Co-Written by Tehzeeb Anis & Prof. Mohammad Akram
After three consecutive lockdowns, the countrywide lockdown got extended again for another two weeks in the form of Lockdown 4.0. This episode of lockdown is witnessing extended relaxation related to travel, market and permission to work in specific sectors. Lockdown is used by the union government as the main instrument to combat the spread of Covid-19 in India but after spending more than two months under lockdown, the expected benefits are mixed and the situation is very volatile for most of the states of India. Certainly this lockdown has thrown many challenges on the states. India is witnessing an increase of about one hundred thousand cases of Covid-19 infection in last three weeks. Bihar is one of those states which are facing several serious problems not only because of outbreak of Covid-19 but also because of return migration of hundreds of thousands of skilled and unskilled workers from different states who have returned because of non-availability of work at their places of stay, caused due to sudden lockdown. The challenges for this state is increasing everyday in this phase as more and more migrant people are returning to their home towns and the pressure on the existing healthcare facilities is increasing.
This corona virus pandemic is creating humanitarian crisis all over India, but the condition is almost worst in the state of Bihar as it has high out migration rate, low level of employment, lack of basic infrastructure and low literacy rate. According to Census of India, Bihar is the second state with highest number of out-migrants. Bihar is one of the poorest states of India with around 33% of the state’s population living below poverty line. In terms of Human Development Index (HDI), Bihar remains at the bottom with 0.576 HDI. This poor HDI is cumulative result of the poor healthcare facilities, lack of employment opportunities and poor literacy rate. The Health Index report suggests that in Bihar, the deterioration between Base Year and Reference Year was primarily due to the performance related to total fertility rate, low birth weight, sex ratio at birth, TB treatment success rate, quality accreditation of public health facilities, and time-taken for NHM fund transfer.
Life expectancy is a very important health indicator which is used to describe trends in mortality in any state. Life expectancy increases when the older generation lives longer and the younger ones dies less. In India, life expectancy has very much increased since 1990 because of reduction in child and maternal mortality and improvement in conditions of healthcare facilities and reduction in the life threatening diseases. Life expectancy of Bihar in 2012-2016 is 68.7 years, out of which the life expectancy for male and female is 68.9 and 68.5 years respectively, which is a matter of concern because since 2000-2004 it hasn’t increased much. In 2000-2004 it was 64.1 years. This is an indicator of poor healthcare conditions prevailing in the state.
Now, the most important question to be raised here is what are the potential threats due to Covid-19 in Bihar because of prevailing morbidity patterns? To understand this, we have analyzed the prevalence of diseases that have caused the most deaths in different age group as it helps to understand the prevailing morbidity conditions in the state. According to Bihar’s Diseases Burden Profile 1990-2016, in the age-group of 0-14 (18.6% of total deaths), most deaths (39.5%) has been caused by diarrhoea and lower respiratory infections and 31.8% of the death in this age group has been caused by neonatal disorder. In the age group of 15-39 years (11.6% of the total deaths), most death (13.5%) is caused by neurological disorders, 13.4% of the death in this age group is caused by Neglected Tropical Diseases (NTDs) and 11.8% of the death is caused by diarrhea and lower respiratory diseases. The lesser number of deaths has been caused by diabetes/urogenital and endocrine disease (3.9%) and the rest by several other diseases. The age group of 40-69 years (38.2% of the total deaths) experienced the highest percentage of deaths. Most of the deaths (33.3%) are caused by cardiovascular diseases and chronic respiratory diseases contributes (12.11%), while the less deaths are caused by digestive diseases (2.4%). For the older generation i.e. 70+ years (31.6% of the total deaths) most deaths are likely to occur due to cardiovascular disease (33.1%) and chronic respiratory diseases (16.4%). Further, 23.2% deaths of the older people occur due to diarrhea and lower respiratory infections (LRIs). Another major health crisis of Bihar is the Acute Encephalitis Syndrome (AES). The age-cohort wise prevailing morbidity conditions makes Bihar very vulnerable to Covid-19 as this virus affects people suffering from co-morbid conditions the most.
