Article: Yogi’s report card: Five years of crumbling health infrastructure

Arshi Qureshi

According to the fourth edition of the Niti Aayog’s State Health Index (2019-20), Uttar Pradesh ranked first out of 19 large states, with year-on-year incremental performance in health outcomes and overall status. In December 2021 – Rajiv Kumar, the chairman of the NITI Aayog, congratulated Uttar Pradesh Chief Minister Yogi Adityanath on his state being the most improved of the country’s 19 large states.

However, a closer look at the official figures reveals that the picture isn’t as rosy as it appears.

According to the most recent National Family Health Survey (NFHS-5, 2019-21), fertility in India is continuing to decline. The World Bank data states – nearly 60 of every 1,000 children born in Uttar Pradesh die before reaching the age of five, nearly as many as in Afghanistan.

Promises by CM yogi Adityanath – Hospitals & Medical Colleges

In 2017 assembly elections – Yogi government promised to set up six AIIMS and 25 new medical colleges.

In July 2021, Prime Minister Narendra Modi claimed that Uttar Pradesh had 12 medical colleges before the Yogi government came to power, the Prime Minister also claimed that the number has increased four-times now.

This statement was claimed by many BJP leaders and was also published as facts. However, according to the Fact Checker – this claim by the BJP leaders and the Prime Minister is untrue.

According to a July 2018 document filed under the Reference Division of the Parliamentary Library on the “Status of Medical Education in India,” Uttar Pradesh had 45 medical colleges during the academic year 2016-2017. There were 16 government colleges and 29 private colleges among them.

The records of the UP’s Directorate of Medical Education and Training, which oversees medical colleges and affiliated teaching hospitals, list government and private medical colleges along with the year they were founded.

Until 2017, the state had 41 government medical colleges and 24 private medical colleges, according to these lists. Furthermore, it demonstrates that, while no private colleges have been established in the state since then, seven government colleges have been established in 2019.

Another claim by the Yogi government was that Uttar Pradesh now has 48 medical colleges, compared to only 12 prior to the Yogi government. This means that the Yogi government established at least 36 medical colleges.

However, according to two responses given in the Lok Sabha in February 2021 by Minister of State for Health and Family Welfare Ashwini Kumar Choubey, Uttar Pradesh has 57 medical colleges, with only 12 of them opening between 2018 and 2020, between academic years 2017-2018 and 2019-2020, ten medical colleges were established in the state, reported factcheck.

Yogi govt’S COVID mishandling

While campaigning in Lucknow, Union Home Minister Amit Shah stated that the Bharatiya Janata Party (BJP) kept the promises made to the people during the 2017 Uttar Pradesh assembly elections campaign. Shah stated that welfare schemes were implemented under the Yogi government and the covid pandemic was handled well.

Samajwadi Party’s spokesperson Abdul Hafiz Gandhi stated, “UP witnessed the worst management of the Covid pandemic.”

Hafiz said that people died gasping for oxygen, bodies were discovered floating in the Ganga, and hospitals were ill-equipped to handle the Covid crisis.

According to mortality data of Uttar Pradesh, the number of people who died in 24 of 75 UP districts over nine months until 31 March 2021 was 43 times higher than the total official Covid-19 death toll reported from these districts over this period, reported Article 14.

Between 1 July 2020 and 31 March 2021, the excess deaths in these districts were 10 to 335 times higher than the reported Covid-19 death toll. According to CM Yogi Adityanath, the state “effectively managed” the Covid-19 situation.

‘‘Documents this reporter obtained for Article 14 under the Right to Information Act, 2005, revealed that during the no-pandemic period between 1 July 2019 and 31 March 2020 these 24 districts registered around 178,000 deaths. Over the same period in 2020-2021, deaths increased by 110% to 375,000, an excess of 197,000,’’ stated Article 14.

In May 2021, many reported large numbers of graves on the Ganga bank in various locations throughout Uttar Pradesh and Bihar. Though these deaths occurred during the peak of the second wave of COVID-19, the Uttar Pradesh government denied that the bodies were those of COVID-19 patients. The government claimed that some communities in the state had a tradition of burying people on the banks of the river.

Sadaf Jafar, the Congress leader, claims that the Yogi government fudged the data – she claims that no testing was done and that the data provided by the state government was fudged.

“Dead bodies floating on the bank of the Ganga tells a story – hospitals were begging for oxygen supply, but the government paid no heed – instead, the government warned the hospitals that their licence would be suspended if they continued to do so,” Jafar said to Maktoob.

She goes on to say that the government threatened civilians who asked for help on social media with confiscation of their property if they continued to spread rumours.

In April 2021, CM Yogi Adityanath directed authorities to use the National Security Act to seize the property of individuals who spread “rumours” and propaganda on social media and attempt to “spoil the atmosphere.”

The Uttar Pradesh Chief Minister claimed that there was no shortage of oxygen in any COVID-19 hospital, but that the real issue was blackmarketing and hoarding.

Jafar also claims that those who died as a result of Covid had no cause of death listed on their death certificates.

In June 2021, the Centre stated in an affidavit to the Supreme Court that all Coronavirus-related deaths should be certified as Covid-19 deaths. It threatened to take action against doctors who “fail to comply” with the rule, reported Article 14.

Concerns about widespread falsification of Covid-19 deaths were echoed by one of India’s top doctors.

“Randeep Guleria, MD, director of the All India Institute of Medical Sciences, told NDTV India that a “death audit” was needed to resolve what he called “misclassification” of Covid-related deaths, which was necessary to develop strategies for the fight against Covid-19 and a third wave.”

