The Big Story: A public health failure

Once the recriminations and the political blame games have died down, it will be time to look at the Gorakhpur tragedy in the eye. Over 70 children died in a week at the Baba Raghav Das Medical College Hospital in Gorakhpur, amid reports that oxygen supplies had been cut off because the hospital had failed to pay the bill. There is appalling negligence here, but also a larger failure that flows through successive governments and across multiple hospital administrations. Gorakhpur reveals how our public health systems are broken and have been dropped from government priorities long ago.

The shortfalls lie in infrastructure, human resources and government spending. The comptroller and auditor general’s report in May, for instance, reveals that the Gorakhpur hospital, the biggest in the district, had a 27% shortfall in clinical equipment and few annual maintenance contracts. Medical college hospitals in other Uttar Pradesh towns showed even higher deficits in critical infrastructure. The terrible pressures on the Gorakhpur hospital, which was so crowded that four children shared a bed in many cases, speak of a gaps elsewhere. Out of a required 120 primary healthcare centres, the district has only 90, of which 26% face an extreme shortage of facilities. And only a third of the villages in the district have access to a health sub-centre within 5 kms. Reports paint a harrowing picture of primary healthcare centres run by wholly unqualified pharmacists, operation theatres in community and health centres closed for lack of specialists.

Which points to a related problem, the acute shortage of doctors and healthcare professionals in these districts. According to the World Health Organisation, in low income countries, the ideal ratio is one doctor for every 1,000 patients while India has one for every 1,700. Of the doctors available, only 20% work in rural areas and at community health centres, over 81% of specialist positions have not been filled. In the absence of doctors, many villages have had to rely on rural medical practitioners with no formal qualifications, or what the Indian Medical Association calls “quacks”. Soon after the Gorakhpur deaths were reported this week, Union Minister Nitin Gadkari frankly admitted that the government was not up to the task of manning hospitals and providing professional healthcare, so could “social institutions” and “entrepreneurs” please run these facilities on government land?

And there lies the nub of the matter: government is unable and even unwilling to invest in healthcare. While experts prescribe that India spend 2.5% of its gross domestic product on healthcare, the country spent only 1.4% in 2014. This figure has remained more or less stagnant since 2010, while states spend an even more negligible amount of their GDP on healthcare. Now the Niti Aayog has even proposed a model with a greater role for the private sector, which has boomed in recent years, driving up the costs of medical care. This means that while swanky, state of the art facilities and highly qualified professionals may be available, they remain out of reach for a large section of the population that cannot afford them. The Gorakhpur tragedy, then, throws up a fundamental question: do governments feel it is not their duty to provide even basic healthcare to the poorest citizens?

The Big Scroll

Menaka Rao travels to Gorakhpur to find that, 72 hours and 30 deaths later, piped oxygen supply was yet to be restored and the hospital was struggling to make payments, that doctors had written repeatedly to the government to ask for funds, and talks to parents who lost their children in the tragedy.

Nayantara Narayanan points out that the comptroller and auditor general had highlighted the poor state of the hospital’s medical infrastructire months ago.


  1. In the Indian Express, Nirmalya Choudhury argues that the focus should shift from relief to building resilience in flood-prone areas.
  2. In the Hindu, Ajit Ranade says that the second part of the Economic Survey is worrying; India should have registered higher economic grouwth, given the macroeconomic climate.
  3. In the Guardian, Owen Jones points out that politicians and newspapers have “fanned the flames of fascism” in the West.


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