To address the issue of poor healthcare infrastructure, the states need to prioritise this sector by diverting funds, creating more capacity in existing hospitals, and constructing more new hospitals
Nanded, a district town in Maharashtra, located 280 km from Aurangabad, faced a man-made tragedy in its public medical facility. Between 1-2 October, a total of 31 patients died while undergoing treatment in the district’s principal government hospital. Sixteen of these were infants and 19 adults. The Chief Minister of the state assured a full probe into the incident. The situation was compounded by an incensed local member of parliament (MP) who forced the acting dean to clean the hospital toilet. The incident created unrest among the doctors and made the complicated local situation even more vitiated. Subsequently, an FIR was filed against the MP under the Scheduled Caste and Scheduled Tribe (Prevention of Atrocities) Act, 1989.
The acting dean of the college and hospital stated that patients from far-off places are routinely brought into the district hospital in extremely critical condition. And if the number of patients mounts steeply, the death rate also shoots up. He absolved the doctors and other hospital staff of any responsibility and said that nationally, 10 to 20 deaths in government hospitals were normal. Most of the infants were premature babies of zero to four days of age with complications that have only a 50-percent chance of survival. The supply of medicines and funds are as per the bed capacity of the hospital. The hospital has 508 sanctioned beds, but the hospital has an intake of around 1,080 patients, leading to a shortage of beds, medicines, and other support items.
The acting dean of the college and hospital stated that patients from far-off places are routinely brought into the district hospital in extremely critical condition.
The High Court has taken suo motu notice of the matter and asked the state government to provide details of the budgetary provisions made for the hospital. In a hearing on 6 October 2023, the advocate general argued based on the affidavit filed by the state government that the unfortunate deaths have to be seen in a specific context. Firstly, most patients were brought into the hospital only after they were already in critical condition. Secondly, the numerical burden of patients in the hospital was huge. Thirdly, the medical education minister of the state confirmed that a shortage of doctors was one of the reasons behind the deaths. He also added that the crisis was preceded by a five-day weekend resulting in a sizeable shortage of staff in private hospitals and the consequent exodus of patients to the government hospital. Given this background, the hospital staff cannot be blamed for gross negligence. The High Court seemed to differ and told the state government that it could not escape responsibility by citing that the hospital was overburdened on account of the inordinately large number of patients beyond the hospital’s carrying capacity. It held, based on the government affidavit, a clear need for ‘more manpower’.
In light of this tragedy, the state government’s stand and the initial observations of the High Court, this article is an attempt at a dispassionate assessment of the situation. It ought to be admitted, at the outset, that public hospitals in the country do not seem to be well looked after. A similar incident occurred in August in a government hospital at Kalwa in Thane district, Maharashtra where 18 patients lost their lives. In 2021, a government hospital in Bhopal was devastated by fire, and four tiny babies perished. In the same year, the civil hospital of Ahmednagar, Maharashtra, also suffered a fire incident, snuffing out the lives of 11 patients, hospitalised for COVID-19 treatment. At the beginning of 2021, the district hospital in the state’s Bhandara witnessed the death of 10 infants in the neonatal intensive care unit. These are merely some of the tragic events that have occurred recently in governmental hospitals.
A similar incident occurred in August in a government hospital at Kalwa in Thane district, Maharashtra where 18 patients lost their lives. In 2021, a government hospital in Bhopal was devastated by fire, and four tiny babies perished.
One of the truths about infrastructure is that building it is merely one part of the job. Just as physical infrastructure such as water supply and roads need to be built and then expanded as the population increases, hospitals need to be expanded and provided in accordance with the growing population load. Maintenance of the medical facilities is the other, and perhaps, the more difficult part. While the first is a one-time investment, the second part is an ongoing process. This needs annual maintenance allocation throughout the life span of the infrastructure and sudden allocations if emergencies arise. Not only does the hospital structure require regular maintenance, but it also must be equipped with medical and paramedical staff, equipment, beds, operation theatres and a whole host of other amenities. Hospitals gain much greater criticality since they deal with saving human lives and nursing people back to health out of the ailments that they suffer.
Efficiently-run hospitals today carry out preventive healthcare facility maintenance on a regular basis. Since hospitals provide 24x7 service, maintenance jobs are particularly challenging. This is well documented and involves neatly scheduled activities such as inspection, servicing and replacement to avoid breakdown situations. A hospital has several areas to cover within maintenance. They comprise building interiors and exteriors, plumbing, heating, ventilation, air conditioning, refrigeration (HVACR) and pneumatics (energy in compressed gas), safety, lighting and the upkeep of all medical equipment.
It is no secret that public hospitals in India are severely strained on account of patient overload. In the case of Nanded, a study by a local NGO found that government hospitals and primary healthcare centres were bedevilled by the twin problems of too many patients and too few staff. It further found that a shortage of equipment forced the neonatal intensive care units (NICU) to force babies to share the same cradle. Unfortunately, the Nanded hospital’s plight is not a one-off situation. It reflects the situation in most parts of the country.
The ADB study also indicated that the large number of rural and urban citizens needing in-patient care has decreased.
It is well-known that India’s public expenditure on health care is low despite the sharp rise in recent years. Since health is a state subject, it primarily falls upon the state governments to take care of their population’s health. In an assessment carried out by the Asian Development Bank (ADB) in 2022, the states’ healthcare sector was found riddled with interdistrict disparities. It was deficient in the number of hospitals and healthcare staff and was further handicapped by a limited range of specialists, overcrowding and poor quality of service. The solution clearly lies in greater prioritisation of the healthcare sector by states and the creation of more capacity in existing hospitals or the construction of more new hospitals.
The ADB study also indicated that the large number of rural and urban citizens needing in-patient care has decreased. The private healthcare system has expanded and the well-to-do citizens who can afford costlier medical care have opted out of the governmental system and taken recourse to private hospitals. The poor, however, have no alternative but to use the government healthcare facilities. Since governments have been unequivocally stating, irrespective of which parties are in power, that alleviating poverty is their primary task, it does not behove them to neglect a primary area that impacts the poor. Men and women in poor health obviously cannot be productive citizens. It would be easy to find money if public resources were wisely spent not on freebies, but in the critical social area of health.
Additionally, public healthcare facilities, as has been suggested earlier, should be brought under the domain of National Accreditation for Hospitals and Healthcare Providers (NABH). This is a constituent board of the Quality Council of India, set up to establish and operate accreditation programmes for healthcare organisations in collaboration with stakeholders. This would bring back attention to patient safety and quality of healthcare based upon set standards, through a process of self and external evaluation.
Ramanath Jha is a Distinguished Fellow at the Observer Research Foundation
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Dr. Ramanath Jha is Distinguished Fellow at Observer Research Foundation, Mumbai. He works on urbanisation — urban sustainability, urban governance and urban planning. Dr. Jha belongs ...
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