He was invited to deliver a lecture on: two years of #BRDoxygenTragedy – continued victimization of Dr kafeel Khan by Uttar Pradesh government and to launch the West -Bengal chapter of ‘Health for All campaign’. 

Dr. Kafeel told the audience that the children in the BRD Hospital died as a result of stoppage of supply of liquid oxygen due to non-payment of dues to vendor by the Government. And in order to hide the inefficiency of the government, he was made a scape goat.

The Allahabad High Court categorically stated that there is no evidence of medical negligence against him and that he was not involved with oxygen tender. In reply to a RTI, the government also accepted that there was shortage of liquid oxygen for 54 hours in BRD medical College on 10^th, 11^th and 12^th of August 2017. And Dr Kafeel Khan indeed arranged jumbo oxygen cylinders to save the dying children.

The UP High court in its judgment on 30th April 2018 observed that there was shortage of liquid oxygen due to abrupt disruption of liquid oxygen supply due to non-payment of dues to the supplier.

He said that “the real culprits of #BRDOXYGENTRAGEDY massacre are those who received letters of dues from suppliers and their action should be thoroughly investigated to know the real facts and they should be removed from their post until pending enquiry including our Health ministers.”

“I demand CBI enquiry of BRD Oxygen tragedy and to move the case outside Uttar-Pradesh as those responsible for the massacre are still at helm and are heading the enquiry”.

Expressing his sympathy to the parents who lost their innocent children and are still awaiting justice, he said the government should apologize to them and also give compensation.

He shared the hard times he faced after his suspension and imprisonment which took a toll on him both emotionally and physically. He also spoke about the horrifying experience when an attempt was made on the life of his brother who was shot and the insensitive attitude of the UP police who tried their best to delay the emergency operation to remove the bullets by many hours.

The Hon’ble High Court in its order dated 07/03/19 has ordered the UP government to finish the enquiry within 90 days that is by 7th June 2019 and  the Hon’ble Supreme Court in his order dated 10/05/19 has ordered the UP government to pay all his suspension allowances dues of approximately 16 lacks

Dr. Khan said that his main concern is that government sponsored victimization of his family is still continued while he is struggling to survive, running from pillar to post for over 2 years now despite the orders of both the High Court and Supreme court. The Uttar Pradesh Government is neither paying his dues nor revoking his suspension subjecting him to a life of turmoil on a day to day basis.

He demanded that the CBI should investigate the matter and rule out any complicity of state officials.

Inaugurating the Kolkata chapter of ‘Health for all campaign’ he said the entire Indian health care system needs an overhaul. According to the Global Hunger Index, India ranks 103 out of 119 and 145 out of 195 in terms of quality and accessibility of healthcare as per the Lancet study.
The specific problems he pointed out are: 50% children are malnourished and 62% are immunized; 8, 02,000 infant deaths were reported in India in 2017 (UN reports);

4 lakh people died of tuberculosis while India has the third-largest number of people living with HIV in the world; there are 1.5 lakh vacancies in health services with one primary healthcare Centre (often manned by one doctor) for more than 51,000 population.

Some of the possible solutions to improve the health care system as per Dr. Kafeel Khan are:
 

1. Access to good quality health care services without anyone having to face financial hardship–for all at all ages irrespective of  caste/religion/region/gender/disability/ economic status.
2. Government should provide health services that are affordable, adequate, new & acceptable for its citizens-free consultation/drugs/diagnostics and free emergency care services in all public hospitals.
3. Increase in public health expenditure to 3% of the GDP.
4. Increase the budget allocated for health services Rs 1.5 Lakhs Cr/every year for the next 5 years.
5. Fill all the 1.5 Lakhs existing vacancies and create new jobs every year.
6. Regularize National Health Mission employees, Equal pay for equal work, social security for them.
7. ASHA workers to get 20000 per month and Aganwadi workers to get 15000 per month minimum salary.
8. Cut GST rate to 5% from the current 18 per cent on health insurance premium.
9. GST exemption for OPD Products and drugs for serious ailments such as cancer and diabetes.
10. Reduce GST rate to 5% from the current 18 per cent on medical technology solutions.

The event was attended by the media and health activists in Kolkata.

Courtesy: Two Circle

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These findings were part of the second edition of Healthy States Progressive India Report released on June 25, 2019 by government think tank NITI Aayog, which tracked and compared states’ performance in the health sector between 2015-16 and 2017-18. The report is “an annual systematic tool to propel states towards undertaking multi-pronged interventions that will bring better health outcomes”, the NITI Aayog wrote.

The report derived a health index for each state based on 23 health indicators falling under three categories: health outcomes, governance and information, and key inputs and processes. ‘Health outcomes’ included indicators such as neonatal and under-five mortality rate, institutional deliveries, sex ratio at birth among others; ‘governance and information’ included data integrity measure i.e. percentage deviation of reported data with survey data, occupancy of officers at key positions at state and district level, while ‘key inputs and processes’ looked at proportion of vacant healthcare provider positions and proportion of IT-enabled human resource management systems in place.

Kerala had the best index score (74.01), followed by Andhra Pradesh (65.13) and Maharashtra (63.99). Uttar Pradesh had the lowest (28.61), followed by Bihar (32.11) and Odisha (35.97).

Seven states saw an improvement in scores while nine states saw a decline. Five of these–Bihar, Uttar Pradesh, Uttarakhand, Odisha and Madhya Pradesh–as we said, are also among India’s poorest. Together with Rajasthan, Jharkhand and Chhattisgarh, which improved their health index scores, these states form the Empowered Action Group (EAG).

Haryana saw the most improvement in its index score in 2017-18, while Bihar saw the largest decline.

