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Interview: Shri Arun Kumar Sinha, Principal Secretary of State for Health & Family Welfare, government of Uttar Pradesh
Along with providing facilities, the state government is also improving health services with the help of modern technology. - Shri Arun Kumar Sinha, Principal Secretary of State for Health & Family Welfare, government of Uttar Pradesh.

Since the issue of health is related to people's lives, it is not possible to ignore it. Those who can afford, prefer seeking treatment in good hospitals, but what about those who find it difficult to arrange for even two meals a day? Such people do not have any other option except to seek treatment in government hospitals, no matter how grave their illness. So, serious efforts are needed to improve public hospitals.

The country's largest state, Uttar Pradesh is on the path of growth right now, what is happening in the field of health in the state? What steps is the government taking in the state to bring about desired improvements in government hospitals? How is the state government dealing with new and old diseases? For seeking answers to all these issues, Mr Sanjay Mishra, senior reporter of met the Principal Secretary of State for Health & Family Welfare, Shri Arun Sinha. Here are excerpts of the detailed discussion:

Q. Although in recent times there has been a significant growth in the medical field but the challenges have risen accordingly, which has proved difficult for the government to overcome, how do you see it from the perspective of the UP government?

A. There is no doubt that our country has made tremendous progress in medical treatment, with hospitals offering modern facilities significantly increasing. Now even people from abroad come to get treated here, which is being called `health tourism'. But the biggest problem is that these hospitals offer very expensive treatment which is out of reach of the common man. Even though the purchasing power of people has gone up, however, it is still difficult to afford treatment in such big privately-owned hospitals. On the other hand, only a few government hospitals are top class, as a result the common man is bound to suffer. If we talk in context of Uttar Pradesh, the state government is trying at its own level to ensure that no person should remain deprived of proper medical treatment. As far as challenges are concerned, of course, challenges are there. According to government standards, there should be a doctor available per 1000 individuals, but so far we have not been able to achieve this goal. Now, the state's population of about 20 crore, which means that there should be at least 20,000 doctors. But in today's date, only 16,000 posts have been approved and 4,000 posts are waiting for approval. While at present, we only have the availability 9,000 to 9,500 doctors. According to me, non-availability of doctors is a big challenge because doctors are the ones who play a key role in the entire health sector. However, in dealing with this problem, the government has taken several steps like increasing the number of seats in government medical colleges. It is obvious that increasing the availability of doctors as per standards will lead to improvement in health services. After this, secondly comes the availability of 'supporting staff'. Basically, we have a public health system which talks about preventive and supportive health. If we talk about life cycle, the starting portion becomes most significant. The talk starts with the pregnant mother and goes to the child, because NHM which began in Uttar Pradesh has three important aspects: 1-Infant Mortality Rate 2- Maternal Mortality Rate 3- Total Fertility Rate. If we compare these three aspects according to country figures, we figure in the bottom range. Hence, we are working towards at least achieving the country average. For this, we need a lot of support. Not only doctors, but supporting hand are also needed accordingly. The condition of Primary Health Centres in the state is worrying. As earlier, even now there is acute shortage of doctors as well as of medicines, although the government is trying its best to improve the situation.

Q. Condition of PHCs is worrying, doctors and medicines are still inadequate, although, the government is taking steps to improve the situation, the circumstances have remained unchanged, what do you have to say on this?

A. The problems I have mentioned earlier would have explained to you the root cause behind the dismal state of Primary Health Centres in the state. We have a system under which there is a district hospital (women and men), a Community Health Centre at the block level, and to support them there is a Primary Health Centre for every 30,000 people. Now, the question is, how do we improve the condition of Primary Health Centres? First of all, we need sufficient doctors. Today, we are struggling with a gap of 700, which mostly affects PHCs, as after being made available for CHCs, there are hardly doctors left that can be enrolled in the PHCs. Although there is support from Accredited Social Health Activists (ASHA) and NHM workers, it is the job of PHCs to guide and supervise them. However, we can say that we are still `weak' at the Primary Health level.

Q. Do you believe that good doctors are reluctant to join Primary Health Centres in rural areas due to lack of facilities?

