New Trade Union Initiative
The tragic death of one more child in Baba Raghav Das Medical College hospital in Gorakhpur, which was the parliamentary constituency of Uttar Pradesh Chief Minister Yogi Adityanath since 1998, on 17 August, possibly due to encephalitis, raising the number of deaths to 72 in the hospital since 7 August, brings to the fore the abysmal state of public healthcare in Uttar Pradesh and in the country. It symbolises the striking government apathy towards the medical well-being of its citizens, and most crucially newborns, infants and children. The deceased were patients in either the Encephalitis or Pediatrics wards. The highest number of deaths was recorded on 10 August with 23 deaths. The deaths were caused by a spread of infections among patients, further accentuated by a shortage in supply of liquid oxygen. As per news reports, stocks of oxygen were withheld by the private vendor, Pushpa Sales Private Limited due to nonpayment of outstanding dues amounting to Rs. 70 Lakh.
Who is culpable?
The District Magistrate (DM), Rajeev Rautela, denied the deaths being caused due to shortage of oxygen supply while the District's Superintendent of Police attributed 21 fatalities to just that. In order to transfer the liability, the Health Minister, Siddarth Nath Singh, claimed that hospital officials did not inform the government about the oxygen crisis. From late March 2017, the now suspended principal of Medical College, Dr. Rajeev Mishra, had made several requisitions for funds to government, including to the Health Minister and the Minister for Medical Education.
The current crisis is not an aberration. The Medical College Hospital has witnessed over 3000 deaths since 2012. These are among 50,000 odd children killed in eastern Uttar Pradesh over the past three decades, most of them due to Japanese encephalitis (JE) and acute encephalitis syndrome (AES). The government’s indifference to this is evident from the recent statement of the Health Minister that “a lot of people come suffering from high fever and if they don’t get treated, it may result in death.”
A magisterial inquiry was ordered on the incidence of deaths. This report, submitted on 17 August, states that “Oxygen supply is an emergency service and the company cannot suspend supply” thereby holding the supplier company liable. The DM further held Dr Satish Kumar, head of the department of anaesthesia and a member of the purchase committee of the hospital, as being primarily responsible for the deaths for being on leave on 11 August without informing the principal. Further, he was held responsible for not ensuring the repair of a faulty air conditioner installed in the encephalitis ward.
The Uttar Pradesh Chief Minister, Yogi Adityanath, has claimed lack of knowledge of the problem. Between 2002 and 2016 as the Member of Parliament from Gorakhpur, Adityanath raised the issue, on nearly 20 separate occasions, in the Lok Sabha ranging from limitations of infrastructure at the BRD Medical College and Hospital to the need for an AIIMS in Gorakhpur, the importance of timely vaccination and the lack of any concerted action by state or centre in tackling the encephalitis epidemic through written questions and during debates in the house.
The paucity of funds for infrastructure development in public health system, especially in the BRD Medical College and Hospital was unambiguously known to Adityanath. Transferring the culpability of criminal negligence to the medical fraternity, and the civil service in a belated attempt through the Chief Secretary’s report of 22 August 2017, in a situation of the failure of the state government to meet its financial obligations and infrastructure failure in a public hospital is only an act of evasion by both Chief Minister and the Health Minister. It is by now well established that knowledge of an existing problem makes elected officials culpable for negligence and failure to act too.
Why this crisis?
In 2015, the NITI Aayog labelled free health care a “chimera”, objected to increasing investment in public health, including on providing free medicines and diagnostic services. Its ‘Model Concessionaire Agreement’ effectively plans to privatise district hospitals in non-metropolitan areas. This directly contradicts the promise of universal health care in the 12th Five Year Plan.
The Central government cleared the long-awaited National Health Policy 2017 in March 2017 promising to increase public health spending to 2.5% of GDP, compared to 10.4% in China and 12.8% in Kenya. Though budgetary allocation has increased successively, the shift in focus from primary healthcare to secondary, tertiary and specialty institutions has led to a public healthcare crisis as in the Gorakhpur case. The shift in focus has been accompanied by the parallel policy drive to privatise, to suffocate public health facilities and services through de-funding, discrediting and divesting.
India is a signatory to the Alma Ata declaration of WHO that puts health as a fundamental human right, and recognises governmental responsibility for the health of its people which was and is to be fulfilled by the provision of adequate health and social measures.
The NTUI has always understood free access to universal healthcare as an essential and necessary component of social security provision. The Gorakhpur tragedy only reinforces our demand and our resolve to press for it particularly when the BJP government at the centre is determined to take down what exists of the public health system.
The NTUI demands:
1. An inquiry, headed by a retired Supreme Court judge, into this incidence of negligence, including that of the UP Chief Minister and the Health Minister.
2. Payment of adequate compensation to families who lost their children.
3. A white paper by the Union Government to put in place a timetable for adopting, implementing and making available the finances for creating universal public health system as recommended by the High Level Expert Group on Universal Health Coverage submitted to the Planning Commission in November 2011.
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