Political Diary

New Delhi, 19 September 2015

Netas Revel In Blame Game

ACHHA WOH MAR GAYE KYA?

By Poonam I Kaushish

Anger and anguish. Despair and desperation. As another life is snuffed out by a callous, heartless and selfish health system. It took the suicide of a seven-year old parents for the Central and Delhi Governments to wake up from their Rip Van Winkle slumber and decipher that dengue had the Capital in its lethal tentacles. So far over 18 have succumbed to the disease in the last one week and there are over 2500 cases and counting. Yet, are netas are busy reveling in a blame game!

Undeniably, the public outrage is not just about dengue or deaths but of our public health being in the ICU while the Government twiddles its hands asserting, “There is no cause for panic. The situation is totally under control. All is well!” Really? You could have fooled me!

Think. Simply, by reeling out do and don’ts, designating hospitals for treatment, testing labs, announcing preventive measures on radio and TV etc one can not wish the infection away nor does it quantify as action. A ghisa-pitta reply which fails to condone the delayed action, bad planning and mismanagement. Underscoring, our cavalier, casual and churlish attitude and approach to a crisis.

Raising a moot point: Is the aam aadmi’s well-being merely about sterile statistics?  Or is the Government becoming a maut ka saudagar? What should one say of India’s under-performing, poorly-funded, leaky public health system, smothered by high population and appalling sanitation?

What do you make of a health system which pulls off the remarkable feat of eradicating polio in ten years but where women continue to die delivering babies and during simple sterilisation surgeries? And isn't it ironical, that though we are one of the largest producers of morphine in the world, a patient in acute pain often finds it very difficult to procure it?

Look at the dichotomy. On one hand, our country is fast becoming the hub for medical tourism where people from other countries flock to get good quality, affordable medical treatment.  On the other most of these facilities are simply not available to the citizens.

The tragedy of India is that even after 68 years of Independence we still can’t make basic healthcare services accessible to everyone. Take dengue, it’s an annual dance of death during monsoons, yet nothing has been done to prevent its outbreak over the last few years.

Thanks to an alarming decline in fund allocation for its prevention and other mosquito-borne diseases like malaria and chickenguniya. From a high of Rs.50 crores in 2012 the Central Government doled out just Rs.17 crores this year. Consequently, this had a cascading effect whereby the Health Directorate reduced share of funds from 10 per cent of the total expenditure to below 5 per cent. Any wonder that this has crippled the war on disease!

Shamefully, the story is the same vis-à-vis other common avoidable diseases are malaria, tuberculosis, kala azar and Japanese Encephalitis. While rural India battles third world diseases like these, rising urbanisation has led to the middle and upper classes being afflicted with ‘developed world’ lifestyle diseases like diabetes and obesity. A fast food culture, increased smoking and alcohol consumption has led to a rise in obesity related diseases like diabetes and cardiovascular ailments

Shockingly, 50 per cent of all villagers have no access to healthcare providers, 37 per cent are chronically starved, 65 per cent are sans toilets while 50 per cent defecate in the open. Add to this, over 1.25 million children die annually before their first birthday, 48 per cent are likely to be permanently stunted due to lack of proper nutrition and only 7 per cent children receive the minimum acceptable diet set by the WHO. Appallingly, doctors medicate prayer to combat these!

Worse, 12 million girls were aborted in the last three decades and 45 per cent women married before they turned 18 resulted in early pregnancies, higher morbidity and mortality rates. Besides, out of 30 million pregnancies nearly 136,000 maternal deaths occur annually and 9 out of 10 pregnant women between 15-49 years suffer from malnutrition and anemia causing 20% of infant mortality. Woefully, a mother dies every ten minutes even as medical authorities continue to drag their feet.

True, the Central Government operationalised the National Rural Health Mission (NRHM) in April, 2005 throughout the country with special focus on 18 States, but statistics of the dead continue to rise. As only 243 million of the 1.2 billion citizens are covered under Government health insurance schemes and a total of 300 million (25% of total population) don’t have health insurance at all.

Clearly, public health has never been a priority of the Government. In fact, India got its first National Health Policy only in 1982-83.  This has lead to grossly inadequate spending in healthcare, less than 1% of the GDP.

A National Sample Survey Organisation study of village infrastructure found that there is only one doctor for 28 villages with over 20,000 people, 54 per cent of villages were more than 5 km away from the nearest Primary Health Centre and 27 per cent were more than 10 km away, only 10 per cent had a dispensary and only 20 per cent had a private clinic or doctor. When he is away on call all is left to God.

Scandalously, according to the WHO, India has a national average of only 45 doctors and 8.9 beds for every 100,000 patients, with the levels far lower in poorer States. Also, while the country is still struggling to bring infectious diseases under control, the incidence of non-communicable diseases is also on the rise. Heart diseases, diabetes, and cancer are expected to show a combined average decadal growth of 47 per cent in future.

Alas, given the dreadful state of our healthcare systems this has made us particularly vulnerable to a disease taking on epidemic proportions. However, none is willing to learn the ABC of health and crisis management or finding lasting solutions.

Where do we go from here? It all depends on our netagan. Perhaps it is time for the Government to realize that economic reform without reforms in the social sectors can become a bane in itself. We need to integrate primary health centres with district hospitals to allow for continuity of care.

Child care and women’s care services should be strengthened by enhancing the availability of trained professionals at primary care clinics and district hospitals. Nodal Government hospitals should be identifies and equipped with strong emergency services for timely critical care along-with the number of medical and paramedical colleges be increased in rural and poor areas.

It is now imperative for India to rethink its strategies and approaches to safeguard public health infrastructure, constitute a public health policy, establish fresh priorities, improve service delivery in public hospitals, rail and road management and establish close links between research, policy and service; with people at the centre of social development.

The Government can no longer bury its head in the sand. Ministerial conferences and Central directives to States will not do. Our leaders need to respect human life. Time is far gone to aver, Koi baat nahi, ek aur mar gaya! -----INFA

(Copyright, India News and Feature Alliance)