The death of over 150 children this month has firmly turned the focus on Gorakhpur’s BRD Hospital, but child deaths are common in this part of the country, beset by dismal health indicators, poverty, sub-optimal health infrastructure, both in the private and the public sectors, and decades of neglect. This is borne out in the National Family Health Survey 4 (2015–16), which for the first time tabulated district-level data (see boxes).
Sample this: Only 9.1 per cent of mothers in Gorakhpur had received full ante natal care, only 34.35 per cent households had “improved sanitation facility” largely interpreted to mean toilets and only 65.4 per cent children in the 12-23 months age group had been fully immunised (defined as BCG, measles and three doses each of polio and DPT).
Health experts list a number of reasons for these numbers in eastern Uttar Pradesh. “There is huge corruption, a kind of an extortionist feudal system. While there are large vacancies in the government sector, the private sector is filled with government doctors. It is a combination of illiteracy, poverty and social backwardness, a feudal structure and weak governance,” says former health secretary K Sujatha Rao.
The fact that so many children brought to BRD suffer from Acute Encephalitis Syndrome (AES), says Dr K S Reddy of the Public Health Foundation of India, shows that primary and secondary care are lacking. In ideal situations, AES treatment can be administered even at the primary health centre level. “Indicators of economic and social development are poor in eastern UP compared to other parts of the state, which have more agrarian prosperity, industrial growth, educational institutions and politically influential leaders. Eastern UP needs intensive investment in development and accelerated expansion of functioning health services,” says Dr Reddy.