An Open Letter to PM by a Doctor to Remind him that Public Health System in India is in ICU

An Open Letter to PM by a Doctor to Remind him that Public Health System in India is in ICU


Dear Prime Minister of India,


You must have tweeted today a “Happy Doctor’s Day”. I thank you on behalf of the whole medical community. But after the pleasantries are over, let me remind you of the biggest irony surrounding it: Death of 190 children due to acute encephalitis in Bihar.

The recent tragic deaths in Bihar has put the spotlight on the ailing public health infrastructure – both in the state and in the country.

Our country reels under what can be called “deplorable public health infrastructure” and thus as a policymaker, one of you your duty is guaranteeing Right to Life of every citizen.

The gory details of understaffed, underequipped and political apathy take us back to 2017 Gorakhpur Tragedy, where a shortage in supplies of medical oxygen led to the deaths of scores of children due to AES.

Despite the Bharatiya Janata Party’s (BJP) titling the health section of their election manifesto to “Health For all”, your govt hasn’t come close to the spending of promised 2.5 percent of GDP in the past decade.

The impact of inadequate funding on the health system manifests itself most visibly in terms of insufficient human resources. The Doctor-patient ratio in India is one government doctor for 11082 patients, more than 10 times what the WHO recommends. Over the last five years, shortage of medical staff, especially doctors, claimed the lives of 72,000 infants in government hospitals of Madhya Pradesh.

As of March 31, 2017, the country had a shortfall of 10,112 female health workers at primary health centers, 11,712 female health assistants, 15,592 male health assistants and more than 6,1000 female health workers and auxiliary nurse midwives at sub-centers.

In fact, primary health centers across the country are in want of at least 3,000 doctors with 1,974 such centers operating without a single doctor. In community health centers, there is a shortfall of close to 5,000 surgeons.

Healthcare staff shortages at the primary level and for specialty care make the private sector the de facto service provider for a vast majority of the population, with adverse financial implications.

Out-of-pocket (OOP) health expenses drove 55 million Indians–more than the population of South Korea, Spain or Kenya–into poverty in 2011-12, as India Spend reported on July 19, 2018. Ayushman Bharat Yojana did exactly this, helping the private insurance players prosper at the cost of public healthcare delivery.

In addition to the inadequacy of funds, the inconsistency in the timing of funds released by the Centre to state governments has contributed to inequity in terms of service delivery across the country.

If India is to get to a reasonable level of healthcare for all Indians, central and state governments must agree on a common minimum program on health, down to the state level, to help stop losing time between naming schemes India needs to take urgent steps to reduce bureaucratic delay in fund disbursement in particular, and to improve Centre-state relations within the multi-party federal democratic setup.

Underlining that the success of a public healthcare system lies in “easy accessibility, availability, and affordability, it is the responsibility of the State to ensure comprehensive health care facilities for all. There is an urgent need for “convergence and integration of child and maternal health schemes of Central and State Governments and their proper implementation.”

The policymakers wake up only after tragedy strikes, as several promises are made beneath the media glare forcing them to act. Soon after, however, complacency takes over. Public healthcare is all about long-term policymaking and building a strong foundation away from political posturing so that tragedies of the kind witnessed in Muzaffarpur can be averted. The public health crisis is burning a big hole in India’s GDP and if the government fails to take stern action soon it will impact India’s growth story soon.

We hope that you read this and think about 190 families that lost their kids.

Sincerely hoping you work in this direction

An Indian Doctor.

Dr Pooja Tripathi

Dr Pooja Tripathi