Political Diary

New Delhi, 10 September 2010

Disease, Flood ‘Strike’ India

IT’S  ONLY  LIFE,  STUPID!

By Poonam I Kaushish

The Gods are angry, very angry with India. Today, ravaged by disease, devastated by floods, destroyed by drought and paralysed by strikes. Turn anywhere across the country the story is the same. Of anger and anguish, despair and desperation, morbidity and mortality. Standing mute testimony to a callous, heartless and selfish polity and administration. After all the aam aadmi translates only into mere sterile statistics to be manipulated at will!

How else should one react to the death of civic and health reforms plagued by corruption and bereft of cure and consolation. Think. Year after year hunger devours Bihar, Jharkhand, Rajasthan, Orissa and Maharashtra, floods wreck havoc in Andhra, W Bengal, Gujarat, Punjab, Haryana and UP. This year God Indra has not even spared the Union Capital Delhi. Which is witnessing unprecedented floods after 32 years. Can disease be far behind?

Brutally underscored by the return of swine flu, malaria, cholera, TB, HIV, small-pox, Hepatitis-B, viral fever, dengue et al. If this spells bad news worse lies in store. With the Commonwealth Games round the corner Delhi is in the pandemic grip of dengue, malaria and viral fever. Whereby the panicky Union and Delhi Governments’ have called in the Army to kill the virulent mosquito! As sweating envoys from participating Commonwealth countries demand guarantee against the deadly mosquito attacking its sportsmen.  Adding palpitations is an SMS sent by the All India Medical Institute about the latest bug, HBF aka high bone fever caused by eating cauliflower. 

The tragedy of India is that diseases acquire epidemic proportions due to the appalling state of our healthcare systems. With none willing to learn the ABC of health and crisis management and finding lasting solutions. All cries of help are met with deafening silence or more of the same: don’t panic, everything is under control. Really, you could have fooled me!

Shockingly, nearly one million Indians die every year due to inadequate healthcare facilities and 700 million have no access to specialist care as 80% of specialists live in urban areas. Experts have predicted 3.75 million deaths due to cardiovascular diseases this year, out of which a whopping 2 million will die due to heart attacks or coronary artery diseases (CAD). As it stands, India totals one-third of the world’s TB cases. And is one of the four countries worldwide along with Nigeria, Pakistan and Afghanistan where polio has not been eradicated.

Not only that. Diabetes and cardio-vascular illnesses are rising. Over 5.6 million children die every year, more than half the world's total. And those who survive are underweight. Said a World Health Organization (WHO) official, “If a child doesn’t die within five years of birth due to mal-nutrition and diarrhea, acute respiratory infection will get him later.” Adding, over 900,000 Indians die every year from drinking contaminated water and breathing polluted air. Even as doctors medicate prayers to combat this.

Adding to woes, there is a huge gap in the number of hospital beds per 1000 population. With a world average of 3.96 hospital beds per 1000 population India stands just a little over 0.7 hospital beds per 1000 population. Moreover, there is a chronic shortage of doctors, nurses and paramedics. Similarly, life expectancy at birth of 64 years in India compares favourably only with that of 63 in Nepal. Again, it is a far cry from Sri Lanka’s 75.

According to a recent survey, the number of licensed medical practitioners per 10,000 individuals had fallen by the late 1980s to three per 10,000 from the 1981 level of four per 10,000. In 1991 there were approximately 10 hospital beds per 10,000 individuals. In comparison China boasts of 1.4 doctors per 1000 people. And over 40% of the primary health centers are understaffed.

Sadly, the Congress-led UPA I and II Government which promised to raise expenditure on healthcare to 2 to 3% of the Gross Domestic Product miserably failed. According to recently released National Health Accounts (NHA) statistics, public health expenditure as a share of the GDP increased from 0.96 per cent in 2004-05 to just 1.01 per cent in 2008-09. Of this, over 80% is in the private sector, contrary to developed societies where nearly 90% of health expenditure is borne by the Government.

Why? The answer lies in our powers-that-be miniscule emphasis on national priorities, refusal to take into account local realities and failure to set our own health agenda. An example. Year after year, in UP’s Gorakhpur district hundreds of mal-nourished children die of a strange encephalitis-like disease yet no effort has been made by local health authorities to find out the cause and cure for it.

Abysmally, after 63 years of Independence, there is a serious discrepancy between providing healthcare through the public health system and the actual level of public health expenditure. This inconsistency between the objectives and resources is the raison d atre of the failure of the health system. Only last week doctors at a prime Delhi hospital and in Rajasthan’s Jodhpur district went flash hartal for being roughed-up by patients’ families. They too seemed to have joined the rising mobocracy brigade which translates democracy into freedom to strike at will and paralyze society at a drop of a hat, 365 days of the year. No matter cost patients dearly.

What next? There are no short-cuts possible. We need to highlight are own health priorities, formulate health policies based on needs and find our own solutions It is now imperative to re-think our strategies and approaches to safeguard public health infrastructure, improve service delivery, establish close links between policy , research and service with the aam aadmi at the centre of development.

There is a need to set up statutory bodies composed of experts with a genuine track record of research and policy making. Who would evaluate health problems, study its context and be involved in decision and policy-making. With special emphasis on problems created by burgeoning population and its impact on the local eco-system, growth of urban slums, environmental  insanitation and decay, stagnant water bodies, rise of drug-resistance and changing life-styles.

Undoubtedly, this will come at an enormous cost. India would need over $25 billion over the next 5 years in health alone. Add to this the cost of dealing with national calamities like the annual kahein-sukhaa-kahein-baaarh ritual we are talking thousands of crores. Predictably, even as are netagan cry foul and reel figures of high fiscal deficit, no money in national kitty etc to fob off spending, they need to be gently reminded about the massive pay hike they gave themselves.

Look at the irony. The country has frittered over Rs 35,000 crore on the 14-day razzmatazz CWG, lost over Rs 60,000 in the 2G spectrum scam, spent $2.1 billion on Delhi’s new airport terminal, written-off over $107 billion of the super-rich and boasts of over 50 billionaires in the Forbes list. Yet, has no funds for the sick, diseased and hungry. Notwithstanding that India ranks 66 among 88 in the Global Hunger Index and 134 in the UN Human Development Index below tiny Bhutan and Laos.

In the ultimate, the time is far gone for the Government to play the pied piper. Decisive indecisiveness will not do. It only holds out promises of more misery, more wrenching news and more cries for the Government to act. To foresee is to govern. No longer can we ostrich-like bury our heads in the sand and wail, its’ only life, stupid! Remember, the health of the nation is reflected in the health of its people. Who will live if India dies----INFA

(Copyright, India News and Feature Alliance)