Gorakhpur and after

More than ten days after over 70 children having died at the Baba Raghav Das Memorial Hospital in Gorakhpur, it is still not clear what caused the colossal loss of lives. The paucity of oxygen cylinders, which led to 30 children dying on August 10 and 11 according to official reports, seems to have been the immediate factor. The run-up of events leading to this situation needs to be established by an independent inquiry and the guilty punished. This points to a systems failure in the hospital, which is incidentally a major healthcare provider for about 15 districts in Uttar Pradesh, besides people from neighbouring Nepal. In the last one week, the supposed role of Japanese encephalitis has come into the picture, even as it became evident that children, particularly infants, were succumbing to a range of ailments. While encephalitis is considered endemic to the region, there is no evidence that an epidemic has broken out this time. In fact, a 2016 ICMR study suggests that scrub typhus, a vector-borne disease that imitates encephalitis but is transmitted by a mite, is perhaps a silent killer in the region. The study also says that scrub typhus is on the rise all over the country. The Gorakhpur episode is the outcome of a broken healthcare system in India’s most populous State, the absence of public hygiene and the poor nutritional profile of its population. That there are only 25 medical colleges, public and private, in UP tells a story.

The spotlight should once again be on UP’s health indices. The National Family Health Survey-4 says that the State has an infant mortality rate of 64 per 1,000 live births, against the all-India average of 37. To place this figure in perspective, Tamil Nadu’s IMR is 21. If India’s maternal mortality rate, at 174 per 1,00,000 live births compares very poorly with Sri Lanka (30) and Vietnam (54), Uttar Pradesh’s MMR rate is closer to 300. As for public hygiene, Gorakhpur is ranked at 314 in the list of 434 cities in terms of cleanliness.

It would be tragic if all these deaths did not trigger a health transformation. Foremost is the need to raise public spending in health from 1.5 per cent of the GDP to 2.5 per cent. Economic Survey 2015-16 points out that “India has emerged as the country with the largest out of pocket expenditure on health, among the BRICS economies, consistently higher at more than 60 per cent since 2008”. Health insurance covers just 6 per cent of UP’s population, which suggests that over-reliance on the private sector can be misplaced. Above all, it is important to draw lessons from an epidemiological fact — that well-fed populations can ward off even vector-borne disease. This is borne out by Punjab’s successful battle against malaria. Whether it is the systems at Gorakhpur, the mass sterilisation drive that led to deaths in Bilaspur in November 2014, or numerous cataract surgeries gone awry, healthcare requires attention in terms of funds and quality of personnel.

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