Election watch

Gujarat’s model of development has done little to improve health of its people

The state’s health indicators are only middling to poor when compared with other states.

In May, the Indian government told the World Health Organisation that it had confirmed three cases of Zika in Ahmedabad, Gujarat. The first case had been recorded in January by the Union health ministry’s Zika surveillance programme but neither the local health authorities nor the people in neighbourhoods where these cases were detected had been alerted to this. In fact, an official with the Ahmedabad Municipal Corporation told Scroll.in, “We got to know about Zika cases in Ahmedabad after reading about it on the WHO website.”

The episode shows the poor state of preparedness of Gujarat – a “model state”, if India’s government is to be believed – for a possible public health emergency. The state, like many others in India, has also failed to contain outbreaks of seasonal infectious diseases like dengue, chikungunya and swine flu. Gujarat recorded the highest number of swine flu cases this year, and the second-highest number of deaths after Maharashtra.

If the much-touted Gujarat model of development has been a success and is being held up as one for the rest of the country to emulate, then it should not be floundering on a basic parameter like healthcare.

Several experts have pointed out that the Gujarat model is a “classic case of a corporate-led development model facilitated by the state which involves increasing prosperity for the rich, but very little benefit… to the wider population”. This includes reduced political attention to and decreased investments in social sectors like healthcare. As a mill worker student told researchers in 2012: “There are roads, big malls, there are big cars, but if you look at the people, the support that people used to get from the government [before BJP came to power], Narendra Modi has reduced it to half … .they [government] wanted to show that there are no poor people in our state.”

Supporters of the Gujarat style of policymaking argue that living conditions of the wider population would improve in the long term once economic growth is achieved and consolidated. If these benefits have indeed trickled down to the poor, marginalised and rural communities of Gujarat, following splendid industrial and business growth, then the state should by now be among the top performers in social indices. But, it is not.

For example, with respect to the fundamental economic indicator of per capita income, Gujarat is nowhere near the top: among the bigger states, Tamil Nadu, Maharashtra, Kerala, and Karnataka are ahead of it. As for Gujarat’s healthcare performance, it is not model in any sense of the term. While bad performance in a few basic indicators could reflect extraordinary circumstances or problematic statistics, Gujarat shows a consistently poor performance in almost every important health indicator.

The following table displays the 13 most populous states (population more than 30 million, except Andhra Pradesh/Telangana) in terms of their performance in some of the important healthcare indices covered in the National Family Health Survey 2015-’16. Gujarat is nowhere at the top and occasionally at the bottom.

Best to worst performance on health services in India's 13 most populous states.
Best to worst performance on health services in India's 13 most populous states.
Best to worst performance on child health outcomes in 13 most populous states.
Best to worst performance on child health outcomes in 13 most populous states.

The table below looks at four conditions which are commonly associated with poverty and deficient basic healthcare, and again the 13 states are arranged in terms of their performance, best to worst. The data for this table is derived from the recently released India state-level disease burden project.

Best to worst performance on basic healthcare in 13 most populous states.
Best to worst performance on basic healthcare in 13 most populous states.

By failing to draw adequate attention to such failures in healthcare that affect common citizens, the Opposition has perhaps lost an important political opportunity. For example, Gujarat is the only state in India aside from Uttar Pradesh where tuberculosis incidence actually increased over the past decade. More embarrassingly, almost 40% of kids in Gujarat below 5 years of age are stunted. Gujarat has more child stunting than even the poorer states of Odisha and Assam. Gujarat also has the worst record among the large states in immunizing its children, being bettered by even Uttar Pradesh, Bihar, Jharkhand, and Odisha.

A recent report by the Comptroller and Auditor General confirms the presence of the skewed priorities of the Gujarat model and the neglect of people’s healthcare. Following are some excerpts from the report which help us understand what kind of healthcare system a common Gujarati encounters today:

“Availability of beds in DHs [district hospitals] was neither as per IPH standards nor in consonance with the requirements...Audit observed instances of highly congested wards and patients lying on the floor; two patients were accommodated on one bed for transfusion of iron sucrose.... The required stocks of essential drugs such as amoxicillin, diclofenac sodium, Hepatitis B vaccine, injection ceftazimide and insulin were not available for more than four months.. Patients were forced to purchase medicines from the open market… Accident, Emergency and Trauma care services were either not available or were not equipped with essential equipment in test-checked DHs.”

