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Public health infrastructure in Bihar is in the ICU

Public healthcare infrastructure Bihar concept. Healthcare workforce piece.
Patients wait to be seen at a medical clinic in Bihar.

The recent tragic deaths of over a hundred children in Bihar has put the spotlight on the ailing public health infrastructure – both in the state and in the country. The National Human Rights Commission has issued notices to the Centre and state governments over what it has termed “deplorable public health infrastructure” and reminded policymakers of their duty towards guaranteeing Right to Life of every citizen.

The Commission said it has taken suo moto cognizance of several deaths due to “deficiencies and inadequacies in the healthcare system” – highlighting in particular “lack of medical care, infrastructure, manpower, and…administrative failure, across the country.”

The deaths of 143 children due to acute encephalitis syndrome (AES) in Bihar’s Muzaffarpur district was the impetus behind the Commission’s notice. However, it highlights other events from years past, mentioning the 2017 Gorakhpur tragedy in Uttar Pradesh, where a shortage in supplies of medical oxygen led to the deaths of scores of children due to AES. In addition, the Commissionhighlighted everyday failings of the public health system in India impugning upon patients’ dignity, both in life and in death. Lack of availability of ambulances was mentioned, resulting in childbirth taking place outside of hospitals – carrying greater risks of complications and maternal mortality – and people being forced to carry the bodies of their family members from hospitals to their homes because of a lack of transport.

Underlining that success of a public healthcare system lies in “easy accessibility, availability and affordability of treatment”, the Commission stated “it is the responsibility of the State to ensure comprehensive health care facilities for all.” It noted that there is an urgent need for “convergence and integration of child and maternal health schemes of Central and State Governments and their proper implementation.”

Image ID: 9321294 (L)
Encephalitis deaths linked to the lychee fruit (pictured) and malnutrition are throwing the spotlight on Bihar’s public health infrastructure crisis.

“The policymakers wake up only after tragedy strikes, as several promises are made beneath the media glare forcing them to act. Soon after, however, complacency takes over.”

The warning comes at a time when India’s public healthcare infrastructure is in shambles, with only one doctor for over eleven thoudand patients at the national level. State by state, the figures differ. Bihar is among the worst-affected states by dismal manpower levels in health facilities. The doctor-patient gap is estimated to be 1 : 17,685. About 79.5 percent of the 1,719 in the district do not have access to a public healthcare facility, with only 630 centres operational.

“What can easily be managed at a primary health centre level, is reaching Muzaffarpur at a critical stage causing deaths. Since there is no primary health infrastructure nearby and no health experts to tell these families the preventive measures, the problem arises,” a senior health ministry official told Livemint

According to the Census of 2011, Bihar is the third most populous state in India, with healthcare indicators, such as infant mortality rate, maternal mortality ratio, and total fertility rate, being substantially higher than the all-India average. The state has a shortage of 1,210 sub-centres, 131 primary health centres (PHCs), and 389 community health centres (CHCs).

The Comptroller Auditor General report states that “completion of 75 CHCs was delayed by one to 33 months. Further, eleven CHCs [were] incomplete even after the delay of one to 36 months, due to non-availability of dispute-free land and slow execution of work. Consequently, there was a delay in the completion of 86 CHCs, which delayed the intended objective of providing improved healthcare facilities.”

The policymakers wake up only after tragedy strikes, as several promises are made beneath the media glare forcing them to act. Soon after, however, complacency takes over. Public healthcare is all about long-term policymaking and building a strong foundation away from political posturing, so that tragedies of the kind witnessed in Muzaffarpur can be averted. The public health crisis is burning a big hole in India’s GDP and if the government fails to take take stern action soon it will impact India’s growth story soon.

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