The recent death of 34 infants within six days in Sishu Bhawan, Cuttack, a post graduate institute of pediatrics and an exclusive healthcare centre for children, shows the callous attitude and negligence of the Health Department in managing the health service of the State.
This tragic incident is a reflection of the status of our health governance managed by unaccountable bureaucracy and the visionless ruling party. In the absence of regular monitoring of hospitals, the visit of political parties in fact finding team and by the State Health Minister is not going to change the situation because Odisha public health sector needs a fundamental change.
Infants and children dying in hospitals every day in different parts of the State are a daily occurrence and many of the cases go unreported. The overall health scenario of the State in general and infant and child healthcare in particular has been a matter of concern for the State because the State has not made adequate investment to strengthen the public health system and continue to maintain a poor status. The people in rural interior and tribal areas still continue to suffer and die every day in the absence of public healthcare facility.
The child population in Odisha from zero to six years comprises 12.6 per cent of the State’s population which is over 52 lakh as per 2011 census. Of them, 27.16 lakh are males and 25.57 lakh females. Along with malnutrition and infection, the issues of negligence by doctors, nurse and other health staff in hospitals has been a matter of concern because most of the deaths have been due to the negligence of the medical staff in providing timely service. Malnutrition is also a result of inadequate healthcare service.
The annual health survey by census of India 2012-2013 says the IMR of Odisha is 51 in the year 2012-2013 but in rural areas it is still higher and higher than national average. The main reason is poor availability of professional attendance and care. The five major diseases, malaria, leprosy, scabies, acute respiratory infection and diarrhoea collectively account for more than 70 per cent of the total patients in Odisha. There has been high incidence of malaria, acute respiratory and tetanus infections and anemia among infants. This is also one of the major causes of high IMR in the State.
After 68 years of Independence, there has been insignificant improvement in health infrastructure in rural areas of the State. The basic facilities such as safe drinking water and latrine under rural water supply and sanitation programme are yet to reach the interior parts and the marginalized sections. The universal integrated child development scheme (ICDS) targeting the children below six years and nutrition and health education of pregnant women covers about 52.11 lakh beneficiaries through 61,000 Anganwadi and 10,000 mini Agwanbadi centers, with an annual budget of Rs 647 crore.
Along with this, there is also supplementary nutrition programme as a combined effort of both the Centre and the State to improve health and nutrition status of children in the age groups of six months to six years. The Government data shows that the coverage of number of beneficiaries in providing supplementary nutrition is more than the coverage of women under nutrition and health education, health checkups and immunization of children. The Rajiv Gandhi National crèche for children of working and ailing mothers for children of zero to six years mostly targeting the children of poor marginalized groups, women workers has not covered a majority of the poor.
It is found that poverty and social exclusion are a major reason of malnutrition but there has been no effort to address the issues among the socially excluded groups in rural and interior parts of the State. The IMR is very high in backward districts having more numbers of excluded groups accompanied with less number of Government medical institutions. The major development programmes for SCs and STs and other rural poor should include healthcare facilities for infants, children and women in their community. The care of an infant and child is the responsibility of the whole family and the entire family engages them in taking care of their pregnant women and children. It has an impact on the employability and earnings of the family. When it comes to health care in case of any illness of child in family, both husband and wife have to come to the hospital all the way from a distance place without proper transportation facility. Even today people carry patients with all difficult traditional transport practices to the hospital. There have been cases of child delivery on the way to hospital without a proper ambulance facility. In most of the hospitals there is no facility of rest room for patient attendants and mostly the poor who cannot afford for a rented room has to suffer a lot by taking shelter in the medical veranda or its outskirt. There has been growing number of middleman and Dalals in the hospitals who are exploiting the poor and illiterate patients and many of them are agents of private hospitals who mostly serve the interest of private hospitals by mediating with the patients. The behaviors of health service providers in health institutions has been subject to dispute by many and in many accusations it leads to unwanted fight among the attendant of patients and the staff. The cleanness, discipline, privacy and security issues of the hospitals are always being managed with less priority mostly in the Government hospitals. There is a need of orientation of health staff on ethics and social conduct in public service especially in case of healthcare service.
The Union Health Minister in a reply in Rajya Sabha said the doctor-patient ratio in India is less than WHO prescribed limit that is 1:1,000. India has just one doctor per every 1,700 people. Every year about 5,500 doctors pass out and most of them are not willing to serve in rural area due to feeling of professional isolation and disparity in living condition and also other reasons which include lack of basic facilities, infrastructure, equipment and well-trained paramedical staff.
In case of Odisha, in spite of increase in Government and private medical institutions still there are only 9.75 doctors per lakh population and less than four beds per 10,000 populations. There has been increase in private medical institutions in districts of Cuttack, Khurda, Kalahandi and Ganjam.
The district of Cuttack has 88 Government medical institutions with 2,440 beds and Khurda has 81Government medical institutions with 965 beds where as there are 348 private medical institutions with 2,919 beds in Cuttack and 224 private medical institutions with 4,155 beds in Khurda. This shows an increasing dependency of people over private medical institutions than Government. The privatization of health sector has been impacting over the Government run health institutions and affecting poor people who are mostly depending on public sector healthcare system in the State. As per Health and Family Welfare source about 20 per cent of posts in hospitals are vacant in the State. The Government doctors are being engaged in private hospitals as consultants. The alternative systems of medicine, Ayush, Ayurveda and Homoeopathy have not been developed in the State especially in rural and tribal areas. It has been observed that number of Central Government schemes and programmes on health has not been properly implemented by the State Government. It is high time the State learnt from other States and made serious attempt in all fronts by pulling resources from public sector companies and funds available with district mineral foundation to build an effective public health sector to serve the people of the State.
(The writer is a researcher and rights activist, who can be mailed at manasbbsr15@gmail.com Mob -9437060797)