Data from the Public Health department accessed by The Indian Express shows that between March and July this year, cataract procedures fell by 80 per cent, male and female sterilisation by 65 per cent, immunisation by 30 per cent, institutional deliveries by 26 per cent and neonatal intensive care admissions by 26 per cent from the numbers for these procedures in the same period in 2019.
The first case of Covid-19 was detected on March 9 in Maharashtra, subsequently lockdown began in phase wise manner from mid-March, and government hospitals were converted into Covid facilities by March end. Till August 27, state had over seven lakh coronavirus cases and 23,000 deaths.
Data shows the conversion of district and civil hospitals into Dedicated Covid Hospitals affected institutional delivery, sick new born (SNCU) admissions, and sterilisation. In Panvel, Jalgaon, Solapur, Aurangabad, patients have to seek private care because of conversion of civil hospital.
In 2019, 38,755 SNCU admissions were recorded in March-July. However the number dropped by 28 per cent to 27,738 this year. In the same period institutional deliveries dropped from 7.31 lakh to 5.35 lakh.
|March-July 2019||March-July 2020||% dip|
|New born ICU admission||38755||27738||28%|
|Maternal death reporting||552||526||4%|
|Infant death reporting||6556||4800||26%|
Data analysed by The Indian Express shows the state’s performance in health programmes like cataract procedures, female sterilisation after delivery, and institutional deliveries had actually improved in January and February this year if figures from last year are compared, but the numbers started plunging March onwards and have not yet picked pace.
For instance, 65,889 cataract surgeries were performed in February 2019, which improved to 70,708 in February this year but dropped to 38,285 in March and further to 142 – 99 per cent drop – in April. “Cataract procedures are elective, they are not urgent, and it is performed in geriatric population. We did not want to take so many risks. Also our resident doctors were first busy with Covid-19 treatment and later exams,” said Dr Ragini Parekh, head of ophthalmology in JJ hospital, that performs 12,000 cataract procedures every year. Even when JJ hospital begins cataract procedures it will screen and operate. “It is important to save lives, we can save eyes later,” Parikh said.
In Jalgaon, patients have started seeking private healthcare because civil hospital remains a Covid hospital. Pratibha Shinde, from Lok Sangarsh Morcha, said, “People are forced to spend out of their pockets for delivery and minor operations since government facility is not there,” she said.
Infant mortality reporting reduced by 26 per cent between 2019 and 2020 for March to July period, and maternal mortality saw a small dip by 4 per cent.
Dr Soumitra Ghosh, assistant professor, Centre for Health, Policy, Planning and Management, TISS, said, “This drop in maternal and infant deaths may be due to under-reporting as many cases may have happened outside government hospitals. Some of these indicators like sterilisation and immunisation may not affect mortality directly, but it will have health consequences in long term.”
Central government guidelines prohibit immunisation in containment zones, but even outside containment zones the reach is limited. A major reason is complete dependence on already overburdened ASHA workers for rural health schemes. In Nashik, ASHA worker Maya Bholap spends four hours daily on Covid-19 screening, and two hours for maternal child care, monsoon ailments screening and other health programmes. “We have too many programmes to handle. I am working for longer hours since few months,” she said.
Smaller health programmes like leprosy, sickle cell, mental health are worse hit. In hospitals for the mentally ill, group therapy sessions have stopped due to fear of crowding. Solubility and electrophoresis kits used for sickle cell have not been procured this year across Maharashtra. Bholap added there is no time left for leprosy, sickle cell, tuberculosis management. Tuberculosis notification itself dipped to 98,046 between January and July from 1.32 lakh recorded in same period last year.
Dr Pradeep Vyas, health secretary, said there are multiple reasons for why health programmes are not bouncing back. Cataract surgery numbers, he said, are low because people are afraid of opting for planned surgeries. Vyas said since civil hospitals have been converted into Covid centres, in some regions delivery numbers may have declined. “We have created alternate arrangement with private hospitals in such districts,” he said. Dr Vyas said the sick new born admissions are at par with last year. “The data operator needs to upload figures,” he said.
(Tomorrow: Impact on Mumbai health programmes)
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