Though the blame game over infant deaths continues among political parties, the startling figures in just one month from three Indian hospitals have raised several questions about the state of health infrastructure in the country.
While both state and central governments in the country appear occupied at pointing out each other’s faults and highlighting incompetency, healthcare facilities await upgrades.
“The problem is that facilities at community health centres cater to specific diseases and the doctors present are also general doctors not specialists. But if there are doctors and facilities to treat infants, such figures can be avoided. Under the National Health Mission, health centres and community centres can only serve as OPD (Out Patient Department) and don’t facilitate IPD (Inpatient Care)", says health expert and senior journalist Pradeep Surin.
Infrastructure in Place
India has the required health infrastructure at the basic level – including primary health centres, community health centres, district hospitals, and regional hospitals – but the startling figures of neonatal deaths are appearing because district hospitals are also referral hospitals, the health expert says.
With regard to the frontline of the nation’s healthcare infrastructure, India suffers from an 82 percent shortage of specialist doctors in its Community Health Centres (CHCs) and Primary Health Centres (PHCs).
As per World Health Organisation (WHO) recommendations, there should be at least one allopathy doctor available for every 1,000 individuals. But, in India, the doctor-population ratio stands at 1:10,926.
“The infant is not provided with required treatment at primary health centres and is often referred to district hospitals because there aren’t specialists at these health centres. Now it takes time for parents to reach referral hospitals when the infant is in critical condition, which leaves less chances of survival by the time infant is taken to the hospital. Therefore, the number of infant deaths is higher in district hospitals than any other hospital", Surin says.
The infant mortality rate in India as per the latest UNICEF data is 39 deaths per 1,000 births, an improvement over the years, but the country is still far behind in meeting the WHO recommendations on human resource and physical infrastructure.
Allocated Health Budget Not Spent
A report tabled in the Indian Parliament in 2019 stated that public health expenditures as a percentage of Gross Domestic Product (GDP) has been increasing since 2015-16. But it has remained within a narrow band of 1.02-1.28 percent of GDP.
“The budget for healthcare is not used. So the problem is not allocation, but spending the amount given to the ministry. The budget comes in April and the first installment to states is given for a quarter and they are supposed to utilise the amount in the given time. But half the time in that quarter goes into getting the approvals for the work from the ministry. By the time they start spending it, the window of the quarter ends and the money goes back to the ministry. After this, the state again needs to apply for the money. It is a big issue", the expert says.
As per the National Health Profile, the centre-state share in total public expenditure on health was 37:63 in 2017-18.