— CAG Report No 2 of 2016 – General and Social Sector Government of Gujarat.

Observers have noted that Gujarat’s social and healthcare indicators are mediocre to poor because Narendra Modi, since he became chief minister, ​diverted government funding for social sectors and development of the poor to the development of big industry: through easy​​ access to land, credit, and infrastructure​, ​as well as tax breaks and subsidies ​for the latter.

Economist Amartya Sen, whose constant warnings that Gujarat should refrain from purely capitalist conceptions of development have never been heeded, says that with the policies of India’s current government, we are the only country in the world trying to become a global economic power with an uneducated and unhealthy labour force. The Gujarat model has failed to substantially improve basic social sector indicators compared to the rest of India and yet the BJP continues to push this substandard model aggressively as a template for the entire country. How Gujarat vote in the upcoming elections will heavily influence India’s future path.

The writer is a medical doctor and health policy graduate, and currently a doctoral student of the history of medicine at Harvard University.

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Changing the conversation around mental health in rural India

Insights that emerged from discussions around mental health at a village this World Mental Health Day.

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According to a National Mental Health Survey of India 2015-16, conducted by the National Institute of Mental Health and Neurosciences (NIMHANS), common mental disorders including depression, anxiety disorders and substance use disorders affect nearly 10% of the population, with 1 in 20 people in India suffering from depression. The survey reported a huge treatment gap, a problem that is spread far and wide across urban and rural parts of the country.

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During the visit, the TLLLF team met patients and their families to gain insights into the program’s effectiveness and impact. Basavaraja, a beneficiary of the program, spoke about the issues he faced because of his illness. He shared how people used to call him mad and would threaten to beat him up. Other patients expressed their difficulty in getting access to medical aid for which they had to travel to the next biggest city, Shivmoga which is about 2 hours away from Davangere. A marked difference from when TLLLF joined the project two years ago was the level of openness and awareness present amongst the villagers. Individuals and families were more expressive about their issues and challenges leading to a more evolved and helpful conversation.

The process of de-stigmatizing mental illnesses in a community and providing treatment to those who are suffering requires a strong nexus of partners to make progress in a holistic manner. Initially, getting different stakeholders together was difficult because of the lack of awareness and resources in the field of mental healthcare. But the project found its footing once it established a network of support from NIMHANS doctors who treated the patients at health camps, Primary Healthcare Centre doctors and the ASHA workers. On their visit, the TLLLF team along with APD and the project partners discussed the impact that was made by the program. Were beneficiaries able to access the free psychiatric drugs? Did the program help in reducing the distance patients had to travel to get treatment? During these discussions, the TLLLF team observed that even amongst the partners, there was an increased sense of support and responsiveness towards mental health aid.

The next leg of the visit took the TLLLF team to the village of Bilichodu where they met a support group that included 15 patients and caregivers. Ujjala Padukone, Deepika Padukone’s mother, being a caregiver herself, was also present in the discussion to share her experiences with the group and encouraged others to share their stories and concerns about their family members. While the discussion revolved around the importance of opening up and seeking help, the team brought about a forward-looking attitude within the group by discussing future possibilities in employment and livelihood options available for the patients.

As the TLLLF team honoured World Mental Health day, 2017 by visiting families, engaging with support groups and reviewing the successes and the challenges in rural mental healthcare, they noticed how the conversation, that was once difficult to start, now had characteristics of support, openness and a positive outlook towards the future. To continue this momentum, the organisation charted out the next steps that will further enrich the dialogue surrounding mental health, in both urban and rural areas. The steps include increasing research on mental health, enhancing the role of social media to drive awareness and decrease stigma and expanding their current programs. To know more, see here.

This article was produced by the Scroll marketing team on behalf of The Live Love Laugh Foundation and not by the Scroll editorial team.