UP’s Tottering Health Infrastructure – Data Belies Claims of UP as 'Uttam Pradesh'

"So far as the medical infrastructure is concerned, in these few months, we have realised that in the manner it stands today, it is very delicate, fragile and debilitated. When it cannot meet the medical requirements of our people in normal times, then it definitely had to collapse in the face of the present pandemic."

This is not some random rhetorical statement. These observations are part of the Allahabad Court's order in May 2021 under the Public Interest Litigation (PIL) in Uttar Pradesh (UP) during the second wave of the COVID-19 pandemic.

The health parameters in UP continue to be grim. Although the latest data from NFHS 5 (National Family Health Survey) has not been released for UP, other sources bring this out clearly. The SRS Bulletin (2019) shows that UP has the second-highest Infant Mortality Rate (IMR) and SRS Special Bulletin on Maternal Mortality Rate in India (2016-18) indicates that UP has the second-highest MMR.

The pandemic exposed the fault lines in the health system and healthcare delivery across India. However, none of the states’ machinery has been as active as the Government of Uttar Pradesh supported by their coterie to claim victory over the pandemic, projecting UP as a ‘model’ state. This is despite several reports which indicate a gross underestimation of deaths during COVID-19, low percentage of fully vaccinated population, increasing and recurrent outbreaks of Dengue, and more recently, the increasing cases of Zika virus.

UP Primary Health Infrastructure – Not Much to be Proud of!

According to the Rural Health Statistics (2019-20), as of July 1, 2020, UP has a huge shortfall in health facilities as per the mid-year population in rural areas – in urban areas, the shortfall in PHCs is 45%.

Figure 1: Shortfall in Health Facilities as per mid-year Population in Rural Areas (2019-20)

Source: RHS (2019-20)

The data also shows that conditions at different levels of existing infrastructure facilities are dilapidated. As of March 31, 2020, out of the total functioning SCs, PHCs and CHCs, the following table shows some important parameters.

Performance of District Hospitals – UP Faring Among the Worst

As per the NITI Aayog report on the performance of District Hospitals, the average number of beds in a district hospital for every 1 lakh population is among the lowest in UP. On average, UP has only 13 beds in a district hospital per lakh population. The NITI Aayog study covered 707 hospitals (about 97%) across the country- 150 are in UP. As per NITI Aayog calculations, out of these 150 DHs, only 16% met IPHS norms for positioned doctors, only 7% met IPHS norms for positioned staff nurses, and 55% met IPHS norms for positioned paramedical staff.

One of the indices is the index for the availability of core health care services, which is based on the proportion of 14 recommended specialities such as General Medicine, General Surgery, Obstetrics & Gynaecology, Paediatrics including Neonatology, Emergency (Casualty 24X7 basis), Critical Care (ICU), among others. UP fares among the worst performers where only one hospital had all the 14 functional specialities. Tamil Nadu, Karnataka, West Bengal, Kerala are the top States in that order, given that they had the highest proportion of hospitals with all functional specialities.

In some of the indices such as the index for the availability of support services in a DH, which includes 14 services such as Hospital Information System implemented in OPD & IPD, sterilisation & disinfection, fully equipped blood bank, transport ambulance, electric & water supply, etc., UP performs better than the India average. But in others, such as the index for diagnostic testing services, bed occupancy etc., UP's performance is again below India average.

It already took far too many years to build two All India Institute of Medical Sciences (AIIMS) in the state – one in Raebareli, which got approved in 2009 and got fully functional only in 2021, and the other in Gorakhpur, which gained approval in 2016 and is only partially operational (OPD and medical college since 2019) with overall work progress of 86% in 2021 (Lok Sabha Starred Question No.172).

High Court Observations - Stern and Damning

In the most recent PIL in the Allahabad High Court regarding shortages during the COVID-19 pandemic, the High Court has reprimanded the state government over the dilapidated condition of the health system in the state and over the mismanagement of the pandemic.

The High Court had directed the state government to fetch "details of the health infrastructure of five districts qua its population". After studying the reports filed by the respective District Magistrates, the bench observed "that health infrastructure is absolutely insufficient in city areas to meet the requirement of city population and the rural areas the Community Health Centres are virtually lacking in respect of life-saving gadgets. In most of the districts, the Level-3 hospital facilities are not there."

Taking the example of Bijnor as a test district to assess the overall health care system in smaller cities and rural areas of the state, the Court noted that "there is no level-3 hospital despite a population of over 1 lakh residing there. The three Government Hospitals have only 150 beds, whereas the total number of BIPAP machines is five and high flow nasal cannula is only 2."

Sadly, this is not new for the UP's government! The dismal performance has continued over the years, whatever be the claims of the current dispensation.

In 2018, another High Court bench comprising Chief Justice D. B. Bhosale and Justice Yashwant Varma had issued orders, directing the Chief Secretary of UP to file a report stating steps taken to improve government hospitals and medical facilities in the state. This order was issued in response to a PIL alleging pathetic conditions in government hospitals in the state. The Court had also directed for audit of state medical colleges through the Comptroller and Auditor General of India (CAG).

Desperate Efforts to Project UP as a Success Model

Despite facts proving to the contrary, there is a desperate effort from some quarters to prove that UP is rather a model state in its management of the current pandemic.

A recent report titled 'COVID War, UP Model: Strategies, Tactics, Impact' was released by the Indian Institute of Technology, Kanpur (IIT Kanpur), claiming to undertake an 'extensive analysis of the handling of the pandemic by the state of Uttar Pradesh based on the data collected from multiple, authentic sources'. The effort was basically to hail UP's success in tackling the pandemic and emerging as a "model" performer!

Subsequently, IIT Kanpur Citizen's Forum, a collective of alumni of IIT Kanpur, compiled a critique of this report. The Forum has argued that the "report out of IIT Kanpur is clearly an attempt to use the prestige of IIT Kanpur to lend legitimacy to the flawed policies of the state government".

Section 5 of the report makes pompous claims regarding the health infrastructure in UP. The critique systematically demolishes the claims and the methodology used. The critique argues that in an attempt to project UP as the best state, "health infrastructure related figures in the report are presented without being normalised against the state's larger population". Once normalised, the availability of health infrastructure in UP is among the weakest. Further, as per the NITI Aayog's Health Index Report (2019), UP figures at the very bottom (rank 21) among the large Indian states. The critique categorically states that "Clearly, the picture is very far from rosy that the IITK report tries to paint."

It is unfortunate to see that there is a blatant attempt in UP by the powers-that-be and their coterie to deny facts regarding continued neglect of health and healthcare services and the dilapidated condition of the health system in the state. To hide the non-performance and mismanagement during the pandemic behind a false publicity attempt is nothing but a mockery of the losses that people have suffered during the pandemic.