A. It is true that the past decade has seen a shift in people's thinking, whatever their own circumstances, but people want to provide better facilities to their families and want to educate their children in good schools. Apparently, the doctors can not be beyond this mindset. If you talk about 20-25 years ago, front-line workers actually preferred to stay in villages, but today the kind of facilities they want to give their children, are not possible to provide in a village. So they prefer to go to cities.

You can also assume this as a major factor contributing to the shortage of doctors in PHCs. Do you think a doctor will come to a PHC in a rural area if he gets a good opportunity in a city hospital? In current times, it is important that we attract doctors to rural areas. We have taken a small step in this direction by keeping the residence of the doctors at CSC. Since the roads are good, the doctors find it easy travelling CHC to PHC. Apart from this, the government also gives discounts on post graduation to doctors who have worked in rural areas. Since post graduation is a big attraction for doctors, while earlier only 50 used to join after selection, now almost 90 are joining.

Q. The Akhilesh government in Uttar Pradesh has especially started 102 and 108 ambulance services for rural area, although, it is a good initiative, it does not seem completely effective. Often the ambulance does not arrive on time. And if it does, it does not take the patient to the right place, what do you have to say on this?

A. I do not think so. The ambulance service is working fine. As far as transporting patients is concerned, it takes them to either the PHC or the CHC according to the severity of the patient's illness. It is not so that the ambulance drops the patient at the PHC and leaves. Now suppose there is a case of delivery, for which facilities are lacking at the PHC, so then the ambulance takes the patient to the CHC. Likewise it is done with other patients. The government wants to take health to areas of the state where people are dying untimely deaths due to lack of healthcare.

Q. Mosquito-borne diseases have become ghastly in the country. Diseases like dengue and chikungunya are proving deadly for people. Each year there are talks of running massive campaigns for dealing with such diseases, but the situation does not improve. What is the UP government doing in dealing with such diseases?

A. For this, the Indian government has already running the Integrated Disease Surveillance Programme (IDSP), apart from this the National Vector Borne Disease Control Programme (NVBDCP) is being run through NHM. The state government is too making efforts in this direction to deal with such diseases. Plans are made and we work upon them accordingly. In the case of dengue and Chikungunya, we have recently experienced and are looking at things that we particularly require in dealing with the diseases, especially in medium term. For instance, I shall keep a small example in front of you that the facility of digital mapping is now available with us. By this, we can know which area has the maximum impact of the disease and which area requires how much of fogging. For now, we have introduced this in Lucknow, but by next year, this facility shall be available in other part of the state as well. It means that by use of technology, we can successfully deal with the menace of these diseases even with limited resources. The state government is working in this direction seriously.

Q. No solid diagnosis of Japanese encephalitis has been found in the east so far and the disease claims the lives of many children every year. What is your take on it?

A. See, as far as Japanese encephalitis (JE) and Acute encephalitis syndrome (AES) are concerned, the government is seriously working on them. Apart from this, Indian Council of Medical Research has tied up with a group of India's top scientists for conducting research on Japanese encephalitis. The team has also come out with a vaccine for Japanese encephalitis, although much more needs to be done in the direction. Although work is also being done on AES, a vaccine for the disease is still awaited. Recently in August, a meeting of the Technical Advisory Group was held in Gorakhpur. The meeting which was presided over by Soumya Somnathan, DG of ICMR, was also attended by experts from other states which are affected by the disease. Although work is being done in this direction, a breakthrough is yet to come. Meanwhile, apart from the research side, there is also a lot of work being done on the treatment side, due to increasing awareness among people. In our state, Gorakhpur and Basti tehsils are most effective, so Pediatrician ICUs have been created in 7 districts of these two tehsils. As a result, the treatment starts early and the chances of survival of the patient increase.

Q. How will public faith be restored in government hospitals?

A. The circumstances are changing now. The government hospitals are changing in both direction and condition. The Central government is running almost 12 programmes through NHM in which the state government also has almost 40 per cent partnership. Last year we spent Rs 6000 crore and this year we have spent Rs 1100 crore under this scheme. As a result, our capacity has increased. We are also moving in the direction on ensuring monitoring of hospitals so that the problems faced by patients can be removed. The role of ASHA workers has also increased. So, we can say that the common man's faith in government hospitals has increased and I believe that by close coordination between state and Central governments, the public health system can be made outstanding. 

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