According to PTI, the Uttar Pradesh government claimed that no deaths were reported in the state due to a lack of oxygen during the second wave of the Covid-19 in April and May.

UP Health Minister Jai Pratap Singh told the state Legislative Council that none of the 22,915 coronavirus victims in the state had death certificates that listed oxygen deprivation as a cause of death.

“Over 1,300 government teachers died as a result of Covid while on poll duty during the Uttar Pradesh panchayat elections, but the Yogi government claims that only three teachers died, the government had only fudged data everywhere, how can they claim that the Yogi government managed the Covid crisis well?” Jafar, ex-spokesperson of Uttar Pradesh Congress Committee asked.

According to information provided by the Uttar Pradesh Primary Teachers’ Association on May 16, at least 1621 teachers and support staff died from COVID-19 as a result of poll duty during the Uttar Pradesh panchayat elections.

The Uttar Pradesh Primary Teachers’ Association provided a list of victims to the chief minister, requesting Rs 1 crore in financial assistance and jobs for their dependents, reported The Wire.

“Uttar Pradesh government handled the covid situation in the most inhumane way possible,” says Jafar.

The Gorakhpur oxygen tragedy – who pulled the plug?

The oxygen shortage tragedy at Gorakhpur’s Baba Raghav Das Medical College in 2017 is still fresh in people’s minds. According to reports, in August 2017 – around 60 children and 18 adults died as a result of a lack of oxygen caused by the contractor’s failure to supply cylinders due to non-payment of dues. The tragedy sparked widespread outrage across the country.

The Uttar Pradesh government denied that the deaths at BRD Medical College were caused by a lack of oxygen.

According to The Wire – the hospital’s piped oxygen supply ran out between August 10 and 13 – leaving doctors and parents of infants being treated for encephalitis and other ailments in the dark.

When 30 deaths were reported between August 10-11, according to Indian Express, the UP government claimed that the children died of encephalitis and other medical reasons and not due to lack of oxygen, despite the fact that it  prosecuted a number of hospital officials for what it claims is the “interruption” of oxygen supplies.

According to a report – over 30 letters were sent to BRD Medical College and the UP government, alerting them to the fact that the budget had not been cleared for months and that pending payments to the oxygen supplier totaled Rs 63 lakhs.

CM Yogi Adityanath had actually visited the hospital the day before the tragedy, on August 9, 2017, the hospital staff had already received a legal notice from the oxygen supplier demanding payment, failing which the service would be discontinued.

According to then UP’s health minister, Sidharth Nath Singh, all infant deaths during that time period were due to natural causes rather than a lack of oxygen. In this case, he refused to accept responsibility for the months of neglect by his own office and his juniors.

Dr. Kafeel Khan, a paediatrician at Gorakhpur’s Baba Raghav Das Medical College, was fired by the Yogi Adityanath government in 2021, more than four years after he was suspended on the case of the encephalitis deaths, there were allegations of negligence and corruption.

An investigation by the government had cleared him of these charges. He was, however, suspended in another case in 2019. Khan was the paediatrician ward chief at the BRD Medical College in Gorakhpur in August 2017 when the alleged disruption in oxygen supply tragedy occured. Khan, along with seven others, was suspended.

Viral fever that gripped western Uttar Pradesh

12,000 people in western Uttar Pradesh’s districts were suffering from a mysterious dengue-like viral fever, with children bearing the brunt of the toll. Over 200 people died in August and September.

The image of parents running from pillar to post with their children in their arms, looking for beds and pleading with doctors to save their children reflected the grim reality of Uttar Pradesh’s health infrastructure.

Some districts in western Uttar Pradesh, including Mathura, Firozabad, and Mainpuri, saw an increase in cases of ‘viral fever,’ prompting the government to declare a state of emergency.

While government officials claimed that all necessary precautions were being taken to prevent the spread of the diseases, opposition parties chastised the government for failing to learn lessons from the deadly second wave of the Covid 19.

According to the Union Ministry of Health and Family Welfare’s Rural Health Statistics Report 2019-20, there is a 76.1 percent shortage of specialist doctors in community health centres (CHCs) across the country. Uttar Pradesh (402) topped the list.

Dr Kafeel Khan says that primary healthcare in any part of the country is in shambles.

“If you go in rural areas, you’ll find nurses and pharmacists running the healthcare centres, you won’t find any doctors, this is the condition of health infrastructure in the state,” Dr Khan stated.

According to Dr. Khan, Uttar Pradesh has a 47 percent doctor shortage in Primary Health Care.

“People in rural areas have to travel several kilometres to avail medical attention, they first have to visit untrained medical professionals,” Dr Khan adds.

As per Dr Khan 75% of primary healthcare centres are taken by untrained medical professionals.

According to The Quint report –  in UP, there are 2,171 specialist doctor posts that have been sanctioned. However, only 816 positions have been filled, leaving 1,355 open. This means that more than half of the specialist doctors in the CHCs, which are considered the backbone of the village’s health system, have yet to join.

According to the report, there are 3,578 sanctioned posts in rural UP’s primary health centres (PHCs), of which 819 are still unfilled. In the face of the dengue outbreak, pressure mounted on city hospitals, and the healthcare system is collapsing.

A critical shortage of infrastructure and manpower at rural hospitals that provide frontline health services to the poor is one reason for these appalling figures.

Arshi Qureshi is an independent journalist based in Delhi.