As Bihar is struggling to fight Covid-19 outbreak, another health challenge is threatening to hit the state i.e. AES, locally known as Chamki bukhar, which inflames the brain cells and targets children in particular. Last year this diseases has led to 176 deaths. According to a report, it is reported that almost five children have so far died because of the disease this year and as of 13th May 2020, 49 cases have been reported which is worrying because the AES is believed to peak in June and July.
Covid-19 outbreak and continuous lockdown has brought many challenges for the poor states like Bihar. One of the major challenges for such states is the poor healthcare system, which is unable to tackle this deadly virus. The public healthcare system of Bihar is poor and is not well prepared to deal with the challenge of Covid-19. As Bihar is the second largest populated state with only 9,729 sub-centers, 1883 PCHs and 70 CHCs healthcare infrastructure, Bihar is certainly very weak at grass root level health facilities and not prepared enough to handle the ongoing heath crisis. The testing capacity of Bihar is also very low. As of 12th May, 2020, the state government was conducting 1900-2000 tests per day. According to reports Bihar with a total of 39,918 samples tested in its seven facilities as of May 13th, has one of the lowest testing rates in the country. Apart from this, Bihar lacks in infrastructure and human resources in the health area and as a result it is apprehended that the upcoming health crisis may have serious impact.
The most important and immediate challenge for the state is to handle the return of migrant workers. From the past few weeks thousands of migrant peoples are returning to the state by special Sharamik trains or buses and trucks, or even by using bicycles, rickshaws and even walking on foot and this is a matter of worry for the state as these migrant people are returning from states like Delhi, Maharashtra, Gujarat, under huge economic and health stress. Further, the number of cases is already high in these states and there are possibilities that these workers may carry the virus to their hometown. According to a report, it has been said that one in every four Delhi returnees tests positive for corona virus in Bihar. The state has tested 835 Delhi returnees of which 218 or 26% have the infection. As of May 17th, 2020, the state has randomly tested 8,337 migrant people out of which 651 tested positive, increasing the positivity rate of 8%. Those returning from Delhi account for the largest share of these 651 cases. The Delhi state officials are insisting that Delhi doesn’t have community transmission and these workers might have picked the virus during their journey back, not in Delhi.
The return of the migrant workers has created fear among everyone that they might be the carrier of the virus and the state government should be prepared to handle the situation.With the return of these migrant workers, the bigger challenge for the state government will be employing these workers or giving some allowances. Once the lockdown will be over, employing these workers at home or at their earlier places of migration will be a serious challenge for the government. Providing foods to the poor population of the state and the migrant workers are another major challenge for the government. Along with this the major challenge for Bihar will be its preparation to tackle the problem of AES this year because this year Covid-19 outbreak has displaced everything. Problems are many; the burden needs to be shared by the Union and State governments and people at large, by following social (physical) distancing and following government guidelines.
As Bihar is facing several challenges and many more challenges are on the way, the state government should make plans to overcome these challenges. The central government should provide adequate funds to the poorer states like Bihar to overcome this health crisis without any further delay and politicization. More testing laboratories and testing kits should be provided to the state so that more samples should be tested in a single day. The migrant workers returning to the states are without money and food and if proper food and ration are not provided to them, a larger vulnerable population may see unforeseen consequences due to starvation which is more dangerous than coronavirus. Along with Covid-19 outbreak, Bihar has to be ready to deal with other prevailing morbidities because the coming months are believed to be the rising months for these diseases.
Tehzeeb Anis– is a Ph.D. Research Scholar at the Department of Sociology, Aligarh Muslim University, Aligarh. Email:firstname.lastname@example.org.
Prof. Mohammad Akram– is Professor of sociology at Department of sociology, Aligarh Muslim University, Aligarh, India. He has five published books and several research papers to his credit. He has worked on areas of sociology of health, migration, work, education and social policies. He is engaged in the profession of teaching, research and supervision for more than twenty years. He is an elected member of the managing committee of Indian Sociological Society (ISS). Email: email@example.com,