Patna: Amidst criticism over poor health infrastructure, Bihar’s poor rank when it comes to the availability of beds at district hospitals, in the recently published NITI Aayog report has increased pressure on the Bharatiya Janata Party-Janata Dal (United) coalition government.
The report, titled ‘Best practices in the performance of districts‘ was released by the National Democratic Alliance government at the Centre last week. It is a joint output of the Union Ministry of Health and Family Welfare, the NITI Aayog and the World Health Organization.
In a unique scenario, the Bihar chief minister, Nitish Kumar, and the state health minister and senior BJP leader Mangal Pandey have both criticised the NITI Aayog over the report.
The report states that only six beds are available for one lakh people in the districts of Bihar – the lowest compared to any other state. Puducherry is on top with 222 beds per lakh.
According to the Indian Public Health Standard (IPHS) guideline, 2012, the number of beds for a population of one lakh should be 22.
Around 36 district hospitals of Bihar and 707 district hospitals from the country have been assessed in the report. The exercise was done from December 2018 to 2019, just before the pandemic broke out.
NITI Aayog member Vinod K. Paul wrote in the foreword to the report, “It is the first comprehensive assessment of the performance of district hospitals in India.”
According to the report, out of the 36 district hospitals assessed in Bihar, only three hospitals followed the IPHS norms in terms of availability of doctors, while only six hospitals could meet the these norms in terms of the presence of nurses. Similarly, in the case of para-medical staff, only 15 hospitals met the IPHS standard.
Not a single hospital in Bihar is included in the list of 26 top performing hospitals in the report.
However, in some indices of the report, hospitals in Bihar fare well. For example, Sadar hospital of Saharsa district is among the top district hospitals doing better in terms of the surgical productivity index. Similarly, several hospitals, including Sitamarhi Sadar Hospital, are among the better performing hospitals in identified support services.
Bihar ministers’ reaction
Since the formation of the NDA government in Bihar in 2005, except for two years between 2015 and 2017 (when Tej Pratap Yadav was the health minister), the health department has remained with the BJP. This report raises questions on the performance of this NDA government in the health sector.
Rashtriya Janata Dal leader and former deputy chief minister Tejashwi Yadav sharply criticised the Nitish government over the report. He tweeted, “Congrats to Nitish ji for making Bihar No.1 from the bottom up with 16 years of tireless hard work. Bihar is getting amazing benefits of 39 out of 40 Lok Sabha MPs and a double engine government. According to the report of NITI Aayog, Bihar has the least number of beds in district hospitals in the country, only 6 beds per 1 lakh population.”
Both Nitish Kumar and Mangal Pandey, after initially leaving the report unaddressed, later questioned the way the NITI Aayog had prepared it.
The chief minister said, “It is not right to prepare a report by considering all states in the entire country equal. The report cannot be prepared by comparing the richest and poorest states.”
“I don’t know how and with whom the NITI Aayog works with to prepare such reports. What was the state of health in Bihar earlier and how much has it changed now? A lot of work has been done in the city as well as in the villages. Bihar has come a long way in improving health facilities. Yet NITI Aayog does not see these things,” he said.
“There are several things that have been wrongly said (in the Niti Aayog report) about Bihar,” Nitish also said.
Health minister Mangal Pandey, meanwhile, said that the NITI Aayog should have also included the condition of the health sector in Bihar before 2005.
Pandey was referring to the tenure of Lalu Prasad Yadav and Rabri Devi – the RJD was defeated in the 2005 Bihar assembly elections and the JDU-BJP alliance came to power.
Pandey said, “NITI Aayog thinks in its own way, on its own scale. It would have been better for the NITI Aayog to tell the people of the state what the (health) situation in Bihar was before the year 2005…what facilities were available, how many medicines were available in hospitals…”
He further said, “If the NITI Aayog had mentioned how many doctors and nurses were recruited, and how many facilities were available to patients before 2005, then the people of the country and the state would have got an idea about development in the health sector.”
On the ground
The Wire spoke to some families who lost their loved ones during the second wave of COVID-19. An overwhelming number considered medical infrastructure at the district level very poor, robbing many of the chance to recover.
Fifty-six-year-old Prabhu Ram, a resident of Sheohar district, was working in a government department in Siwan, his health started deteriorating and he developed shortness of breath. He was sent from Siwan to Sheohar, but due to lack of adequate oxygen arrangements at the Sheohar Sadar Hospital, he could be kept there only for a day.
His wife Niharika told The Wire, “We brought him to SKMCH Hospital in Muzaffarpur on April 30 due to lack of treatment facilities at Sadar Hospital. There was not even an empty bed. A COVID-19 patient’s death meant that we were able to get a bed, but my husband died two days later, on May 2.”
“Had there been a better medical system at the Sadar Hospital in Sheohar, my husband could have survived. The medical infrastructure in Sheohar is extremely poor. There are no treatment options in the government hospital of the district. Patients are referred from there to Patna or Muzaffarpur,” said Niharika.
Seventy-year-old Madan Mohan Sharma, a resident of Gaya town, tested positive for COVID-19 but could not be admitted to the government hospital due to shortage of beds. He died days after he was discharged from a private hospital.
His relative, Nitindra Kumar, told The Wire, “He was very critical but Anugrah Narayan Medical College and Hospital did not admit him citing shortage of beds. Later, we admitted him to a private hospital. He was discharged from the hospital but died after three days.”
Kumar feels that a government hospital would have been able to give Sharma the treatment he needed.
‘Take report seriously’
Health experts say that while the NITI Aayog report can be criticised at many levels, the Bihar government would do well to pay heed.
Public health expert Dr Vikash R. Keshari told The Wire, “The government should take the report seriously and work on improvement of healthcare facilities at the district level.”
“The report has no baseline data to indicate how much progress has been made in the last decade or during a certain period. So, the Bihar government is right to some extent in questioning the method of preparing the report,” he added.
Keshari added that the report should have formulated an action plan instead of just offering data.
Dr. Ajay Kumar, the senior vice-president, Indian Medical Association’s Bihar chapter, said, “We cannot say that nothing has happened in Bihar. Government has improved health facilities but we still have deficiencies,”
“So we should take the report in true spirit and improve health facilities further instead of denying or politicising it,” he told The Wire.
(Courtesy: The Wire)
