COVER STORY
‘ Gorakhpur shocked , but didn ’ t surprise ’
K . Srinath Reddy , president of the Public Health Foundation of India chaired the high-level expert group on universal health coverage . In an interview with Pragya Singh , Reddy blames “ our society ’ s negligent approach ” for children dying in hospitals from treatable conditions , and argues that less economic inequality would mean better public health even at the same per capita GDP .
What ails healthcare for children — lack of planning or inadequate resources ? India needs an overhauling of its health services . Resource allocation is critical , but the crucial element is human resources . A primary health centre ( PHC ) or community health centre ( CHC ) doesn ’ t deliver due to lack of equipment and staff . Most sub-centres don ’ t function . PHCs don ’ t have doctors and CHCs don ’ t have specialists . Where should one begin solving the problem ? Inadequate skill and motivation make primary healthcare the biggest loser . Forty per cent children have not been immunised in India , while the corresponding figure is just 10 per cent in Botswana and Rwanda . Even in a time of civil conflict , Sri Lanka achieved above 95 per cent immunisation . We have a large percentage of underweight and stunted children , highly vulnerable to infections and serious brain and cognitive problems . We have created a recipe for childhood vulnerability , and all its ingredients flow from the healthcare system itself , compounded by an environment unsuitable
“ We have focused too little on public health , rural or urban . The children are dying of treatable conditions , not terminal diseases .”
for healthy growth — unclean water , poor sanitation .... Where should the money go — to the cities or the villages ? We have focused too little on public health , rural or urban . Start from low-income zones and where vulnerability is highest — those who come to big cities to work in the construction industry , seasonal migrants , farm workers and women in low-income families and so on . Did the Gorakhpur tragedy , where children died after a disruption in oxygen supplies , surprise you ? I was shocked , but not surprised . Earlier , and ever since , there have been a spate of child deaths in hospitals . In Gorakhpur , a co-incidental factor — the disruption in oxygen supply — led to the crisis . Even the media , perhaps , would not have reported it otherwise . Primary and district hospitals are in a bad shape in eastern UP , which is economically backward , with serious sanitation problems and undernourishment . Why do people trek from their villages to a tertiary-care medical college for a disorder that does not require specialist care ? Treating encephalitis demands only paracetamol , water and electrolytes , so the PHCs should be able to do it . For respiratory assistance , a ventilator should be available at a district hospital . Why should a top-level hospital ’ s corridors be crowded for this , further dividing the attention of doctors ? This reflects the failure of our health system to build services in the districts . What are the lessons from Gorakhpur ? Abuse or neglect of a child is taken seriously in many societies , to the extent of taking children away from negl igent or abusive parents . But we allow children to die with out medical care . They are dying of treatable conditions , not terminal diseases , due to our society ’ s negligent approach . You have said India should spend 8-10 per cent of the GDP on health … We are at 3.8 per cent .; let ’ s hope it reaches four or five . Our public expenditure stands at 26.5 per cent , whereas in the US , often projected as an advertisement for the private sector , or in Brazil and China , it is above 50 per cent . O
their pradhan does not sanction Swachh Bharat toilets for poor Dalit families . We meet up with Krishna , an ASHA worker , who says , “ I do the rounds in villages since the Tama centre is unusable . I can handle vaccination , but we don ’ t get antibiotics or medicines for fevers and pains despite several complaints .”
Tripathi acknowledges some sub-centres were incomplete or abandoned . “ We have funds to overhaul 30 of them ,” he says . He suggests a visit to another sub-centre in Sahjanwa proper , where a new encephalitis treatment centre is under construction . All medicines will be free . The idea is to treat fevers as close to home as possible , as Tamil Nadu has done , so as to avoid treatment delays , a major cause of infant mortality . The bad news : the duty doctor was asleep in the only air-conditioned room . In the 12-bedded ward , the only patient ’ s family complains that auxiliary staff extorted
Rs 2,050 from him and another patient . “ Treatment is meant to be free , but we wanted no problems , so we paid up ,” says Satish Maurya , a 22-year-old tea-seller whose wife delivered a child here . The doctor , shaken awake , said he had no knowledge of what was going on .
Delays , created by the sub-par infrastructure in the hinterland , are a real killer . Ask Kamla and her daughter-in-law Kanchan . A primary and then a secondary healthcare centre , where Kanchan was brought with unknown pregnancy complications , both cited a lack of doctors and expertise . She had to go to a private hospital in Gorakhpur finally . Match that experience against the statistics . Mehrotra ’ s study says only a quarter of UP ’ s sub-centres , PHCs and community health centres ( CHCs ) are in place . Less than five per cent of the PHCs are functioning . There are fewer
24 OUTLOOK 2 July 2018