Inside Bihar’s crumbling health system, nothing has changed

Despite receiving the dubious distinction of being at the bottom over the last two years in the health index prepared by NITI Aayog, no efforts have been made to change the health systems in Bihar.

In 2019-20, the Bihar government drew up a demand and received close to ₹3,300 crore from the Centre under the National Health Mission (NHM). Last year, it utilised only close to fifty per cent of the NHM budget. It received an additional ₹300 crore under government-run cashless health insurance scheme Pradhan Mantri Jan Arogya Yojana (PM-JAY) or Ayushman Bharat.

Promises to revamp health system are lofty, but little has changed close to two months after a spate of child deaths due to Chamki bukhaar or Acute Encephalitis Syndrome (AES) that claimed 175 lives since the beginning of the year up to July 31.

Failing PHCs

Budhanidevi (60) is sitting in front of the X-ray machine at Kanti Primary Healthcare Centre (PHC) in Muzzafarpur to get her broken hand scanned. She meekly pays ₹70 for the service. She is oblivious of the fact she is supposed to get the service for free. She is handed over no receipt of her payment.

The State Health Society has released over ₹46 lakh to Muzzafarpur district in 2019-20 for providing radiology services free of cost to patients under the NHM.

However, PHC’s data entry operator Manjeet Kumar says, “After the contract of IGMS Medical Systems expired in April 2018, we were told to locally arrange for services until a time that new tenders are floated and implemented. So we are charging minimal fees, it is better than patients paying up to ₹200 in private set-ups.”

IAS officer Manoj Kumar who is the Executive Director, Bihar’s NHM, told BusinessLine that they were having extreme difficulties in tendering for X-ray services and had floated five back-to-back tenders but to no avail, and were in the process of repeating the process for the sixth time.

“Meanwhile, we have made funds available of over ₹14 crore across public health care systems for free radiological services under NHM,” Kumar says. He assures an inquiry into working of Kanthi PHC.

Poor infrastructure

While PHCs are over-burdened, the infrastructure at the lower rung of health sub-centres is non-functional.

Even as Prime Minister Narendra Modi announced building of 1.5 lakh health and wellness centres (HWC) with yoga facilities, diabetes, blood pressure and cancer screening, in Bihar this is far cry. Kumar noted that the State NHM has not been able to make even one HWC fully functional of the 598 designated ones, even one year after the announcement. Also, one step above the PHCs, the block level hospitals are ill-equipped leaving medical colleges to bear a huge burden of patients, notes Rajeev Kamal Kumar, Assistant Professor, Sociology of Patna-based AN Sinha Institute of Social Studies. A case in point is Sri Krishna Medical College and Hospital (SKMCH) spread over 160 acres in Muzaffarpur.

Every third patient in SKMCH sleeps on the floor in corridors ridden with fleas that reek of nauseating urine stench. There are only 600 beds against which close to 955 patients are admitted. Mounds of plastic and food waste accumulate inside and outside the building. The entire back of SKMCH is a dumping ground with over two dozen pigs rummaging through the waste in close quarters to corridors of the ward.

SKMCH superintendent Sunil Kumar Shahi is at his wit’s end managing cleaning in the hospital.

“Do you realise this hospital building has no drainage facilities? They forgot to build drainage outlets while conceptualising the structure,” says Shahi. The shoddy state of affairs only came to light when the hospital became a centre point of child deaths earlier in June.

“Only after June, ₹2.5 crore has been sanctioned to build a drain outlet which will carry excreta out of the campus, however there is no nullah for proper channeling of waste. We are figuring out that one,” said Shahi.

Aggrieved parties line up outside new secretariat waiting to meet the Health Minister and complain that model tender documents have not been followed while selecting security guards in Government Pharmacy Institute, Patna. “Because Nil charge tenders will not be accepted, the lowest bidder bid at ₹0.001 for services. This is the sad state of affairs,” alleged an aggrieved contractor.

“Our hands are bound. We have to award the tender to the lowest bidder,” Bihar’s Health Minister Mangal Pandey told BusinessLine.

Also, in light of crumbling public health systems and lack of interest of private facilities to join Ayushman Bharat — patients are taking the maximum hit. Of the 700 hospitals registered with, 560 (80 per cent) are government-run and 140 (20 per cent) private.

“We have taken action to proceed and disempanel at least six private hospitals from Ayushman for malpractice in providing services,” said a State health society official.