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Aug 14, 2017

Lessons to be learnt from the Gorakhpur tragedy

Oxfam India   /   Diya Dutta

While Gorakhpur is indeed a blot on India’s human development scorecard, it is by no means a unique case. Hyderabad, Malkangiri, Malda, Chattisgarh and the list goes on where precious lives were lost due to institutional apathy, mismanagement and corruption. The Gorakhpur Baba Raghav Das Medical College tragedy, where at least 60 children died due to lack of oxygen, indicates a deeper malaise of lack of political will and government apathy. In a country which at present allocates a mere 1.4 percent of its GDP to health, while 28 percent rural and 21 percent urban population access public health services (as of 2014, Jain, Kumar, Nandraj, Melo Furtado 2015), this is not surprising.


In 2015, 193 governments across the world—including the Indian Government-- made a commitment to reduce inequality and eradicate poverty through the Sustainable Development Goals (SDGs) till 2030. Sadly, India ranks a low 132 out of 152 countries. In other words, it is a country with high inequality combined with a low commitment to doing anything about it. On social spending, which includes health, education and social protection, India has a dismal ranking of 149. How do we hold governments accountable for the promises that they have made in the SDGs?



In the Gorakhpur case, Pushpa Private Ltd, the sole gas supplier at Baba Raghav Das Medical College had written several letters to the senior officials to request the clearance of its dues (Rs 68 lakhs), which were pending for over 6 months. These letters were marked to not just the Head of Department (HoD) of BRD Medical College, but also to the District Magistrate of Gorakhpur; Director General of Medical Education and Training, Lucknow; and the Principal of Secretary Medical Education, UP. There was no response from any of these people. Consequently, the gas supplier had cut the hospital’s main oxygen supply. The price of the hospital’s callousness was thus paid by poor families, which turn to government health facilities, as they cannot afford private health care.


These kind of tragedies break down the faith and confidence of people in government services forcing them to turn to private health service providers in the hope of better care. The exorbitant expense of private health care facilities often pushes these families into deep debt and poverty. In a country that is one of the most unequal countries in the world, this should worry the political leadership. The state of affairs in government hospitals, which are understaffed is appalling. In India, we have 1 doctor per 1700 patients whereas WHO prescribes 1 doctor per 1000 patients. This means that there is a shortage of 5,00,000 doctors in the country, along with ill-equipped facilities, lack of enforcement mechanisms to ensure quality, and the governance makes the public healthcare system unfeasible. Related to this is the lack of health insurance in a country where the public health system is faltering. Health shocks are one of the biggest reasons why people slip into poverty and sharpen inequality. Unlike other countries such as Germany, Japan and Thailand, India is yet to find an effective model of universal health insurance coverage which can pool in resources and distribute health risks within the population.



The Government cannot wash its hands of its duty to provide free and good quality health services to the poor. The indifference in the system must go and the faith of people in government services restored. The new National Health Policy 2017 espouses that the government is committed to raising healthcare expenditure to 2.5% from its current 1.4% by 2025. Yet that is too little too late.



There is a need to increase healthcare expenditure to 5% of GDP in the coming years. Government also needs to make efforts to infuse more healthcare professionals into the system. India also needs to learn from other countries that have successfully adopted universal healthcare systems, which prevent its populations from health shocks, and the vulnerability to slip into poverty. At present, the alternative to the ineffective state-run healthcare systems is private healthcare—72% rural and 79% urban population (as of 2014. Jain, Kumar, Nandraj, Melo Furtado 2015)—which is both expensive (at times unaffordable and leads to further debt and loans for the poor), and poses serious issues on quality.


It is essential for the government to put in place effective monitoring and governance mechanisms, which ensure quality and value for money in the private sector. Above all, the government cannot abdicate its responsibility to provide quality healthcare, which is affordable to millions of Indians, to its citizens especially the poor. State sponsored healthcare should be an official tool to check rising poverty and inequality in the country. The government must strive to reverse the current figures of state vs. private healthcare seeking behaviour of the population and bring in more and more people within government –sponsored healthcare systems. 



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