Uttar Pradesh Chief Minister Adityanath on Sunday announced that a team of specialist doctors would investigate the deaths of more than 70 infants at the Baba Raghav Das Medical College hospital in Gorakhpur over the past week. The state government has denied that the deaths were linked to a disruption of oxygen supply caused by delayed payments to the supplier. However, a report of the Comptroller Auditor General of India shows that ensuring steady oxygen supply is not the only challenge that the hospital faces.

The report analysing the performance of general and social sector institutions in the state in 2016 showed that at least four government medical colleges, including Baba Raghav Das Medical College, did not use funds provided by the government to procure clinical and teaching equipment.

According to the report, Baba Raghav Das Medical College spent Rs 426.13 crore of the Rs 452.35 crore allotted to it between 2011 and 2016. Despite spending nearly 95% of the allotted funds, the audit observed that the hospital had a 27% shortage of clinical equipment as against the required standards prescribed by the Medical Council of India. It is not clear from the report whether the shortfall in equipment was because of poor management of funds or inadequate allocations. The shortfall was the least in the paediatrics department, where more than 70 children died last week.

The report found that the lack of annual maintenance contracts had resulted in equipment like colposcopes used for screening of cases of cervix cancer, Nd-YAG Laser used for intraepithelial lesion treatment, NST machines used for foetal monitoring during labour and ultrasound machines used for prenatal diagnosis and gynaecological diagnosis had not been functional for more than five years. More than 200 pieces of equipment installed in 11 departments had not been covered by these maintenance contracts. The report also found irregularities in the tender processes for acquiring equipment like Magnetic Resonance Imaging machine and a Cobalt-60 unit.

This is a poor track record for a 950-bed hospital that is the biggest medical facility for patients in Gorakhpur district, as well as those in other parts of eastern Uttar Pradesh, Bihar and Nepal.

The inadequacies and irregularities are not confined to the Gorakhpur medical college. Three other medical colleges in Meerut, Jhansi and Lucknow showed even higher deficits in critical infrastructure.

No state for public health

Uttar Pradesh ranks in the bottom three for public health infrastructure among big states, according to data by compiled by Brookings India.

Gorakhpur, for instance has 3,319 villages of which only 1,114 have access to a health sub-centre within 5 km. The district requires at least 120 primary health centres but has only 90, a shortage of 26%, which Brookings analysts categorise as an extreme shortage of facilities.

There is a 54% shortage of primary health centres across Uttar Pradesh and the existing primary health centres across Uttar Pradesh have a severe lack of infrastructure.

Given this state of public health infrastructure, it is not surprising that Uttar Pradesh has very poor health indicators. The latest round of the National Family Health Survey shows that the infant mortality rate in the state is 64 deaths per 1,000 live births and the under-five mortality rate is 78 deaths per 1,000 live births – the worst among all states in India. The survey also shows that more than 46% of children are stunted, that is they have low height their age, while 17.9% are wasted with low weight for height. More than 39% of children are underweight. The state also records the highest number of maternal deaths at 258 deaths per 100,000 live births.

The encephalitis scourge

Uttar Pradesh’s Gorakhpur division is classified as “highly endemic” for encephalitis with outbreaks of acute encephalitis syndrome occurring here since the late 1970s. Some experts have even estimated that the Baba Raghav Das hospital has had an average of 200 deaths per bed since the the outbreaks began. Despite this heavy and repeated death toll, successive central and state governments have been unable to bring the disease under control.

Data for 2017 is only till August 6.

Regardless of what is found to be the immediate cause of the recent deaths at the Baba Raghav Das Medical College, the state will still be accountable for its continuing failure to combat a disease that afflicts thousands and kills hundreds every year.