Can India Stop Its Children From Dying?

A child receiving care in the encephalitis ward at the Baba Raghav Das Medical College hospital in Gorakhpur, India, this month. Credit Sanjay Kanojia/Agence France-Presse — Getty Images

Two children younger than 5 die every minute in India. Even by India’s easy acceptance of child mortality, the death of 70 children within five days at a hospital in the northern city of Gorakhpur was hard to accept.

A majority of the children who died had been struck by Japanese encephalitis, a mosquito-borne, potentially fatal viral brain infection that periodically ravages the Indian state of Uttar Pradesh. But the immediate reason for at least half the deaths appeared to be the cessation of piped oxygen into the intensive care ward. Japanese encephalitis has no known cure, and as it progresses, patients require oxygen to survive.

Despite 11 reminders over six months, the Uttar Pradesh government did not pay the company that supplied oxygen to the Baba Raghav Das Medical College hospital. The company acknowledged it had threatened to stop supplies but denied it had actually done so. The state administration, with its own role in question, vaguely promised “stringent action against the guilty.”

In a country chronically short of medical facilities, the Baba Raghav Das hospital is the largest and most important referral hospital in a poor, populous region, serving a population of more than 50 million in hundreds of nearby towns and villages. Stunned parents — carpenters, construction workers, security guards, homemakers and others from poor families — streamed out of the hospital with the bodies of their dead children.

Many said the police had removed them from the hospital after their children died. Some who sought autopsies were told to bring masks and gloves for coroners, suggesting the breadth and depth of the state’s health care crisis.

Gorakhpur, a city of nearly 700,000, is home to Yogi Adityanath, a controversial monk and Hindu nationalist politician who was chosen by Prime Minister Narendra Modi to be chief minister of this, India’s most populous state, in March. Mr. Adityanath, who has a penchant for hate speech against Muslims and faces accusations of rioting and attempted murder, has politically dominated Gorakhpur and the adjacent region and represented it in the Indian parliament from 1998 to 2014.

Although disregard for human life is common in India, the images of dead children from the Gorakhpur hospital were followed by intense criticism. “This is not just a tragedy, it is a massacre,” Kailash Satyarthi, an Indian Nobel laureate, tweeted.

Indian politicians are expected to look after their home constituencies, but Mr. Adityanath defended his record and dismissed allegations that his government was criminally negligent at worst and incompetent at best. One reason for the deaths, he said, is that “we do not lead a clean and hygienic life.”

Several leaders from India’s ruling Bharatiya Janata Party played down the tragedy. Amit Shah, the powerful B.J.P. president and Mr. Modi’s confidante, said, “In such a big country, many incidents happen; this isn’t the first time an incident like this has happened.” Irrespective of the local government’s political ideologies, Gorakhpur and Uttar Pradesh have repeatedly witnessed mass death from disease, grim reminders of the state of its public-health system. The Baba Raghav Das hospital’s records reveal that 3,000 children have died within its walls since 2012.

India’s crumbling health care system heaps repeated indignities on its people. A husband walked for miles with his wife’s body slung over his shoulder because ambulances refused help. Rats gnawed at a newborn in a hospital. Patients traveled across the country to seek health care in big cities, living on sidewalks for weeks, waiting — and sometimes dying — before they got an appointment.

Unlike in the United States, where health policies can hold the political stage, health care in India has never been an electoral issue. In the spring, in the run-up to the election that brought Mr. Adityanath to power, only 1 percent of voters in Uttar Pradesh identified health care as a priority.

Indians rarely debate health policy, and the attitude may have something to do with an Indian fatalism in matters of life and death. It allows the government to get away with repeated public-health scandals. A major reason for India’s health care crisis is that it spends about 1.3 percent of its gross domestic product on health (the global average is 5.99 percent), and while an extensive annual survey meticulously analyzes economic progress, its health data are released only once a decade.

India’s infant mortality rate has fallen 76 percent over the past half-century, but it is still higher than 150 middle- and low-income countries, many poorer than India, including neighbors Nepal and Bangladesh.

India is part of the BRICS grouping of nations because of its economic and military power. On health care, however, it has largely fallen behind fellow BRICS members Brazil, Russia, China and South Africa. China reduced stunting from 32.3 percent in 1990 to 9.4 percent in 2010. India lags behind, having reduced stunting from 62.7 percent in 1990 to 38.4 percent in 2015.

And Uttar Pradesh, home to about 200 million, sits at the bottom of the health rankings of India’s 36 provinces. The state’s infant mortality rate — the number of children who die for every 1,000 born — is 47, the third highest in India. The state government spends $7 a person every year in health care, 70 percent less than the Indian average.

Over 15 years, as the state’s population surged 15 percent, the number of village health centers, the front line of the public health care system, decreased 8 percent because many fell into disuse or were not staffed. Successive state governments are responsible for the withering of the public-health system.

India’s better-governed southern states of Kerala, Tamil Nadu, Andhra Pradesh, Telangana, Karnataka and Goa have invested in their health systems and have healthier people. Poorer, northern Indian states, such as Uttar Pradesh, have lower standards of governance and tend not to make public health a priority. Uttar Pradesh must invest in its health system and hire more medical staff. But it needs to do more than that.

Days after the tragedy in Gorakhpur, an Indian Medical Association inquiry team found dogs and rats in the wards of the Baba Raghav Das hospital, a sight that doctors and patients accept as normal. Uttar Pradesh needs a new normal.

Samar Halarnkar is the editor of IndiaSpend.org, a data journalism nonprofit analyzing public policy in India.

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