Gorakhpur's creaky health infra: Tragedy was waiting to happen

The death of over 60 children within the span of a few days at Gorakhpur's BRD Medical Collegehas caused ripples of shock and anger across the country and abroad too. As state and central government ministers and officials scramble to find out what actually happened, ground reports seem to indicate that, as suspected, oxygen supply to the children's ward and the ICU had indeed run out.

But the moot question is: Was this tragedy just waiting to happen? Preliminary investigations suggest it was certainly deemed to occur. BRD Medical College is one of the few tertiary care public hospitals in this heavily populated region of Uttar Pradesh that caters to over 3.5 lakh outpatients and 40,000 inpatients every year.

While BRD's creaking infrastructure and mismanagement have played a role in the deaths, a larger question may again be bypassed - Why is BRD Hospital a "big centre" to which patients, not only from Gorakhpur but others districts around it, come in thousands? After all, many of their diseases (including Japanese Encephalitis) and treatment procedures do not require super-specialty level medication. So, why is it that a person has to go to BRD only to be treated for Japanese Encephalitis?

A look at Gorakhpur's health infrastructure reveals the chilling state of affairs. Just 11 primary health centres out of 68 in the district function 24x7 - which is what they are mandated to do. There are just six first referral units in the whole district which has a population of nearly 45 lakhs. There is just one sick new born care unit and only three new born stabilization units in the whole district.

In fact the reach of the much-vaunted mother and child health programmes of the government is also severely limited. Although estimated deliveries in 2015-16 were 1,29,429, based on the past trends and number of women in child-bearing age, the reported live births in the district were just 58,674 - that is, 45% of the total. Clearly 55% of the children were born outside the whole institutional framework .

A glance at Gorakhpur's National Health Mission district-level approved budget for 2016-17 reveals some bizarre and misplaced priorities of the officials. Of the Rs 82.46 crore allocated to Gorakhpur district, child health and the Rashtriya Bal Swasthya Karyakram (National Children's Health Program) together account for a measly Rs 1.89 crore - that is, just over 2% of the total.

In contrast, family planning is allocated Rs 1.61 crore, and health personnel get Rs 10.6 crore.

But simply allocating more resources is of course not the solution because as another report shows, health personnel in the state are distributed in the most imbalanced way with Lucknow division having 187% of its requirement of obstetricians and gynecologists while Goraphpur has 83% and neighbouring Azamgarh just 50%.

Similarly, while Kanpur has four general surgeons for every sanctioned position, Gorakhpur has about one for two sanctioned posts. So, while the oxygen supply issue needs a quick and just resolution, a deeper look at what plagues Gorakhpur’s healthcare system is urgently needed.