Upgrading district hospitals better than new AIIMS

Setting up AIIMS (All India Institute of Medical Sciences) in underserved areas and states has been high on the agenda of successive health ministers. It’s no surprise because AIIMS in New Delhi is a brand that represents the best in medical education, treatment and care. The healing prowess of its skilled doctors are legendary – when cases get complicated and other doctors throw up their hands, patients turn to AIIMS, much like the pious turn to prayer in times of distress. This faith results is more than 10,000 sick patients, around half of them from under-served neighbouring states, queuing up to get treated at its out-patient department every day of the year.

Decongesting the tertiary hospital by taking super-specialty healthcare to people’s doorsteps by creating AIIMS-like institutes in states sounds like a grand idea and it was no surprise that the Centre bought the argument, beginning by allocating Rs 1,650 crore in 2013-14 for six AIIMS in Bhubaneshwar, Bhopal, Raipur, Jodhpur, Rishikesh and Patna.

Following the six, eight more AIIMS have been sanctioned, with the one in Bilaspur in Himachal Pradesh being the latest to get the Cabinet nod for an outlay of Rs 1,350 crore under the Pradhan Mantri Swasthya Surakhsa Yojna in January this year.

The campuses and infrastructure is the best money can buy, but isn’t working is the staffing.

The six regional AIIMS are struggling to find faculty and non-teaching staff. In July 2017, 583 (31%) of the 1,830 sanctioned faculty posts were filled, and 3,862 (17%) of the 22,656 non-teaching appointments had been made.

Upgrading hospitals
In such as a scenario, Modi government’s move away from setting up of new AIIMS to upgrading 24 district hospitals to government medical colleges and hospitals is a great step. Not only will it ensure at least one medical college for every three parliamentary constituencies and one government medical college in the smallest of states, but also ramp up hospital infrastructure and expand capacity. Doctors, nurses and other medical staff already working there will get opportunities to specialize without having to relocate from their existing medical practices.

India’s total health expenditure as percentage of GDP hovers around 4.7%, with out-of-pocket spending accounting for 63% of this spend. This pushes 63 million people — close to the population of the United Kingdom —into poverty each year because of catastrophic health expenditure.

Modicare is expected to help many such people access healthcare, but this will happen only if governments – both state and Centre – provide quality primary healthcare near home for timely diagnosis and referrals. Tragedies such as the deaths of around 670 children in Uttar Pradesh, including Gorakhpur, from acute encephalitis syndrome and Japanese encephalitis can be avoided if basic fever and anticonvulsant medicines, basic oxygenation and monitoring fluid balance is available at the primary health centres and the community health centres.

Toilet travails
Finance Minister Arun Jaitley’s linking open-defecation to women’s dignity, girls’ education and the country’s health was the other big push for public health. Jaitlley announced the setting up of 2 crore toilets to add to the 6-crore built since the launch of the Swachh Bharat Mission to make the country open defecation free by October 2, 2019.

More people defecate in the open in India than the rest of the world combined, which results in 1.3 lakh tonnes of human waste being produced each day. One lakh tonne of this waste is untreated and leaches back into the soil and water, contaminating food and water and causing diseases such as diarrhoea, which does more than cause a bad bout of runnies. It kills an estimated 100,000 children in India each year, who die of acute dehydration.

Those who survive are scarred for life. Frequent diarrhoeal infections during the first two years of life impair brain development, show more than one study. Diarrhoeal infections also lower immunity, exposing malnourished children to host of deadly secondary infections, such as tuberculosis and pneumonia.

Unsafe food and water is the biggest cause of malnutrition in India, where 38.4% children are stunted (low height for age), and 35.7% are underweight (low weight for age), shows National Family Health Survey 4 data. Decentralised solutions waste management solutions, such as the GOBAR-DHAN (Galvanizing Organic Bio-Agro Resources Dhan) scheme to convert cattle dung and solid waste in farms to compost, fertiliser, bio-gas and bio-CNG, will help lower the dependence on sewerage systems for waste disposal and increase the viability of setting up toilets in remote areas.