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Over the past few years, frequent incidences of infant deaths at the government run hospitals pointed to a deeper crisis of the health care system in India. The major concern and the way out after recent incidence of infant deaths in Rajasthan’s Kota district (a Congress-ruled state) could be sorted out by seeking government attentions for ensuring accountabilities, but the unfortunate news of infant deaths in Gujarat’s Rajkot and Ahmadabad district, (a BJP ruled-state) calmed down the opposition to wind up the blame-game story. The ill-fated news of 319 infant deaths at state-run hospitals of Rajasthan and Gujarat in December 2019 sparked the controversy afresh prompting number of question marks on health administration in India. The repeated incident of infant deaths at government run hospitals has been hitting the news, particularly after the infamous Gorakhpur tragedy of 70 child deaths in a couple of days in the month of August 2017. In post independent India, the repetitively incidences of the infant and child deaths in several parts of the country put a blot on our governance as administrative lapses always have been one of the causes of the incidences. The poor and the downtrodden sections of the society have always been on the victim – side of such ill-fated disasters occurred at government run hospitals as they are un-reached and uncovered from highly affordable health accessibilities. Despite the existence of public health into the state list, providing quality health care accessibilities among all the people still remain a chronic challenge before every government due to financial constraints and pitiful infrastructure. Therefore, redefining health administration needs to be brought into the thrust area of the government. The following five ill-fated tragedies of infant and child deaths in government run hospitals clearly illustrate administrative lapses and medical negligence of state governments for the last four years.

Rajasthan’s Kota tragedy of infant deaths in December 2019

The nationwide headlines with full of media coverage of 104 infant deaths in December 2019 at the J.K. Lon Maternal & Child Hospital, Kota, Rajasthan acted as a flame for political infighting over the cause of the deaths.-this is not a new turn of events. Over the course of 2019, the hospital already recorded 940 infant deaths prior to the nationwide headlines of 104 infant deaths in the month of December. Putting the political blame-game story aside, the Kota tragedy unduly exposes full of administrative lapses and medical negligence such as crumbling infrastructures, financial constrains, acute shortage of medical practitioner etc unmasking the health care system of India. The National Commission for Protection of child rights (NPCR) in its fact finding report mentioned glaring discrepancies at hospital, including shortage of functional ventilators, life support equipments and also the unavailability of faculty as per the MCI norms. Therefore, administrative lapses of the hospital needs to be introspected and analyzed in-depth by the Congress government apolitically.

The administrative lapses into the Kota tragedy may also be linked with the existing state budget, which lacked focus and commitment, had left public health sector starving for adequate resources as budget allocation for health sector has gone down from 6.16 percent in 2018-19 to 5.97 percent for the current year. The reduction in health share allocation signifies overall undermining of public health care leading to effect on functioning of public hospitals in Rajasthan. Though, financial constraints for every state government have been one of the chronic challenges, creating hurdles in public health care since independence.  Now, redefining our health administration as well as ensuring accountabilities towards the causes of the deaths at government run hospitals becomes a need of the hour.

Gujarat’s Ahmadabad and Rajkot tragedy of infant deaths in December 2019

The news of 219 infant deaths in two government hospitals of Gujarat state in the month of December 2019 also spread nationwide headlines revealing maladministration from several viewpoints. The tragedy in the BJP ruled state acted as a censure of the existing model of development of Gujarat unmasking all the developmental proclamation as made by Narendra Modi during the 2014 general election. In an industrialized and developed city, namely Rajkot, there have been 134 infant deaths at the civil hospital in the last month of 2019 and a total 1,235 infant deaths throughout the year. And, at the same time there were 85 deaths in Ahmadabad civil hospital in December and 253 deaths in the last three months of the year. The rising figure of these causalities in government hospitals happens to be a matter of concern as health care remains as a major component of the development.  Government’s expenditure on health sector accounted 4.5 percent of the 2018-19 budgets, which are much lower than a number of other states in India. The reduction of allocation in the health share signifies overall disheartenment of health care creating hurdles in the functioning of hospitals. Therefore, the health sectors should be prioritized so as to make public health care as a quality and accountable resolving the lapses and negligence occurring due to financial and other constraints.

Bihar’s Muzaffarpur tragedy of infant deaths in June 2019

In June 2019, the nationwide news of 132 encephalitis deaths of children in government run Sri Krishna Medical College and Hospital (SKMCH), Muzaffarpur, Bihar traumatized the nation in which administrative failure” and the “state’s apathy towards people” became the proven causes of the tragedy. The deaths have been continuing for the last 10 years, which were unnoticed and unexposed of administrative failure of the government. The government lacked in preventive mechanism as well as health awareness for specific illness responsible for the fatal infant deaths at government run hospitals. Though, the roles of doctors have been appreciable for their hard working and overtime, despite lack of resources and poor infrastructure in the hospital. Hence, the focus of the government deserved to be on strengthening the health care infrastructure so that such disasters can be prevented over the time. The financial position of health administration needs to be strengthened in the state budget allocation in order to provide quality health care as prevailing huge poverty in the state itself becomes a challenge. Therefore, redefining health administration institutionally and financially becomes a matter of compulsion.

UP’s Gorakhpur tragedy of infant deaths in August 2017

The infamous Gorakhpur tragedy of 200 infant deaths in the year 2017 always happens to remember such two days of darkness of health administration exposing insensitivity towards lapses and negligence at BRD medical college led to a huge shortage of oxygen supply responsible for the deaths. The inquiry committee revealed administrative failure of hospital administration including financial lapses and unavailability of life support equipments responsible for the fatal tragedy. Although, the tragedy has been utilized as a weapon for political parties putting blame each other without any concrete responsibility.   Later on, there have been long political rift between government and oppositions parties. Though, the administrative lapses of non-payment of bill of Rs. 50 lakh forced the company to cut off the supply of oxygen led to the causes of the infant deaths over the night. The accountability has always been a missing aspect of the health administration, despite health finds its place in state jurisdiction. Although, the Gorakhpur tragedy acted as a solid and the long time appetite of the media running a business through debate and discussion, but did not sensitize the issues for redefining health administration in India.

Conclusion

With the passing of just two years, India would attain its 75 years of independence with full of revolutions in all areas of development leading to be a developed country. But, the rising number of infant and child deaths occurring in government hospitals for the last four years gives a wake-up call for introspection as well as redefining health administration. The above five mentioned incidences of tragedies keeps us reminded for the reform at policy level as administrative lapses and medical negligence always became one of the causes of the tragedy. At the same time, financial strengthening must be prioritized by the government so as to redefine health administration including provision of autonomies for resource utilizations. In India, primary health care happens to be highly dependable on budget allocation depending upon bureaucratic channel. The World Health Organization testimonies that infant deaths within the first 28 days of birth often suffer from conditions and diseases associated with a lack of quality care at birth or in the days immediately after.

Dr Ahmed Raza, Assistant Professor, Department of Public Administration, MANUU (a central university), Hyderabad, India


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