Andhra Pradesh and Maharashtra saw the most improvement in rankings–by six and four positions, respectively–while Tamil Nadu saw the highest decline, falling from third to ninth position in 2017-18.

Health Index Ranking Of Larger States, 2015-16 & 2017-18

Source: NITI Aayog

Among eight smaller states, Mizoram ranked first (73.70) while Nagaland ranked last (37.38). Tripura and Manipur showed the most improvement in health score. Four out of eight smaller states showed a decline in the overall health sector performance.

Among union territories, Chandigarh ranked first in overall performance (63.62) while Daman and Diu performed the worst (41.66). Dadra and Nagar Haveli saw the most improvement.

Why EAG states continue to flounder

Five of eight EAG states, as we said, saw declines in their overall health index score in 2017-18 as compared to 2015-16, the base year. Bihar saw the highest decline (-6.35), followed by Uttar Pradesh (-5.08), Uttarakhand (-5.02), Odisha (-3.46) and Madhya Pradesh (-1.70).

Bihar’s decline in performance was due to poor performance in indicators in 2017-18 under all three categories as compared to 2015-16, the NITI Aayog report showed. The state’s total fertility rate–the average number of children born to a woman–increased from 3.2 in 2015-16 to 3.3 in 2017-18. The prevalence of low birth weight increased from 7.2% in 2015-16 to 9.2% in 2017-18. Its sex ratio at birth declined from 916 females per 1,000 males in 2015-16 to to 908 in 2017-18, and its tuberculosis treatment success rate was 71.9% in 2017-18–down from 89.7% in 2015-16.

Bihar also took the 191 days  in 2017-18 to transfer National Health Mission (NHM) funds from state treasuries to departments or societies from 40 in 2015-16.

In Bihar, there is not a single district or sub district hospital with a quality accreditation certificate in 2017-18, a decline of 27.16 percentage points since 2015-16.

In Uttar Pradesh, the decline was due to high prevalence of low birth weight, low TB treatment success rate, poor average tenure of key positions at state and district level (18.98 months), and low birth registration (60.7%). The TB treatment success rate fell from 87.5% to 64%, while the percentage of low birth weight babies increased from 9.6% to 11.8%. The birth registration fell from 68.3% to 60.7%.

Health Index Change & Ranks For Large Indian States, 2017-18

Source: NITI Aayog

In Uttarakhand, the decline was due to high rates of neonatal and under-five mortality, low stability of key administrative positions at district levels, a 30-percentage-point reduction in functionality of primary health centres performing specified number of C-sections per year, and NHM fund transfer delays. The state’s neonatal mortality rate increased from 28 deaths per 1,000 live births to 30, and its under-five mortality rate increased from 38 to 41.

While the “immediate outcomes” of under-five mortality and neonatal mortality rates have improved in most EAG states (except Uttarakhand), most “intermediate outcomes” such as full immunisation coverage, institutional delivery and TB treatment success rate have not and need “significant improvement”, the report said.

What worked for Rajasthan, Jharkhand and Chhattisgarh?

Among EAG states, Rajasthan (+6.30), Jharkhand (+5.99) and Chhattisgarh (+1.34) saw improvements in their health index scores. 

Rajasthan’s neonatal mortality dropped from 30 deaths per 1,000 live births to 28; its under-five mortality dropped from 50 to 45. It also reduced the prevalence of low birth weight from 25.5% to 14%, and vacancies in specialist positions in divisional hospitals from 47.7% to 18.4%.

Jharkhand showed an overall improvement in health outcomes from 2015-16 to 2017-18: neonatal mortality rate (from 23 to 21), under five mortality (39 to 33), total fertility rate (from 2.7 to 2.6), sex ratio at birth (902 to 918 girls per 1,000 boys), full immunisation (88.1% to 100%), institutional deliveries (67.4% to 88.2%) and TB treatment success rate from (90.9% to 91.7%).

Chhattisgarh’s improvement was due to better performance on “key processes”: it improved 24-hour functional primary health centres from 40.3% to 111.3% (that is, more than the targeted number), first trimester antenatal registration from 74.6% to 89.4% and community health centre grading from 47.7% to 67%.

Performance of “front-runners” also declined

High ranking states, called “front-runners”–scoring in the top one-third–also showed a decline in their performance. Of these, Tamil Nadu (-2.99) saw the largest decline, followed by Kerala (-2.55) and Punjab (-2.20).

“The states which were already performing well do not show as much incremental change as states that were poor performers before and have more scope to improve,” said V K Paul, member, NITI Aayog, during the press conference to launch the report in New Delhi.

Andhra Pradesh and Maharashtra were the only two states that were among the top one-third states on both overall performance as well as improvement in performance. Andhra Pradesh had the highest proportion of indicators (63%) among the larger states which fall in the category of “most improved” or “improved”.

“Despite relatively good performance, however, even the front-runners could further benefit from improvements in certain indicators as the highest observed Index score of 74.01 is well below 100,” the report said.

The report also found that there was a general positive correlation between the health index scores and the economic development levels of states and union territories as measured by per capita net state domestic product.

However, the report found, a few states–such as Jammu and Kashmir, Manipur, Mizoram, Andhra Pradesh and Punjab–with relatively low level of economic development performed well in the health index. 

“The lessons from these states may provide some insights on how to improve health index scores in states with similarly low level of economic development,” said the report. “On the other hand, some states and union territories with relative high level of economic development did not perform as well in health index score, such as Goa, Delhi and Sikkim.”

This story was first published here on HealthCheck.

(Yadavar is a special correspondent with IndiaSpend.)

Courtesy: India Spend

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