Gorakhpur Tragedy: No country for children

The staggering number of deaths reported from Gorakhpur and Jamshedpur should be looked at against the larger backdrop of the failure of the public health system

Often tragedies are followed by outrage and action. When tragedies are followed by more tragedies and outrage does not lead to action, you know that the system is crumbling. The recent spate of deaths of children reported in two states with the worst health indicators—Jharkhand and Uttar Pradesh—are cases in point. Just days after Ward No. 100 of BRD Medical College in Gorakhpur turned into “Mritak Lok” (land of the dead), with 70 children dying in a matter of days, 61 more deaths have been reported from the same hospital in the last 72 hours, taking the total death toll to 131 in less than a month. In Jharkhand’s oldest industrial city of Jamshedpur, on the other hand, 52 infants have died over 30 days due to malnutrition. Unfortunately, it is not the first time that such incidents have put the spotlight on the crumbling health system. However, the more important question to ask is if these deaths will be able to push the authorities out of their bureaucratic inertia and the government to pour more money into the starving health sector. 

Nearly two children under the age of five died every minute in India in 2015. As far as the recent deaths are concerned, while the immediate reasons cited may be a shortage of oxygen, overcrowding of hospitals during disease outbreaks, the truth is that both Uttar Pradesh and Jharkhand have one of the worst health indicators in the country, worse off than some of the poorest African nations. According to the National Family Health Survey data, UP has an Infant Mortality Rate (IMR) of 64 percent and Jharkhand 44 percent. At least 45.3 percent children in Jharkhand are stunted and in UP, the figure stands at 46.3 percent. An inadequate health system coupled with a large population and poor nutrition indicators inevitably leads to a devastating number of deaths every time there is a disease outbreak. 

We have become a group of people that have no qualms about accepting that a few of us would die because public health facilities will not reach everyone in time of need. These issues are not even talking points during elections

In a question raised in the Lok Sabha by two BJP legislators on the deaths of 156 children due to Japanese Encephalitis in Bihar in August 2014, it was found that the government had promised prompt action and put a a five-pronged strategy in place to tackle the crisis that arises every year without fail. In 2016, 196 children died because of the disease and this year, at least 30 children had died until July. To imagine that states with such poor indicators would be caught off-guard during the season when it is known that more and more cases of Japanese Encephalitis (JE) would be reported is alarming, to say the least. 

The gap between healthcare providers and people seeking medical attention is glaring, with 3,600 Primary Healthcare Centres (PHCs) catering to 97,000 villages in UP. The ground-level workers, Accredited Social Health Activist or ASHAs and Anganwadi workers, who the government relies on to get to the masses in villages are not trained properly and paid poorly. Because of rampant corruption, a lot of women who are illiterate also make their way into the workforce and that compromises data collection and monitoring. A medical superintendent at a district hospital in western UP had said that the gap is so huge that we have accepted it as a fact of life that the situation will not change. There is often trouble when a new medical officer comes in and tries to shake things up and such people are few. Most are happy to maintain the status quo. We have become a group of people that have no qualms about accepting that a few of us would die because public health facilities will not reach everyone in time of need. These issues are not even talking points during elections. 

The fact that health is a concurrent subject only makes matters worse. Whenever a National Health Policy comes out, the Central government spells the healthcare roadmap for the entire country but has no responsibility to come out with a plan to make sure it is implemented on the ground. In that sense, a national health policy spells a grand vision only on paper which may not necessarily translate into any improvement on the ground. 

While public health expenditure has steadily increased over the years, it has not kept its pace with the country’s growing population. There was much celebration when the NFHS 4 data was released earlier this year and it recorded significant improvement in health indicators. However, juxtaposing those figures with the number of child deaths recorded in this month alone should be an eye opener. For a country that is beset with an over-burdened and starving health sector, the recent deaths in Gorakhpur and Jamshedpur should only ring the alarm bells.