is a severe shortage of doctors in Uttar Pradesh. He said assistant professors or an MDs (doctor of medicine) usually earn up to Rs 70,000 per month in a government hospital or medical college but their pay packet can go up to Rs five lakh per month if they work with private players. He said this migration should be stopped and the government should come up with a solution that lasts as long as 50 to 60 years.

He noted that the state’s population is more than 21 crore and the number of doctors graduating from state-run medical colleges every year is less than 5,000. Further, most of them do not want to work in government hospitals. As per WHO’s recommendation, Uttar Pradesh should have about 2.1 lakh doctors.

Taking a toll

Recently, a seven-month-old baby boy died of multiple organ-failure at RML Hospital. His mother, Shilpi Yadav, 23, told Firstpost he was admitted for five days but the doctor checked on him just once; it’s the nurses who were attending to him. Dr Kailash Dulhani, the lone paediatrician at the 100-bed RML Hospital, said the baby was extremely critical and had already turned blue when he was brought in.

Even as the distraught mother believes the government hospital’s ineptitude claimed her baby’s life, she asks where else they could have gone, given their limited means. Hailing from Bibiganj in Uttar Pradesh, she said they are poor and cannot afford to pay the bills of a private hospital.

A few weeks ago, Mohammad Kaimuddin, 30, of Kushinagar district lost his four-year-old son to Acute Encephalitis Syndrome after five days of treatment at Baba Raghav Das Medical College in Gorakhpur. He said the sympathetic nurses told him he should have taken the child to a private hospital instead.

(With inputs from Yogesh Bharadwaj in Mathura)

Read Part 2:  With only 78,000 doctors for 21 crore people, state has turned playground for quacks

Read Part 3:  Per-capita health expenditure of India’s most populous state is half the national average

The author is a Lucknow based freelance writer and a member of  101Reporters.com , a pan-India network of grassroots reporters.