Jharkhand ensuring last-mile public healthcare delivery

Source: ehealth.eletsonline.com

With healthcare becoming a focus point, as reflected through Narendra Modi Government’s game-changer Ayushman Bharat scheme, the Government of Jharkhand has gone out of its way to evolve the State’s healthcare delivery system, enabling people of all strata of the society better patient care in terms of accessibility and affordability.

One must have vivid memory of last year’s incident when Prime Minister Narendra Modi had launched the scheme from the soil of Jharkhand, providing much needed succor to poor and vulnerable section of the society. Taking a leaf from the Centre, the Jharkhand Government is taking all measures to improve care delivery system to ensure wellbeing of each and every citizen of the State.

Our latest cover story titled ‘Jharkhand Making Giant Leap to Ensure Inclusive, Affordable Healthcare’ thus touches upon various aspects of this all-important healthcare sector.

It highlights how the State has come a long way since its inception in 2000 and has made tremendous progress in every sectors including healthcare.

Despite having lots of challenges in terms of hilly terrain and a large swathe of tribal population, the State has improved its rank in healthcare index and recent Niti Aayog report vouches for the same. The story encapsulates how the State Government has leveraged Public Private Partnership (PPP) model to fill infrastructural gaps on many fronts.

The latest issue also features insightful interview of Dr Nitin Madan Kulkarni, Secretary, Department of Health, Medical Education & Family Welfare, Government of Jharkhand, who sheds lights on various initiatives of the Government undertaken to improve healthcare delivery to the last mile.

We also have a special feature on Emergency Medical Services which takes into account various aspect of emergency care and its significance in providing immediate care in critical situations.

The magazine has also insightful articles on Public Private Partnership model which plays a pivotal role to resuscitate healthcare infrastructure.

The articles on behalf of Medall, Ziqitza HealthCare, Apollo Tele Health Services, Healthmap, and Tata Motors present comparative accounts of their contribution to bolster patient care across length and breadth of India. With such a bouquet of articles, interviews and stories, we hope this edition will evoke an invaluable response from our esteemed readers.

Bihar’s affidavit in SC depicts poor state of healthcare facilities in state

Source: business-standard.com

In a shocking revelation about medical care facilities in Bihar, which is facing an outbreak of acute encephalitis syndrome, the state government Tuesday told the Supreme Court that there are only 5,205 doctors in government-run health centres against the sanctioned strength of 12,206.

The state government, in an affidavit filed in the apex court, said that only 5,634 nurses were there in government run hospitals and health centres against sanctioned strength of 19,155.

The court had on June 24 directed the state to apprise it about the status of public medical care facilities, nutrition and sanitation within a week in view of deaths of over 100 children in Muzaffarpur due to the outbreak of AES.

Regarding AES cases, the state government said 824 cases have been reported and the number of deaths was 157.

It, however, said that it was not known whether 24 deaths out of 215 cases were due to AES.

“State of Bihar had already taken all possible steps to prevent the spread of the disease by providing additional medical facilities at the affected region, public awareness campaign at the village level, involving various agencies to assist the government etc,” it said.

Giving details of the status of available clinical human resource, the Bihar government said there was 57 per cent and 71 per cent vacancy of doctors and nurses respectively.

In case of lab technicians and pharmacists, the vacancy stands at 72 per cent and 58 per cent of the sanctioned strength, the affidavit said.

“It is respectfully submitted that the overall human resources available in health system in the state is not as per standard norms,” the affidavit said, adding that health department has taken steps to recruit medical officers, para-medical and other technical support staff.

It said that requisition for recruitment of 4,012 general duty medical officers and 2,425 specialist doctors has been sent to the Bihar technical services selection commission.

The state government said that Chief Minister Nitish Kumar himself “is personally involved and actively engaged in finding ways and means to control and treat the dreaded AES disease” in Bihar.

It said that the state, in cooperation with the Centre, All India Institute of Medical Sciences and other agencies, has simultaneously provided all medical facilities to treat the affected children.

“The steps taken up by the State has prevented spread of the disease and has reduced the fatality rate arising out of the AES disease,” it said, adding, “In view of the steps taken by the state of Bihar, the fatality rate has come down to 19 per cent whereas the global fatality rate of AES is around 30 per cent”.

“In view of the constant and consistent efforts taken by the state of Bihar and in view of the change in weather conditions, there is a substantial reduction in number of reported cases of AES and JE in the State. The state of Bihar would continue its efforts to prevent any such condition in future,” it said.

The state government said that malnutrition is associated with the issue of sanitation and safe drinking water and they are already working on sanitation and hygiene issues under the ‘seven-nischay yojana’.

