When red tape turned a noose around little lives

On July 30 last year, in a tiny private hospital in Uttar Pradesh’s Pharenda town, a son was born to Rambha and Sonu Yadav. The couple were ecstatic. But their joy was short-lived. The baby developed breathing difficulties and was referred to the government-run Baba Raghav Das (BRD) Medical College in nearby Gorakhpur.

“The doctors told me that my baby would just not cry,” Yadav says, recalling how he took the new-born on his motorbike to the hospital 44 km away.

On August 10, 2017, the medical college ran out of central oxygen supply. Yadav’s baby died, along with 22 others.

It has been a year since the deaths made national headlines. The Yogi Adityanath government drew much flak, there was outrage all around, and widespread call for an overhaul of the medical facility.

The Ministry of Health and Family Welfare had asked States and Union Territories to improve the quality of postnatal care. They were also asked to suggest a need-based proposal for augmenting infrastructure, capacity-building, equipment maintenance, and for ensuring uninterrupted supply of essential medicines.

A year on, little has changed. No one from the government approached Yadav’s family to probe the case; nor has there been a ‘death audit’: an international best practice in such cases to reach the roots of the matter.

Twenty-three children died on August 10, 2017, of which 14 were neonates. Three days earlier, on August 7, 2017, four neonates had died; the casualty for August 8 was seven; and six on August 9. The figures were obtained from a letter sent to then Union Health Secretary CK Mishra, by the Uttar Pradesh Additional Secretary Anita Bhatnagar Jain, and accessed through an RTI query.

“My baby was doing okay till August 10 (2017). He was admitted to the neo-natal unit. A hustle broke out that day, as nurses took to ambu-bags to resuscitate babies. Parents were not allowed inside. After a few hours, my name was called out on the mike. My baby was handed over to me, wrapped in a cloth,” Yadav said.

Even as the State government admits that oxygen ran out on August 10, 2017, it never conducted a death audit and maintains that the deaths did not occur due to oxygen failure.

Was it a managerial mishap, or was it a larger issue, of crumbling government infrastructure in medical facilities?

While bureaucratic squabbles ensued, the oxygen supplier and four doctors have been released from the Gorakhpur district jail, three clerks and a pharmacist continue to be lodged in the prison.

A drive around Gorakhpur town’s upmarket areas reveals that every other bungalow houses a private medical practice; most of these doctors are either on government rolls or previously employed with the State.

Around the BRD Medical College, contrastingly, there is a strong stench of urine and little children openly defecating within the premises. Across the road from the hospital, chemist shops feature banners indicating that they function as agents for government doctors who run their private practice.

The nearest sub-centre from Yadav’s home in Pharenda is in Machligaon which only opens once a month when a nurse visits for vaccine rounds.

A new primary health centre, built at an expense of ₹1.5 crore, is the proverbial white elephant. Of its 17 rooms, only one is open. Only two of seven sanctioned posts have been filled — those of a pharmacist and a ward boy. While the pharmacist, though unqualified, examines patients, the ward boy doles out antibiotics such as ciprofloxacin for minor ailments. Facilities such as an oxygen machine for resuscitating weak babies at birth are still missing.

And 10 km away, at Kampiar Ganj, a mother-and-child hospital (MCH) is non-functional. National Health Mission documents show that in 78 sub-districts, 30-bedded MCH wings had been proposed at an expense of ₹3 crore each.

The first instalment of ₹1.5 crore for each centre was released by the Centre in 2012-13, and the second and third instalments of ₹75 lakh each were released in 2013-14 and 2015-16, respectively. While the construction is complete in 69 of the 78 wings, none is currently functional.

“Between 2013 and 2015, the UP government built three times the required [number of] health centres with 90 per cent human resource shortage. It was a massive real estate project. How can you run centres without adequate human resources?” asks Shamika Ravi, Member, Prime Minister’s Economic Advisory Council.

Along with paltry human resources, unspent balances of health funds are a major concern in UP. Details accessed by BusinessLine through RTI reveal that between March 2005 and March 2018, the State has had an unspent balance of ₹3,255.24 crore, while an additional ₹3,457 crore was released to the State by Centre in 2017-18.

“It is the State’s duty to ensure that payments are made on time after multiple reminders were sent from medical college for release of funds. More so, what is a few lakh rupees (towards non-payment of oxygen dues) when a massive amount of ₹3,255.24 crore is lying unspent from the NHM budget,” commented a senior official in the Union Health Ministry.

In fact, the 950-bedded hospital attached to the medical college in Gorakhpur that serves 12 districts, does not have a cardiac medicine department or one for cardio-surgery. In case of a heart-attack, the patient is left to the mercy of private nursing homes or transported to Lucknow — 750 km away and a 12-hour journey by road.

Meanwhile, a ‘super-speciality’ wing is under construction, adjacent to the existing medical college. On the other end of the town, about 10 km away, a 750-bedded All-India Institute of Medical Sciences is on the cards, but construction has is yet to begin. The Cabinet had approved a budget of ₹1,011 crore for the AIIMS wing in 2016.

“The construction has not begun yet, as we are still in the process of clearing rubble of the demolished Cane Research Institute. In all likelihood, we will miss the deadlines as we are running late on all counts,” said a site employee from HSCC (I) Ltd, which is the executing agency.

Nearby, an 8-storey, 100-bedded district-run MCH lies vacant. Funds worth ₹20 crore were disbursed by the Centre in three instalments — ₹10 crore (2012-13), ₹5 crore (2013-14), ₹5 crore (2015-16) — under the National Health Mission. The MCH was to be operational by March 2017, public records accessed by Businessline show.

“We should be able to inaugurate it in 2018,” says an official. Construction work was initiated for 53 such hospitals across UP, of which 24 are incomplete. None of them is functional. Now, it has been proposed that they be run in public-private partnership.

While the public health apparatus continues to be wrapped in red tape, conditions remain abysmal on ground. The truth about the baby deaths will likely never emerge.