As political parties rack their brains over caste and religion combinations, the state of Bihar’s healthcare will probably not feature anywhere in the conversation.
It’s a dismal picture: every health sub-centre in Bihar caters to more than 10,000 people, every primary health centre (PHC) to a little over 55,000 people and every community health centre to a whopping 14.87 lakh people.
Compare this with the corresponding national figures and the norms set for the National Health Mission. A rural sub-centre is supposed to cater to a population of 3,000-5,000 and the national average is 5,426, about half of Bihar’s 10,699. A PHC is supposed to cover a population of 20,000-30,000; in reality each centre in India caters to 32,944, far better than the 55,284 catchment population of Bihar’s 1,883 PHCs. As per norms, a CHC is supposed to cover a population of 80,000-1,20,000. Each CHC in India caters to 1.54 lakh, a fraction of Bihar’s 14.87.
The state with a population of 10.41 crore is also grappling with a shortage of specialists, though given the abysmal figures for the country as a whole, the 71% shortage of surgeons, physicians, paediatricians, obstetricians and gynaecologists, and physicians is only marginally more than the national average of 63%. The state has a 70% shortage of surgeons (83.4% nationally), a 77% shortage of obstetricians and gynaecologists (76.3%), an 81% shortage of physicians (83%) and a 81% shortage of paediatricians (82.1%).
It is not surprising that the state, once a constituent of the group that had earned the BIMARU tag for themselves, lags behind drastically in most health parameters, except perhaps in infant mortality where India’s efforts has earned it recognition on the world stage. According to data from the 2013 sample registration system, Bihar’s IMR stands at 42 (for every 1,000 live births) against the national IMR of 40.
At 219 (maternal deaths per 1,00,000 live births) Bihar’s maternal mortality rate as per SRS 2010-12 is, however, far more than the national figure of 178. The total fertility rate is 3.5 against the Indian TFR of 2.4. TFR is the total number of babies a woman would have if she survived to the end of her reproductive life and maintained the current age-specific fertility rate throughout her life.
“Health is never an election issue, getting better health infrastructure does not get you votes, at least not in the north Indian states. That is why it is never a priority. I had built a hospital in my constituency, had bettered health facilities but when I started campaigning, nobody ever talked about it. Constituents will call you up to get an appointment in AIIMS etc, but a PHC in their village will not get you votes,” says a senior leader of a national party, who has been a minister in his state.
Mohan Rao, who teaches public health at Jawaharlal Nehru University, recounts his visit to Bihar’s Madhubani district a couple of years ago to highlight the dismal situation in the state. “People said things had improved a lot under Nitish but it was so bad that I could not even imagine how things were earlier. We actually met people who had sold off everything they had for medical treatment. There is no literature on why health does not reap electoral dividends in India unlike, say, in the United Kingdom but the moving away of the middle classes from the public health system certainly contributed to its degeneration,” Rao said.