Bio Edit

BioSpectrum (India) - - BIO CONTENT - Milind Kokje Chief Edi­tor milind.kokje@mmac­

Some re­cent re­ports and news about health­care sec­tor are alarm­ing as they bring into fo­cus two im­por­tant an­gles – grow­ing dis­ease bur­den on one hand and sharply con­trasted in­ad­e­quate health­care fa­cil­i­ties, par­tic­u­larly at the grass root level on the other.

World Health Or­gan­i­sa­tion (WHO) in its re­cent re­port high­lighted that 61% of deaths in In­dia are at­trib­uted to non-com­mu­ni­ca­ble dis­eases (NCDs). Al­most 23% are at risk of pre­ma­ture death due to such dis­eases. NCDs caused over six mil­lion deaths in In­dia in 2016 as per the Global Bur­den of Dis­ease (GBD) study pub­lished in Lancet last year. In­dia is at the 127th po­si­tion among 188 coun­tries in achiev­ing UN’s health re­lated sus­tain­able de­vel­op­ment goals (SDGs).

In­dia’s poor per­for­mance on health­care front gets ex­posed by fre­quent news about deaths of pa­tients due to in­ad­e­quate fa­cil­i­ties in hos­pi­tals. It is also due to the fail­ure of the au­thor­i­ties to reach the health­care fa­cil­i­ties to the sick peo­ple in re­mote ar­eas. A re­cent re­port pointed out that while the govern­ment is set­ting up new All In­dia In­sti­tutes of Med­i­cal Sci­ences (AIIMS) at dif­fer­ent places, five ma­jor projects in a cam­pus of AIIMS in Delhi, which started in 2014, are de­layed due to lack of funds. First the be­gin­ning of the work on im­ple­men­ta­tion of these projects de­layed by a decade af­ter they were pro­posed and even af­ter the work be­gan it got fur­ther de­layed.

The fail­ures of au­thor­i­ties on var­i­ous such counts are no more re­stricted only to the pub­li­ca­tion of news, but the Comptroller and Au­di­tor Gen­eral (CAG) has now of­fi­cially nailed them in its re­cent per­for­mance au­dit re­port, leav­ing no scope for any counter ar­gu­ment.

The most in­ter­est­ing part of this re­port is that paucity of fi­nan­cial re­sources is gen­er­ally cited as the cause for in­ad­e­quate in­fra­struc­ture in the govern­ment sec­tor but that is not the case here. A mas­sive Rs 9,509 crore re­main un­spent in the Na­tional Ru­ral Health Mis­sion in 2015-16. It is not a case of a sin­gle year. This amount has steadily in­creased from Rs 7,375 crore in 2011-12.

While the funds on such a large scale re­main unutilised, health­care in­fra­struc­ture in var­i­ous forms, in­clud­ing sub-cen­tres, pri­mary and com­mu­nity health cen­tres re­main in­ad­e­quate. The short­fall ranged be­tween 24% and 38% and in case of five states the fa­cil­i­ties are only half of the re­quire­ment. In over 1200 cases the con­struc­tions have been done but the fa­cil­i­ties are not op­er­a­tional.

Same is the sit­u­a­tion of equip­ment, drugs, and hu­man re­sources. Equip­ment is in short sup­ply at some places and where equip­ment exit they lie unutilised due to non-avail­abil­ity of the re­quired hu­man re­sources. Average short­fall of five types of spe­cial­ists ranged from 77% to 87%. Short­age of nurses in 236 Con­trib­u­tory Health Ser­vices Scheme (CHSs) is over 1000. Drugs are not only in short sup­ply, but where they are avail­able they are given to pa­tients with­out con­duct­ing qual­ity checks and with­out ob­serv­ing ex­piry dates. The per­for­mance re­port points out to the in­ad­e­qua­cies in the ru­ral health­care in de­tail.

The CAG has shown the to­tal ne­glect of the ex­ist­ing fa­cil­i­ties and in­fra­struc­ture in the health­care. As a re­sult of this the min­istry cur­tailed the cost es­ti­mates of Na­tional Health Mis­sion 2020 fol­low­ing the crit­i­cism of the in­ad­e­qua­cies by NITI Aayog and fi­nance min­istry. The es­ti­mates are cur­tailed when the ru­ral ar­eas re­quire much more health­care fa­cil­i­ties with more spend­ing.

The re­port is cer­tainly an eye opener for all. But more than that, it can be also looked at by the union and state govern­ments as an op­por­tu­nity to take cor­rec­tive steps on an ur­gent ba­sis for speedy im­prove­ment. Oth­er­wise, it will con­tinue to re­main as one more re­port like many pre­vi­ous ones, gath­er­ing dust.

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