Over 150 children have died in the last few weeks in Bihar’s Muzaffarpur district, otherwise famous for its lichi fruit, of acute encephalitis syndrome. It seems they are mostly children of families who work in these orchards and had consumed the lichis on empty stomachs.

Lichis are a great fruit but when consumed on a stomach that is and remains otherwise empty (school summer holidays and no mid-day meal for the children) even through the night can turn lethal. What is the preventive procedure? Alert the parents in April before the lichi season sets in to ensure that children with a lot of lichi in them have a meal before going to sleep at night. That’s all!

And when a child falls ill, there should be a standard operating procedure for hospitals to first diagnose the cause and know what to do with such cases. As a report in BusinessLine has indicated, last year the public were suitably alerted and there was no such tragedy; this year the system failed. The lessons learnt from children dying from the same condition in Gorakhpur a couple of years ago seem to have been forgotten.

The reason for narrating these details at such length is to emphasise the critical importance of publicly delivered preventive and primary healthcare for the poor in both town and country.

Last year the government announced with great fanfare the Ayushman Bharat scheme, describing it as the largest government funded healthcare system in the world! It consists of two parts. One is every eligible family being covered for ₹5 lakh per year of cashless secondary or tertiary care. This is the part which brings in health insurance companies and gets the maximum publicity.

Primary care

The other is healthcare at the primary level through health and wellness centres which seek to upgrade existing sub- and primary health centres. It is these that form the backbone of public healthcare in the country. If these run well the poor have access to healthcare within easy reach, they are treated in time and do not have to in many cases make financially debilitating journeys to larger hospitals in towns. It is clear that public healthcare at all levels was non-functional in Gorakhpur and, despite Ayushman Bharat, seriously falls down in Muzaffarpur.

When Ayushman Bharat was launched in October last year it envisaged setting up 1,50,000 health and wellness centres in four years. Other than offering routine services, these will also cover non-communicable diseases and maternal and child health, plus offer free essential drugs and diagnostics. At the time of launch, 2,287 of these had come up across the country.

The Centre is to bear 60 per cent of the costs of Ayushman Bharat and the States 40 per cent. The Budget for 2018-19 allocated ₹1,200 crore for these centres. In the interim Budget for 2019-20, health and wellness centres have received an allocation of ₹1,600 crore, against a revised estimate of ₹1,400 crore for the previous year. Till February, 8,030 centres were set up in the country.

Funding pattern

While the total number of centres has gone up by three and a half times the total allocation has gone by only a third. Though the government has repeatedly stated that money is not a problem the cardinal reality of public healthcare in India is that it suffers from a severe lack of funding and right now the health and wellness centres are no exception.

In making public healthcare work the buck stops with the State governments. It is they who have to set up the centres and run them well. Here we come up against another cardinal reality of Indian public life — the difference in the quality and efficiency of one State government from another. And the difference shows right from the start — the setting up of these centres.

As of February, Bihar, according to its own submission, had 211 centres whereas Tamil Nadu had 1,318 and Andhra Pradesh 1,316. Bihar accounts for 8 per cent of the country’s population but only 2.6 per cent of the health and wellness centres.

What is to be done? Backward States have to get their act together. Bihar in recent years has come a long way. Under Nitish Kumar there has been a remarkable improvement in fields as far apart as law and order and the quality of roads.

The need of the hour is obvious. The entire country must forget political differences and join hands to bring up the administration of backward States. Nothing less than the lives of children is at stake. If this sounds cliched then it reflects a reality that is as unchanging as it is unacceptable.

The writer is a senior journalist

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