The current state of affairs in Bihar can be seen as an acute manifestation of perennial weaknesses in its healthcare system. These weaknesses are not limited to the system’s ‘hardware’ – like infrastructure and human resources, which are frequently highlighted and debated. The problems encompass the ‘softer’ aspects of the system as well, such as governance, trust and accountability. Therefore, it is important to understand these challenges in order to understand why the overall system in the state has traditionally struggled to rise to the occasion.
The state of Bihar constitutes India’s more than 10 crore population. Despite of having a huge chunk of population the health infrastructure of the state doesn’t cater to the growing demographic demand. Bihar remained at the bottom in the health index prepared by the NITI Aayog in the last two years and still remains unequal for a large section of the state’s population.
Last year Bihar received an amount of Rs.3300 crore from the central government under the National Health Mission but utilised only 50% of it. It also received a hefty amount of Rs.300 crore under the PM Jan Arogya Yojana for revamping and expanding the reach of healthcare infrastructure but nothing concrete happened on the ground.
The Acute Encephalitis Syndrome wrecked havoc in the state, taking the lives of 175 people last year.
Shortage of Healthcare Staff
According to the State Health Society of Bihar Report 2019-20, there are only 311 vacancy for the specialist doctors out of 701 sanctioned posts. Among the general doctors, out of 695 sanctioned posts, only 349 vacancies have been notified, this means a shortage of about 50% doctors in public health facilities. There is a significant shortage in the number of staff nurses and auxiliary nurse midwives as well.
In 2018, Prime Minister Narendra announced the setting up of Health and Wellness Centres (HWC) with yoga facilities, diabetes and cancer screening under the Aayushman Bharat Scheme but not much is seen on the ground. According to Rajeev Kamal Kumar, an Assistant Professor at AN Sinha Institute, the healthcare facilities at block level are not much equipped to deal with secondary and tertiary level healthcare needs, except the medical colleges which bear the brunt of a huge chunk of the population.
One of the major challenges in the governance of health systems lies in the administrative framework. The size and the organisational framework of the state’s health department is limited. It is heavily centralised with no separate secretariat and directorate. There is also less autonomy given to health and medical services, medical education, food safety and drug control. The senior most position is occupied by a generalist rather than a specialist having knowledge of public health and medical education. No director level post has a public health expert sitting on it. Due to this the state health department is poorly equipped for public health disasters like the COVID-19 pandemic. The State Health Society, created as a special purpose vehicle under the National Rural Health Mission has limited its function to only policy implementation rather than drafting and formulation.
Quick Action Points
To strengthen the already ailing health sector of Bihar, it is required to immediately revamp its primary health sector. More Primary Health Centres (PHCs) should be built to reach the masses. Building more sub-health centres and recruiting more ASHA workers with better remunerations is the need of the hour since the ASHA workers are among the front line health warriors of the country. Strict monitoring of nutritional norms prescribed for the children and women should be implemented with optimum distribution of health care workers like doctors, nurses and other para-medical staff. Investing more in healthcare to build more medical colleges and encouraging research and development in finding the root causes of severe diseases is the need of the hour.
The contemporary times call for a robust state involvement in basic sectors like health and education. A better and robust public health system can reach out to the most marginalised sections of our country who are left out of the quality healthcare system which has become a lucrative thing, affordable only for the well-offs. The time is ripe to strengthen the public health system and strive for inclusive and equitable growth.
Aman Sharma is a student pursuing Public Administration from Jamia Millia Islamia.
Edited by: Varda Ahmad
Disclaimer: The opinions expressed in this publication are those of the author. They do not purport to reflect the opinions or views of The Jamia Review or its members.