Health was in much focus for the last three years due to COVID-19. The governments seemed to take some initiatives towards providing some care for the people during the pandemic. But if there was some hope that the political class would give healthcare enough attention, then this has been belied with the political class going back to business as usual.
COVID-19 will not be the last pandemic, given the extent of environmental destruction and increase in human-animal conflict. But, sadly, we, as a society, have not learnt our lessons from COVID-19 and have not invested in the health of the population. It is in this context, and the immediate context of the state elections, that we need to discuss where Karnataka in general and Bengaluru in particular stand vis-à-vis health.
Karnataka’s poor health indicators
There has been considerable improvement in population health of Karnataka. But the state’s health indicators have always stayed in the middle range. It has been neither exceptionally good nor exceptionally bad. But it is to be noted that Karnataka’s health indicators are the worst among the southern Indian states.
The Maternal Mortality ratio (MMR) is at 69, even though it has improved from 228 in 2001-2003, it is still nowhere near Kerala’s level of 19. Similarly, when it comes to Infant mortality rate (IMR), Karnataka has an IMR of 21 as compared to Kerala at 6.
In Karnataka, 65.5% of children, between the ages of 6 months and 5 years, are anaemic, so are women who comprise 48 %. Of course, the averages mask the inequalities within the state with districts like Raichur and Bidar performing much worse.
Issues in the healthcare system
Recently, we did a state level convention on health, with many organisations and networks participating, to find out the issues that plague the healthcare system of Karnataka. The following concerns were expressed by the participants which are also largely backed by evidence:
- The lack of a Right to Health framework in the state
- Very low public expenditure on health at 0.8% of GDP, leading to a very weak public health system.
- High Vacancies of staff, particularly specialists, in the public health system. Despite this, the government announced ‘namma clinics’ to provide some care for the people in anticipation of the elections.ut the initiative was a non-starter as the issues that affect the public health system are much more structural and the same issues that affect the public health system also affected ‘namma clinics’.
- Lack of availability of free medicines in the public facilities resulting in very high Out-Of-Pocket-Expenditures (OOPE).
- Insistence on documentation such as Aaadhaar, Thayi Card etc. for the patients to avail services. Lack of these have led to outright denial of care and death for patients.
- Post Covid- 19 there has been a drastic increase in the mental distress among populations, but mental health is not given a priority by the health department.
- Lack of empathy by the providers/staff of the facilities sometimes leading to outright abuse of the patients.
- The state government has increased the engagement with the private sector but without any change in population health outcomes. Additionally, the state refuses to put in any effort to regulate the unethical, irrational and profit-mongering of the private sector.
Approach towards the pandemic
During the first wave, the public health system was trying to get a grasp of the situation and was in a constant catch-up scenario. A task force was constituted and periodic guidelines on handling of the illness, COVID-appropriate behaviour, quarantine, isolation and other such issues were issued. However, largely, the public health problem was handled more from a policing approach rather than a scientific one.
Public health aspects like testing were sidelined. There was more emphasis on the security aspects, with the police being more visible during COVID-19 rather than the public health community. There were unethical, stigmatising practices, such as stamping and marking the houses of people under quarantine.
The need to strengthen the public health system
Another major feature was the near absence of the private sector in treating patients – both COVID and non-COVID. While the small hospitals closed down, others overcharged the patients. This also showed up the weak regulatory practices of the state. So, most of the care burden during COVID-19 fell on public facilities, indicating the inevitability of strengthening the public health system despite the inclination of the government(s) to encourage unbridled privatisation.
The second wave, the so-called Delta wave, was total mayhem. But the government did get its act together and became a ‘convening authority’ for the hospital beds in the city, where it negotiated with the private facilities to earmark 50% of their beds for COVID treatment referred by the state government or the municipal corporations.
There was also an attempt at capping the prices of testing and treatment. Despite this, demand outstripped availability and there was a frantic search of facilities by the common people for beds, oxygen cylinders, PPE kits etc. There were also quite a few malpractices by the private sector. The government did take some action against such facilities, but these were very few and far between.
A Health Vision Group Report on health services in the state
Another initiative that the state government initiated was the constitution of a ‘Karnataka Health Vision Group’ in 2021 to come up with a roadmap on health services for the decade 2021-30.
While the committee itself completed the report, titled ‘Advancing People’s Health in Karnataka: Vision for Progress’ by the end of 2021 (despite the change of the chief minister in between) with some far-reaching recommendations, but the formal launch of the report was considerably delayed till August 2022 and the government did not have enough time to move towards implementing the report.
Some of the recommendations in the report included increasing the public health expenditures from current 0.8% of GDP to 2.5% of GDP; to move towards a Universal Health System; to address staff vacancies and such other structural matters.
In conclusion, the state government did take some action during the pandemic, but did not make any substantial progress towards addressing some of the structural issues in the healthcare system.