Day 66 – Q 1.Each year thousands of children die in government hospitals in India. Recently, more than a hundred children died in a hospital in Rajasthan. Why do such incidents occur so frequently? Critically examine. What urgent measures are needed to salvage the situation? Suggest.

1. Each year thousands of children die in government hospitals in India. Recently, more than a hundred children died in a hospital in Rajasthan. Why do such incidents occur so frequently? Critically examine. What urgent measures are needed to salvage the situation? Suggest. 

भारत में हर साल हजारों बच्चे सरकारी अस्पतालों में मरते हैं। हाल ही में, राजस्थान के एक अस्पताल में सौ से अधिक बच्चों की मौत हो गई। ऐसी घटनाएं इतनी बार क्यों होती हैं? समालोचनात्मक जांच करें। स्थिति को उबारने के लिए किन जरूरी उपायों की जरूरत है? सुझाव दें।

Introduction:

A recent UNICEF report revealed that in India over 882,000 children under the age of five died in 2018 — that is over 100 children every hour, or a child every minute, out of which, most of the casualties have been in government hospitals, which is shocking for a country aspiring to be a global superpower in the near future.

Body

• As per official records, more than 600 infants have died in child care wards of government hospitals in Rajasthan and Gujarat since December 1, 2019, where all of the deaths occurred in the neonatal and perinatal ICUs.
• The children were brought into the hospital by parents, mostly from economically weaker sections, from surrounding rural areas where the children were found to be critically ill when brought to the hospital.

Such a situation has been observed repeatedly with regards to government hospitals across India and especially North India. This can be due to the following factors: 

• Open door policy and increased referrals – Unlike private facilities, public medical hospitals cannot turn away a patient who comes to them which leads to  two/three children on a bed being a common sight in public facilities. This is further exacerbated by the sickest children who have been referred out of other hospitals landing up in public facilities.
• Lack of adequate infrastructure – Majority of public medical facilities are suffering from infrastructure deficiencies. For example, the neonatal ICUs and paediatric ICUs of government medical Colleges have insufficient beds. But the occupancy ratio is more than 180%,  which clearly indicates the ;evel of overstretched facilities.
• Poor Primary and Secondary health facilities – With lower levels of public healthcare being defunct, the entire load falls on the tertiary level. It also means people having to travel hundreds of kilometres to access the most basic healthcare services which could have been taken care of by a district level hospital closer to their homes.
• Quantity and Quality of manpower – a shortage of doctors and supporting staff in the paediatrics department which is evident from the recent case where National Commission for the Protection of Child Rights (NCPCR) in its fact finding report observed that the hospital did not have faculty as per norms. 
• Sanitation and Hospital’s procedural deficiencies – A lack of infrastructure and staff, along with unhygienic conditions may have played a role along with maintenance issues. For example, in the recent Kota case, the Press Trust of India news agency cited that more than 70 percent of key equipment like infusion pumps, warmers and nebulisers for newborns were not in working condition at the hospital.
• Other – Further, other situational factors also play an important role like newly born children suffering from low birth weight, premature deliveries and nascent infections, children being admitted at the last minute, increased referrals during the cold month of december, etc.

At the same time, other factors like a good proportion of babies being underweight (an estimated 35% babies born in Rajasthan have low birth weight, which is less than 2.5 kg), travelling long distances in the cold to reach the hospital, the non-availability of baby warmers, etc also play a critical role. 

In this regard, the following measures can be considered worthwhile for salvaging the situation and avoiding loss of precious lives:

• The task of making the primary and secondary level health institutions functional ought to be the utmost priority, such that people can access effective healthcare for common and easily treatable conditions nearest to their homes.
• All the vacancies for medical and paramedical posts should be filled promptly and the administrative procedures should facilitate speedier permanent appointments.
• Rural service should be made compulsory for health personnel of varying categories immediately after their graduation. There should not be waivers of any kind to allow the personnel to avoid doing such service.
• For maximal utilization of the infrastructure of public hospitals, provision should be made for both morning and evening OPDs. The necessary staff, equipment, and space should be provisioned for running such clinics and diagnostic set-up.
• Addressing the most common risk factors for child mortality with prevention methods such as access to diarrhea and pneumonia treatment, measles and tetanus vaccinations and increasing access to quality healthcare.
• Much of north India has been hit by a severe cold wave since late in December, and there is a need to provide blankets, bedsheets and heaters to the patients at the hospitals

Conclusion

From a hospital administrator’s point of view,it is necessary to remember that there are no shortcuts to long lasting solutions. Nonetheless, it is important to realize that health is a social phenomenon and a public hospital is a social institution which cannot be developed in isolation from the societal conditions in which it operates, which clearly demonstrates the need for a social revolution with regards to improving health apparatus in the nation.