Seeking accountability

Gorakhpur shows political will necessary to reform health care

Reports that almost 30 children had died in 48 hours, and over 60 in five days, in Baba Raghav Das (BRD) Medical College in the eastern Uttar Pradesh town of Gorakhpur have naturally touched off something of an uproar. It is true that the area is subject to seasonal upsurges of Japanese encephalitis, a mysterious disease that is spread by a mosquito-borne virus, which has tragically afflicted children for decades. But on this occasion, the ravages of the disease appear to have been clearly compounded by administrative errors — oxygen in the hospital had run out, reportedly because the hospital was months behind in paying the dues to its oxygen supplier. And, further, on one of the five days in question, the hospital had actually been visited by Uttar Pradesh Chief Minister Yogi Adityanath — who till recently, not so coincidentally, represented the city and environs of Gorakhpur in the lower House of Parliament since 1998. It would be unfair to blame all these dozens of deaths squarely on the chief minister and the current government of UP. The failure to deal squarely with Japanese encephalitis is not entirely the fault of the local people’s representative, and Mr Adityanath inherited a corrupt and creaking health infrastructure in the state.

That said, it is clear that there are problems in how he has set out to reform it. The UP Budget, when it was presented, did not appear to be structured to make health investment a priority, nor has there been any visible attempt to shake up the supervision of government hospitals. Mr Adityanath and the Bharatiya Janata Party do not appear, in effect, very different from their predecessors. All political parties seem content to let the existing health system continue unreformed, even if it is based around patronage, bribery, corruption, and exploitation. These four characteristics all seem to have been on display in the administration of BRD Medical College and appear to have led to these tragic deaths. Yet the first response of the government was to shift responsibility away from systems to individuals; a hospital administrator has been suspended, as has a surgeon who made the obvious mistake of talking to the press. And, most tellingly, a First Information Report has been lodged with the police naming the unfortunate private company that suspended oxygen deliveries after months of reminders about overdue payments.

This tragedy should focus attention, first, on the complicity of the political class in maladministration; and, second, on the lack of efforts to solve the puzzle of Japanese encephalitis. But the systemic problems with Indian government health care should not be lost sight of. Procurement, as is seen in this instance, is hopelessly corrupt. Doctors seek supplementary private employment. The regulation offered by the Medical Council of India can be charitably described as a joke. State governments use health care, medical procurement and hospital colleges as sources of patronage. But, as this newspaper has recently argued, a complete privatisation of health care, along the lines suggested by a recent NITI Aayog paper, is also not a reasonable way out. There is no alternative, in other words, to reform the institutional control of public health care delivery. That will take political will. And political will can only emerge from political accountability. Let there thus be political accountability for the Gorakhpur tragedy.