India’s ailing health system

Who cares for children ?

A year back, a 10-year-old tribal boy Umesh Medhi made a frantic appeal to Prime Minister Narendra Modi to visit his villages in Malkangiri in Odisha where 73 of his fellow children had lost their lives in the outbreak of Japanese encephalitis.

“Sir. Save our lives. Many of my friends have died of Japanese fever . You are roaming around the globe. Cannot you come over to our villages and see how are children dying here ?”

Medhi, a student of class IV of Polkanda Primary School under Sikapali gram panchayat, described the ordeal of parents who lost their children in the Japanese encephalitis. What prompted the tribal boy to write to Narendra Modi was Malkangiri villagers’ belief that the
Prime Minister could be their last hope !

This is understandable since nothing moves the Indian system of democracy unless a heavyweight leader or the Prime Minister himself takes personal interest in matters of public concern. I have no clue whether the Prime Minister responded to Medhi’s pleas since Modi’s priorities then were global rather than the sufferings of Malkangiri children or grieving families of debt-ridden farmers who committed suicide !

What can anyone do if ordinary people’s distress signals do not touch the hearts of our leaders ? Mercifully, the Prime Minister at least expressed his grief at the latest Gorakhpur tragedy during his Independence Day speech from the Red Fort. However, passing references can hardly help solve a deep-rooted rot in the country’s terribly sick medical system.

Public health care has never been a priority of our leaders in the States or at the Centre who have presided over the country’s destiny over 70 years of Independence. The poor, the have-nots, the tribals and the backwards hardly figure in our VVIP-oriented society. Our leaders sell them “dreams” of promises and people are left with no option but look heavenwards with dying children in their arms ! This is the India we all have learnt to live with, whether high-profile persons at the helm happen to be BJP-led NDA Prime Minister Modi or CM Yogi or CM Akhilesh Yadav or CM Mayawati or Sonia Gandhi’s UPA power bandwagon of Prime Minister Manmohan Singh !

Unfortunately, we see more of politics than serious efforts to go deep into the issues of children’s mental or physical health and work out concrete plans of action to make the life somewhat easier for the deprived and disprivileged sections of our society. No wonder, we continue to see replay of the same old stories of bunglings, malpractices and horrible working conditions in hospitals from Odisha to Bihar to Chhattisgarh to West Bengal and now in Gorakhpur in UP.

In Uttar Pradesh, Chief Minister Adityanath Yogi does hold out some promise since he has also represented Gorakhpur for five terms in the Lok Sabha. However, ironically, politics has already taken charge of the Gorakhpur tragedy. Rahul Gandhi, Akhilesh Yadav and other opposition leaders are already at their old political games. Even CM Yogi’s Health Minister Siddharth Nath Singh plays his own brand counter-politics on the shortage of life-saving oxygen cylinders at the Baba Raghav Das hospital.

Be that as it may. The District Magistrate’s report on the Gorakhpur tragedy is bound to open a can of worms. Even the Chief Secretary’s report submitted to CM Yogi is quite revealing.

Anomalies in cylinders’ record log book show serious financial bungling. This is the same old story of how persons at the helm cash in on the people’s sufferings. So do several government doctors with their flourishing private practices !

India’s medical system is indeed terribly sick. The country has one of the poorest health records in the world. Public expenditure on health is 1.58 per cent of GDP – far lower than the global median of 5 per cent.

According to the UN’s Millenium Development Goals (MDG) programme, 270 million or 21.9 per cent of people out of 1.2 billion Indians lived below the poverty line of $ 1.25 in 2011-12. Moreover, 84 per cent of all health care expenditure in India is out of pocket. This means a large number of families are constantly at the risk of falling into poverty on account of high health expenses !

According to UNICEF India, over two million children die every year from preventable diseases. The worst situation is faced by rural areas residents living below the poverty line.
Small wonder that every third child in India is malnourished . But, who cares ? What is particularly disquieting is that we do not have proper services or programme for children with mental health issues. In fact, the mental health budget remains just one per cent of the existing highly inadequate total health budget. In U.P., the latest report suggests that the Yogi government has slashed medical education budget by 50 per cent. What a shame !

Uttar Pradesh has actually the worst record on child care, with 46 per cent of the children being underdeveloped, including Muslim boys and girls ! My point is simple. Why can’t our Ministers, MPs, MLAs, bureaucrats cut down their hefty pay packets and perks to improve the lot of our poverty-stricken youngsters ? But the VVIPs hardly care for children !

What is needed urgently is a “total overhaul “ of the health system in the country with a view to promoting what Prof Rajni Kothari once put it, new concepts of public management and accountability. Apart from rational restructuring of public health ministeries and departments, the lower levels of administration in hospitals and primary health centres are critical areas for health care. They require special attention since “a million points of contact” are established at low operational levels every day.

In this context, I wish to quote S. Banerjee from his study titled “Some Reflections on Administrative Reforms” (Management in government, Vol 1 April June 1969). He says :

“If administrative reforms are to catch the imagination of the people of this country, our thinking and action will have to descend at the ground level. Our ingenuity and imagination will have to leave aside for a while the lofty “Manuals” which guide the path of our policy-makers in government headquarters, sitting in secure ivory-towers far from the maddening crowd ! They will have to be directed towards simplifying the maddening procedures, the multicity of terms and the vexatious rules to which the counter-clerk is asked to adhere. No high-powered commission is required to do this task. The answers lie in the much-neglected ‘obvious steps’.”

Over three years back, Prime Minister Modi had promised to bring about good governance at all levels of administration. But, where is good governance in critical areas affecting the life of the country’s ordinary citizens and the poor in our high-profile hospitals and health centres ?

Will the Prime Minister and State Chief Ministers, including Adityanath Yogi, learn from simple thoughts and work for eliminating the existing hiatus between the hospital authorities and the millions of people and their children ?

I hope that something something good would come out of the Gorakhpur and Malkangiri tragedies !

To ward off negative traits in the polity, we need to spread the message that “power does not reside in objects, it resides in systems”, which are meant to serve the greater good of society – and not individual interest. We cannot afford anarchy parading as democracy in any area of public functioning. We have to move beyond personalities and think of common interest of ordinary citizens and the future of millions of our suffering children. George Eliot has beautifully conveyed the idea in the following passage :

Our deeds still travel with us from afar,
And what we have been makes us what we are.

Over to our Prime Minister Modi. It is high time he took stock of his numerous promises and tested them on the touchstone of ground realities !

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