It’s Code Red on the critical state of the nation’s health

The last few weeks could well go down as among the darkest periods for healthcare in the country, in recent times.

Doctors were on strike across cities protesting violence against them by patient families, children are dying of seasonal encephalitis, hospitals are ill-prepared to address this emergency, reports suggest infants landed up in an ICU (intensive care unit) after being given diabetes medicines instead of paracetamol in a post-vaccination exercise, doctors are committing suicide, exposing fissures in medical institutions — the disconcerting list warns of tremendous pressure being put on the existing healthcare system.

Healthcare is in a state of emergency, a crisis arising from the lack of adequate spending on resources and infrastructure, besides inconsistent political support. There have been attacks on doctors in the past and incidents of children dying for want of adequate healthcare, but this clustering of incidents and the all-India doctors’ strike is the first of its kind, cautions Dr K Srinath Reddy, President, Public Health Foundation of India.

As hospitals are faced with a shortage of doctors and para-medical staff, patient care takes a massive hit, leading to distrust and increased anger.

It is not uncommon to run into situations where CT scans are not done in a Government hospital as the machine is under repair or the in-charge is on holiday. Shortfalls are reported, across the country, on oxygen supplies, medicines, etc. And ill-trained staff give rise to situations where patients are misdiagnosed and treated.

For years now, medical experts have urged successive Central governments to increase India’s spending on healthcare and the promise now is to increase it to 2.5 per cent by 2025. But is that enough?

Reddy points to Government reports that want States to up their health spends to 8 per cent of the total State spending by 2020. That is next year, he says, wondering from where States will bring in these additional funds. The Finance Commission should give States some direction on how to raise these funds and the Centre needs to give grants to States like Bihar, witnessing the tragic death of more than 100 children due to seasonal encephalitis.

Caught in politics crossfire

Allegations abound that health officials in Bihar were involved with the Parliamentary elections which is why they failed to alert parents on the lychee-seed linked metabolic encephalitis that could kill children. Reddy says, “health needs to go beyond politics and Governments”.

Since health is a State subject, it is often caught in the crossfire of politics between the Centre and State governments, resulting in the crisis that patients experience these days. “India suffers when the health of its people in any State suffers,” says Reddy, adding that the country will not be able to achieve its economic growth projections if its health fails.

Public health workers urge the Centre to increase budgetary allocation to over 5 per cent of GDP to invest in infrastructure, training, services and resources. Doctors suggest that district and private hospitals be converted to teaching ones to expand the doctor base and encourage those from the region to stay on and serve the local population.

An increase in hospitals and its services should, for instance, include support and redress systems for doctors to help cope with pressure or report bullying to avert suicides. And well-staffed patient grievance cells should be trained to tell patients their rights, explain procedures, outcomes and pricing, besides cautioning against attacking doctors or the hospital.

Training of doctors, para-medics and support staff levels cannot be emphasised enough. Explaining the need for standard operating procedures (SOP) and training, against the backdrop of the Muzaffarpur tragedy, Dr Gagandeep Kang, Executive Director with the Translational Health Science and Technology Institute, explains that a seasonal illness has causative drivers, which could be mosquitoes or food toxins, for instance, and a good diagnostic system is needed to know the difference.

Then comes treating or managing the patient’s illness, and then there is the aspect of prevention, she says. “Being able to recognise and manage illnesses requires trained staff. Junior doctors are the first line of call. Since administrative staff keep changing, it is important to have SOPs and a preventive strategy to act before an outbreak,” she says.

Well-reasoned suggestions are close at hand from patient-groups, doctors and experts to address the pressure cooker scenario of healthcare in the country today. However, the question is, are politicians willing to listen and drive the change that’s required?