Falling short: is India’s public’s health on life support?

Last week, seven-year-old Avinash, died from dengue after being turned away by several hospitals in the Capital. His parents subsequently committed suicide having lost their only child. An entire family, wiped out for want of a hospital bed.

Even as this tragedy sinks in, another child, six-year-old Aman lost his life to dengue after being shown the door by another Delhi hospital. The public outrage that followed saw the Government send show-cause notices to the hospitals asking them why they had denied the children medical facilities.

But the bitter truth is that the shortage of medical facilities and staff has been festering in the Government’s backyard for a long time now. The recent tragic deaths are not just a reflection of the abysmal state of health in the national capital but a chilling insight into the scenario across the country.

At a major Government hospital in well-heeled South Mumbai, for instance, an office assistant whose wife had travelled from Bihar for a kidney surgery was unable to get preliminary tests done on the scheduled day for the most absurd reason. A CT scan could not be done on her because the department-head was on holiday till the end of that month. And there was none else to do the scan, hospital authorities said, since they were severely short-staffed.

Against this backdrop, the unsettling truth is that India’s population growth is not being matched by investments to enhance medical education or build hospitals at the same pace. And this sets the country up for a critical demand-supply mismatch with costly repercussions.

“India is a short supply story in healthcare,” says Vishal Bali, referring to the shortfall of medical and para-medical staff, medical education, beds and other medical infrastructure.

Bali is co-founder of Medwell Ventures, and in the past, has headed the Fortis and Wockhardt chain of hospitals. “The basic instruction in a hospital is that a medical emergency must be stabilized,” he says. “In the Delhi case, the hospitals may have also been short on paediatric infrastructure and specialists,” he observes.

The way infectious diseases are coming back over the last couple of years (be it H1N1 or dengue), India would be staring at such situations time and again, he cautions, pointing to hygiene and sanitation that still leave much to be desired.

“This is mission critical. The health of the country is in the ICU (intensive care unit),” says Bali, stressing that health be put on the national agenda, with increased funds funnelled into medical education and infrastructure creation.

Across political parties, Governments have promised an increase in healthcare spending to about 3 per cent of GDP (from less than one percent presently). But that has remained no more than a promise, still to be fulfilled.

Amit Sengupta of Jan Swasthya Abhiyan points to the disconcerting trend of some of the affected families having chosen a private institution over a Government hospital. “Public health systems seem to suffer from a trust and perception problem that they do not work, he says. But hospitals are over-crowded because a large number of people in tertiary hospitals do not need to be there. In the case of dengue, except for a small percentage that go into hemorrhagic shock, most tend to recover. Everyone does not need to be admitted, just monitored,” he explains. “But that requires good primary care facilities close-by and they are as good as non-existent. . The tertiary care gets over-crowded because the primary level does not work,” says Sengupta.

In public hospitals, the staff shortage is compounded by inadequate investments in medical technology, pathology (blood testing) and radiology services (X-ray, CT scans etc), he observes.

What ails healthcare is clear to the Government. But the more meaningful part is how effectively it chooses to address these severe shortages. So families like Avinash’s are not required to “know someone” in a hospital (as his grandfather told the media) to get admitted into it.