Concern is mounting in Uttar Pradesh that the government of Yogi Adityanath has got its priorities badly mixed up. Public hospitals in the state are struggling with a mountain of challenges, yet top officials seem distracted on far less important issues.
Over 70 infants – children less than a year old – died in the first five days this month at the Baba Raghav Das Medical College in Gorakhpur. The hospital is the only affordable tertiary-care facility for six districts in the eastern state.
More than 440 infants reportedly died at the hospital in October and total deaths since January are about 1,900. Deaths go up every wet season due to outbreaks of Acute Encephalitis Syndrome and other diseases. However, premature birth, low birth weight and pneumonia also cause many deaths.
The death and admission ratio at this hospital is 1:4. The ratio at other government hospitals in UP is roughly 1:6. All this is happening on the home turf of Yogi Adityanath, the monk-cum-chief minister of India’s most populous state. The BRD medical college hospital is the same institution where 48 kids died, and spurred nationwide outrage in August, allegedly due to a snapped oxygen supply. The government had claimed that not a single death was due to a lack of oxygen supplies.
Media reports have noted the inadequate resources and overburdened staff at this hospital. People expected some action or a solution from the government. Yogi has instead announced a plan to open cowsheds in each of the state’s 75 districts to protect the cows. “If Indian culture has to be saved, then people will have to save Gai, Ganga aur Tulsi (cows, the river Ganges and Tulsi plants),” the chief minister said on November 6.
He also warned people, “If any person indulges in cruelty to cows (leave aside talk of killing of cows), he will find himself behind bars.” Yogi’s love for cows is unparalleled. The backyard of Gorakshnath temple has a big cowshed where he spends a lot of time whenever he’s in Gorakhpur.
The BRD medical college doctors insist the number of deaths has not increased. However, it is not declining either, which should be the cause of concern for the government. “But the CM hasn’t spoken anything on this issue,” his critics say.
India’s worst infant mortality rate
Gorakhpur is not an aberration. Uttar Pradesh has the country’s worst infant mortality rate, according to the fourth round of the National Family Health survey – 64 for every 1,000 live births, which is similar to poor African nations like Mauritania (65) and war-ravaged Afghanistan (66). The national average is 40.
Some 360,000 infants die in Uttar Pradesh (UP) every year before their first birthday. This translates to 980 infant deaths every day, which is unacceptable in the developed world. Over 70% are neonates (less than a month old) who have a far higher risk of mortality than any other period during childhood.
Half of the babies that die within their first month are premature, born before 37 weeks of pregnancy, or have a birth weight of less than 2.5kg, according to data based on the 2012-13 census. Over 13% deaths are attributed to birth asphyxia, 12% to pneumonia and the rest to other diseases.
UP also has the country’s second highest maternal mortality rate, at 258 deaths per 100,000 live births. The state also has a dismal level of mothers delivering their babies at healthcare facilities – 56% is one the lowest ratios in the country. A senior government doctor said, “Most mothers are under 18, anemic and malnourished, who, due to lack of access to contraceptives, have multiple unwanted pregnancies.”
The high rates of infant and maternal mortality suggest that nutritional and ante-natal schemes for pregnant women are also not implemented properly. Clearly, all is not well in the state.
Politics prevail over systemic reforms
Experts say lives could be saved if the state had better medical facilities and an aggressive approach. Educating couples, especially women, would help make government schemes more effective.
But the narrative in the state isn’t focused on the welfare of children. Instead, it is currently dominated by the Taj Mahal controversy to painting everything saffron and protecting cow. “Instead of working on systemic reforms, the chief minister is busy with rhetoric and propagating his party’s ideology”, his opponents say, noting that the state has a huge developmental backlog.
Mr Yogi – known among his followers as “Mahant Ji” – is always seen in a saffron kurta (long tunic) and dhoti (traditional Indian dress). He keeps his head shaved and is still the Mahant (chief manager) of one of India’s biggest temples, Gorakshnath Peeth.
In the seven months since he has taken the charge, his office has changed color, from white to saffron, as have the curtains and chairs. Public buses and even the government’s website have adopted his favorite color. Students are given saffron-colored school bags. The state telephone directory and booklets distributed to mark 100 days and then six months of the Adityanath government are also saffron. “Even sunrise and fire are saffron in color,” the chief minister said recently.
Crumbling system of public healthcare
The public health system is chronically ill because of corruption, private practice and skewed manpower, experts say. “Most government doctors either have their own hospitals or they are associated with some private hospitals. They divert the patients coming to public facilities to their own set-up. Only the poorest ones are left at the mercy of government hospitals, where junior doctors, nurses and ward boys manage things. Naturally, patients’ death figures will be high,” Dr RK Saini, president of an association of doctors in provincial medical service, said.
But the Bharatiya Janta Party (BJP) rejects claims by critics that the government is not focused on healthcare. The party insists that adequate resources are being made available for hospitals and says the number of deaths has not gone up, as television reports have claimed. It also asks why cowsheds shouldn’t be built, and says painting buildings is just “routine work”.
“Those who criticize our plan to set-up cowsheds must explain why they shouldn’t be made. Saffron paint of the secretariat building is being criticized by the opposition parties, though it was routine maintenance work. A color had to be chosen and saffron was picked”, BJP’s state spokesperson Harish Srivastava said.
“Our focus on healthcare and the budget for it hasn’t changed. Two advanced life-support ambulances have been deployed in each district. Over 1,000 doctors have been recruited, [and] the retirement age of serving doctors has been increased and a proposal to reemploy retired doctors is being considered,” Srivastava said.
On the large number of infant deaths at BRD medical college, he said: “The Gorakhpur medical college hospital is the only big facility in the east of Uttar Pradesh. It receives patients from Nepal also. Most kids are already in a critical condition when they reach the hospital. To curb acute encephalitis syndrome deaths, appropriate measures in terms of prevention, vaccination and awareness are being taken.”
“Recruitment of doctors at BRD and other medical colleges is out of the government’s ambit. The number of faculty and other staff in teaching institutions is decided by the medical university, which is an autonomous body.
“The chief minister has held meetings at BRD hospital several times and has given directions to tackle the situation. Things have improved and you must visit the hospital now to check yourself.”
On poor implementation of nutritional and ante-natal programs in the state, he said, “Schemes are being implemented but it is difficult to reach out to every needy citizen.”