As Gorakhpur tragedy fades from news, this is what UP must do
The Gorakhpur episode is slowly fading away from public memory, though similar incidents continue to be reported from other parts of the country. The episode should have served as a wakeup call about the poor state of the public-funded health system in the country and led to systemic changes at the national and state level in the health sector.
Instead what we have seen is knee-jerk reaction and steps that at best are treating symptoms of the problem and not addressing the core issue itself. The criminal cases against doctors by the state government and the announcement to establish a research centre in Gorakhpur by the Union government are examples of this.
Uttar Pradesh needs a thorough review of the primary and secondary health system in the state and a commitment to enhance public investment in the sector. Over the years, the health system has either been neglected or nurtured in undesirable ways.
Data shows that Gorakhpur is an "above average" district in Uttar Pradesh in terms of availability of public health infrastructure, ranked 19 out of 75 districts in the state. This should not be a consolation, given the fact that the state itself is among the three worst performing ones in India for access to public health, along with Jharkhand and Bihar. So, even better-ranked districts like Gorakhpur have poor indicators.
The first point of contact in the primary health system is a sub-centre (SC). Gorakhpur has 27 per cent fewer sub-centres than what is prescribed under the Indian Public Health Standards, according to the Health Monitor developed by Shamika Ravi of Brookings India using public data.
Only 45 per cent of people have access to a sub-centre within five km of their village and a mere 36 per cent people have access to a primary health centre (PHC) — the next level after a SC — within five km of their village. In the absence of access to a SC or PHC, quacks become the first point of contact when a child falls sick. This may be one of the reasons why tertiary hospitals in Gorakhpur get a large number of kids in critical condition.
The secondary level of the health system is in no better shape. Community Health Centres (CHCs) are supposed to form the second tier of the system. Somehow UP has plenty of CHCs. “The requirement is to have at least one CHC for every 1,20,000 population. The SP government built nearly three times as many CHCs as required.
The requirement in UP (as per population) was 1,300 CHCs, there are now 3,772 CHCs. But their quality is extremely poor — on average in UP there is an 83 per cent shortage of health specialists, 77 per cent shortage of nursing staff and 77 per cent shortage of lab technicians in CHCs.
There is a 54 per cent shortage of functioning X-ray machines, 18 per cent shortage of operation theatres,” pointed out Ravi. This means the second level of health system too is dysfunctional. Therefore, simply pumping up money in tertiary care hospitals and setting up more of them is not going to save lives.
(Courtesy of Mail Today.)