“It is respectfully submitted that the state government has initiated a socio-economic survey in affected areas to ascertain socio-economic factors behind AES incidence to initiate vigorous and coordinated campaign with the active involvement of the concerned departments to bring about speedy improvement/change in the socio-economic status of the relatively poor people who are mainly susceptible and vulnerable to the threat of AES disease,” it said.

The state government said that they are fully aware and “quite conscious of recurrent resurfacing” of AES cases in Bihar and has been continuously taking steps to protect and save precious human lives.

Besides Bihar, the apex court had also asked the Centre to file response on the issue.

The apex court is hearing a petition filed by advocate Manohar Pratap who has said that he was deeply “pained and saddened” by the deaths of more than 126 children, mostly in the age group of one to 10 years, in Bihar due to AES.

“The deaths of children are a direct result of negligence and inaction on the part of the respective state governments of Bihar, Uttar Pradesh and Union of India in handling the epidemic situation which arises every year due to outbreak of AES also called Japanese encephalitis,” the plea said.

The petitioner has also sought directions for all possible steps to stop the disease outbreak in the earlier epicentre, Gorakhpur in Uttar Pradesh, and to create awareness about preventive steps and first aid.

Symptoms of AES include high fever, convulsions and extremely low blood sugar levels. Among the factors said to trigger the syndrome are malnutrition.

There were more than 44,000 cases and nearly 6,000 deaths from encephalitis in India between 2008 and 2014, said a 2017 study published in The Indian Journal of Medical Research (IJMR).

Researchers said the patients often report acute onset of fever and altered consciousness, with a rapidly deteriorating clinical course, leading to death within hours.

Litchis grown in Muzaffarpur, the country’s largest litchi cultivation region, are said to contain a toxin which can cause a drop in blood sugar levels if consumed by a malnourished child.

AES outbreak puts focus on ailing healthcare infrastructure in Bihar

Source: livemint.com

NEW DELHI: The rising death toll of children suffering from acute encephalitis syndrome (AES) in Bihar’s Muzaffarpur district not only points to a health crisis, but also the crippling healthcare infrastructure in the state.

According to the latest data available with the ministry of health and family welfare, about 79.5% of the 1,719 villages in Muzaffarpur district do not have a public healthcare facility. There are only 630 public healthcare facilities in Muzaffarpur, the data reveals.

“What can easily be managed at a primary health centre level, is reaching Muzaffarpur at a critical stage causing deaths. Since there is no primary health infrastructure nearby and no health experts to tell these families the preventive measures, the problem arises,” said a senior health ministry official, requesting anonymity.

Experts also said that in view of the children’s deaths and the number of new cases being reported every day, the district level infrastructure is about to collapse.

“Encephalitis cases have always been witnessed in areas which are economically disadvantaged and have rudimentary health infrastructure at the primary care level. Health infrastructure is a major issue given the high mortality in Bihar. The easy solution to this disease is balanced diet in each meal,” the official said.

“Even if children show early signs, regular glucose consumption can solve the problem. The early warning signals that should be provided to villagers also seem to be absent,” he added.

The official said malnutrition, compounded by heat and humidity, unusually high this year, is the major cause for the high death toll.

According to the census of 2011, Bihar is the third most populous state in India, with around 40% of its population below the poverty line. The major health and demographic indicators of the state, such as infant mortality rate, maternal mortality ratio, and total fertility rate, are substantially higher than the all-India average, and reflect the poor health status of the people. The state has a shortage of 1,210 sub-centres, 131 primary health centres (PHCs), and 389 community health centres (CHCs).

So far, 167 children have died in Bihar, with Muzaffarpur recording 117 deaths. Other districts include Vaishali (19), Motihari (12), Begusarai (8), Samastipur (8), and one each in Arrah, Sheohar and Purnia.

“Blame it on the scarcity of health facilities or unawareness among masses, patients from almost all the villages in Muzaffarpur are coming to us in critical stages, which is increasing the death toll. Private hospitals are unable to handle the pressure,” said Sunil Shahi, medical superintendent, Sri Krishna Medical College, Muzaffarpur, which is handling a majority of the cases.

Interestingly, Muzaffarpur city is part of the centre’s smart cities’ list. According to a recent report by the Smart Cities Mission of Housing and Urban affairs, the doctor-patient ratio at Muzaffarpur is as low as 80:100,000 patients. The report said there are four large hospitals in the city, 46 nursing homes and 175 medicine shops. The city provides some access to healthcare for its residents, but healthcare facilities are “overburdened and far from many residents”.

The Comptroller and Auditor General (CAG) of India 2018 report said improved healthcare facilities could not be provided because of project delays. “Completion of 75 CHCs was delayed by one to 33 months. Further, 11 CHCs was incomplete even after the delay of one to 36 months, due to non-availability of dispute-free land and slow execution of work. Consequently, there was a delay in the completion of 86 CHCs, which delayed the intended objective of providing improved healthcare facilities.”