Deaths due to encephalitis, heat-stroke expose state of health care in Bihar

More than hundred children have died in Bihar’s Muzaffarpur district due to acute encephalitis syndrome (AES). What makes the tragedy even worse is that AES is not a new phenomenon in this region.

A 2017 paper ( in medical journal The Lancet says that AES cases peak between mid-May and June, also the Litchi harvesting season in the district. The paper also says that outbreaks of an acute unexplained neurological illness have been reported since 1995 from Muzaffarpur, which is the largest litchi fruit cultivation region in India. The paper, which is based on a survey of 390 patients in 2014 with a median age of four years; of which 122 died, says that the illness was associated with toxicity from litchi consumption and absence of an evening meal among children.

The paper recommended “minimising Litchi consumption among young children, ensuring children in the area receive an evening meal throughout the outbreak season, and implementing rapid glucose correction for children with suspected illness” to prevent AES deaths in the district. While the first two are behavioural/information dissemination challenges, the last one could have been achieved with functional primary health facilities. The paper says that “limitations in the ability to provide aggressive critical care, including closer respiratory monitoring and mechanical ventilation, probably contributed to mortality among affected children” while calling for strengthening of clinical intensive care capacity at the treating hospitals in Muzaffarpur.

Simple as they may appear, these recommendations are not very easy to implement in Bihar, a state which is extremely backward when it comes to medical infrastructure.

According to a 2016 World health Organisation (WHO) study, using 2011-12 National Sample Survey Office (NSSO) data, Bihar had just three allopathic doctors and four nurses per 100,000 people against an all-India average of 34 and 32.

See Chart 1: Doctors per 100,000 people

Another set of statistics from an NSSO report reveals the poor state of material infrastructure in the health sector in Bihar. Out of thousand persons who were treated for an ailment in Bihar between January to June 2014, 764 availed the facilities of a private doctor/clinic, against 57 in primary health centres, 81 in government hospitals and 98 in private hospitals. The all-India numbers were 504 for private doctor/clinic, 170 and 241 for government and private hospitals and 85 for primary health centres. In other words, the share of patients in Bihar, who were treated at a hospital, which is more likely to have better facilities than a private clinic, was less than half the all-India figure.

See Chart 2: Place of getting treatment

Both these statistics point towards a deficiency of health infrastructure in the state. However, the Bihar government has done the opposite of what should have been done.

Statistics from the RBI’s publication on state finances show that Bihar has not even been honouring its budgetary commitments regarding health spending. In 2014-15 and 2015-16, the latest years for which actual expenditure figures are available, capital expenditure on the medical and public health sector were 44% and 74% of the budget estimates (BE). In 2016-17, the BE figure itself was cut by almost one-third of the BE amount in 2015-16. The 2017-18 BE figure (latest statistics in the RBI publication) was only 90% of the 2016-17 figure. These figures suggest that augmenting health infrastructure is a dispensable goal for the state government.

See Chart 3: Capital expenditure on health in Bihar

To be sure, the revenue expenditure on medical and health has increased every year during the 2014-15 to 2016-17 period; the latter being revised estimates (RE). However, 2017-18 BE figures for revenue expenditure were lower than the 2016-17 BE and RE figures. While revenue spending is used to take care of recurring expenses such as salaries and in this case medicines; capital spending is what is used to crate new facilities.

AES is not the only factor which has been leading to untimely and preventable deaths in the state. More than hundred people have died of heat-stroke in southern parts of the state, which could not have happened had even basic treatment been administered in time.

Unless these things change, tragedies like AES will continue to be an annual ritual in the state.

First Published:
Jun 18, 2019 23:58 IST

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