Healthcare system’s absent accountability

Healthcare system’s absent accountability

The death of 63 children in Gorakhpur’s Baba Raghav Das Medical College and Hospital is the most recent manifestation of the poor healthcare system in the country. It is a tragic example of the lack of accountability and rampant inefficiency in the system, and absence of a public health policy that is focused on reducing the incidence of diseases like Japanese encephalitis, diarrhoea, malaria and cholera.
Public spending on health is low: 0.22% of the GDP in 1950-51 and a little over 1% of GDP in 2016-17, while the world average is 5.99%. Public spending on health has to increase drastically, especially in a country where the vast majority rely on public institutions for medical needs. India already has one of the highest out-of-pocket expenditures, 78%, for healthcare. Further, the system must have accountability, with a role for the local government in supervision of hospitals.
While central and state governments have a role in making budgetary allocations and disbursing them on time, actual expenditure and management of healthcare is local. A public health approach that seamlessly addresses issues of sanitation, prevention and access to primary healthcare is essential if we are serious about stemming the tide of preventable deaths. Patients and their families go to hospitals at their most vulnerable and deserve to be treated with respect and provided the best care available. Their economic status should not define the quality of care.
The tragedy in Gorakhpur, unfortunately, is not a one-off incident. It is the latest manifestation of a dysfunctional healthcare system. Fixing this will require funds, dedication, better systems and accountability. The good news is that none of this is impossible: southern states, after all, do manage similar tasks in heathcare a whole lot better, on the whole.