State apathy towards healthcare is killing

Maharashtra, India’s wealthiest state, spends a mere 0.7 per cent of its GDP on health. Its health budget went down by 7 per cent this year compared to the last.

An unusual celebration was held recently in Mumbra. The small group of people gathered weren’t celebrating a bonanza for this neglected township outside Mumbai, but only the setting up of a committee by the Bombay High Court to look into the status of an unfinished municipal hospital there — something of crucial importance to them.

Fifteen years in the making, its scope had reduced from a multispecialty hospital to a regular one, even as its costs had escalated from Rs 10 crore to Rs 139 crore. An unknown number of lives had been lost in those years as critically ill patients had had to be rushed 12 km away to the nearest public hospital. An inkling of the lives lost came in August, when 23 patients died in two days at this faraway hospital. Doctors admitted that they just couldn’t cope with the load of an entire district.

A similar factor was at play in the deaths of 31 patients over 48 hours in the Nanded government hospital last month. Built for 500 patients, the hospital had double that number taking treatment when the deaths occurred. The government ascribed these to a long weekend during which private hospitals were closed, admitting thereby that patients came to its facility only as a last resort.

Indeed, a mother who lost her unborn twins lamented that after having received substandard treatment there during her first pregnancy, she had registered at a private hospital for her second. Unfortunately, she was forced to come back to the government hospital.

A news channel’s report showed why all but the most desperate avoided this government facility: pigs shared space with patients’ relatives in the open drain that served as a washing area; the reporter had to cover her nose outside the toilets. In their defence, the hospital’s cleaners said each of them were expected to clean multiple wards. Their grouse was borne out by statistics of vacancies in cleaning staff in government hospitals: at last count, these stood at 42 per cent.

These vacancies haven’t cropped up overnight. In the last three years, the Bombay High Court ordered the Maharashtra government to fill up vacancies including those of doctors and nurses in public hospitals at least four times.

In its frequent interventions in Maharashtra’s public healthcare system, sometimes in response to PILs, other times, through suo motu actions, all that the court has asked the government to do is its duty: ensure its citizens’ fundamental right to health. But while its orders, often savagely worded, have raised hopes among citizens, the government’s refusal to act has repeatedly let them down.

Just two instances would suffice to illustrate how little successive Maharashtra governments care about their citizens’ health. The Bombay High Court started dealing with malnutrition deaths of Adivasi children in Melghat as far back as 1993. In April, it was still passing orders to set up proper health facilities in this backward region, home to the state’s poorest citizens.

Last year, the state’s nurses went on strike against the government’s decision to fill up vacancies by entrusting their hiring to a private agency. Unfazed by this action by a section considered the backbone of any health facility, the dean of Mumbai’s largest government hospital shrugged off its impact, saying that student nurses would be summoned to fill in the gap. In 2021, a top municipal officer even boasted that all that they had to do was pay a lumpsum to the agency entrusted with hiring hospital staff; the salaries would be looked after by the latter.

This time too, after the court asked it not to shrug off its responsibility for the Nanded deaths, the government announced a hiring spree — to be contracted out to a private agency.

To understand the venality of those who have, over the decades, ruled over India’s wealthiest state and Asia’ wealthiest municipal corporation, it’s enough to take a glance at these figures. Maharashtra spends a ‘magnificent’ 0.7 per cent of its GDP on health. Its health budget went down by 7 per cent this year compared to the last.

For the current government, health appears to be the last priority. Neither Chief Minister Eknath Shinde (Shiv Sena) nor Deputy Chief Minister Devendra Fadnavis (Bharatiya Janata Party) visited the Nanded hospital where 31 people died, because the health portfolio belongs to the third party in this coalition. But here’s the rub. The other Deputy Chief Minister, Ajit Pawar, from the Nationalist Congress Party, didn’t bother either.

(Jyoti Punwani is a senior journalist.)

Disclaimer: The views expressed above are the author's own. They do not necessarily reflect the views of DH.