Dear Arbind Sinha,

Health had been a relatively non-issue in the personal agenda of the masses in
India for whom getting two square meals is a matter of great concern and worry-
even today some 300 million people are below the poverty line, approximately 26
percent of the total population of India. Bihar has the largest share in the
population below the poverty line. I remember two occasions when I was face to
face with the poor quality of health infrastructure of Bihar and realised how
appaling the situation is! Last year my own sister lost a new born baby just
hours after his live and normal birth because there was no paedritician in the
hospital at the moment. The second occasion. Two years ago, I was sitting in a
district level government hospital at Chapra on an appointment with a doctor and
suddenly an old lady approached the doctor with her son who had consumed some
poison in a suicide bid due to his failure to pay back his loans. He needed
Oxygen and doctor was told by the staff of the hospital that there was only one
operational facility for oxygen which was being used for attending to a
clinically serious girl child. The doctor said that she can now wait and the
oxygen facility must be transferred to the more needy boy who had consumed
poison!"A district level hospital, and only one operational oxygen facility?" I
asked the doctor. The doctor said that this is only a part of the ugly face of
poor medical infrastructure. You can see the collapsing buiding in which bed for
in-patients are in shambles. The out- patients cannot be attended to if rains
occur , there is no leakproof roof!Most of the districts have the same story to
tell. And failed government hospitals mean more business to private doctors and
hospitals where patients are fleeced by doctors and their brokers.I am telling
all these things at the cost of repetition. But I am not mocking, how could I? I
know that only 20 percent of my family members have come out in places like
Delhi and the remaining 80 percent live there and depend on these roofless,
medicineless, oxygenless hospitals, and above all when my old mother will fall
ill someday, she will also go to these hospitals!! I am only reminding the state
of affairs to me and all my friends, I am not mocking.

I agree with you Arvind that the level of health awareness through the use of
various modes of communication is important. It is important to make the masses
aware about various options available in government and non-government
organisations for ameliorative and palliative cures! But a more important
question is how do we organise our health services and are they sufficient and
efficient for such a densely populated state? The answer we know. The hospital
patient ratio or the doctor patient ratio is very bad and so is the state of
health infrastructure. It took about 55 years to government of India to realise
that a big country like India needs six All India Institute Of Medical Sciences
like hospitals and health reserach Centres, we do not know how many years Bihar
would take to have some model hospitals of its own? Health expenditure as
percentage of total expenditure in Bihar or per capita health expenditure in
Bihar are very low.But lack of funds are not the sufficient reason for failure
on this front. It is mismanagement and absolute indiffernce towards this sector.
I have some questions in my mind which I fail to answer in this regard. Some of
them are as follows:

(1) If a district level hospital does not have roof and oxygen, where do we
invest Rs. 2 crore per annum of local area development funds of our Members of
Parliament? Is there any more important area where they spend this precious
resource?

(2) If we charge 25 paise or one rupee in government hospitals from out patients
and a nominal fees from in -patients for not giving them any clinical facility
worth the name and forcing them to go to private hospitals and paying in lakhs
of rupee, do we impart any social or economic justice? Is is not better to
Charge some realisable and affordable fees, say Rs. 100 or 200 which can sustain
and help in procuring clinical gudgets. In other words, is not possible to
charge some "users charges" to avoid fleecing of the poor patients by private
doctors and hospitals? Or do private hospitals pay something to government
hospitals to remain in poor shape?

(3)If at all we want to communicate with people, let's communicate them to
compel their leaders to increase public expenditure on health and education, the
rest of the economy would take care of itself.

(4)The social sector is important, but expenditure for social sector must flow
from income generated in the farming and manufacturing sector. It is important
to boost growth in these sectors, if we want to sustain high level of social
sector spending at government or private levels. Are we doing anything concrete
to boost our growth performance? Do many of us know that growth in net state
domestic product per annum has been lowest in Bihar in the decade of 1990s?

(5) Non government organisations play a crucial role in delivering such services
in many parts of the country. How many such initiatives are operating in Bihar?
One question which often comes to my mind that crores of repee is spent on
Durgapuja in Bihar and finally no asset or infrastructure is created. Can all
Durga puja samitis make a pledge to donate ten percent of the money they
mobilise to hospitals? Can public give up a part of its ostentatious
expenditure for the sake of health and education infrastructure?

(6) Why doctors have no employment in Bihar when the number of sick people has
been on increase due to poor nutrition, sanitation, potable water and lack of
awareness? Why cannot government reduce some of its liabilities in the
non-performing assembly of Bihar and wasteful expenditure on the Members of
Legislative Assembly to employ some thousand more doctors in government
hospitals?

I was impressed by you my friend that you talked about the Bihar which is sick,
very rarely we talk about it nevertheless!!! Tomorrow many other Biharis will
talk about it. And some may act, some may lead in this direction. I think, why
not me? And hopefully Bihar will come out of the list of "Bimaru" states one
day. But we will have to answer these questions, my friend!


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