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By Nitin Chandola

The gaps in the health facilities of Uttarakhand can be easily understood by the ranking of the state in Health Index 2018-19 published by Niti Aayog in June 2019. The state received 19 th rank out of 21 larger states of the country. With the base year of 2017-18, the rank fell from 17th position to 19th due to the lack of the prime health care facilities in the region. Recalling the election campaign the of BJP led government in 2017, PM Narendra Modi’s promise of boosting the developmental infrastructure in the Himalayan region of Uttarakhand seems to be a fallacy according to the pace recognized by Niti Aayog in health Index report. There has been serious glitches found in the primary and secondary healthcare sectors of Uttrakhand. It is a well-known fact and many media houses across the country have already reported on the way delivery of children in remote areas of Uttrakhand.  These incidents are not only a reflection of uncompetitiveness of the administration in the districts but also shows the political unwillingness of justifying the vast mandate that the majority of BJP of Uttarakhand received in 2017.  Falling of the rank to 19th from 17th shows that the “double engine” has already derailed as far as the Healthcare facilities are concerned in the remotest Himalayan regions of Uttarakhand.

 The prime concerns of the report is to attain the Sustainable Developmental Goals by 2030 across India. Hence from the past year

Uttarakhand is also focused on developing a short catalog and indicator to meet the competitiveness at attaining the 17 prime goals of SDG by United Nations.  In the section of SDG 3 i.e Good health and wellbeing, Niti AAyog has released the Health index to point out the current condition of healthcare facilities in various states and union territories.

The overall failure of Uttarakhand has been tagged as an “aspirant”, which is among the states like Madhya Pradesh, Odisha, Uttar Pradesh, and Bihar.  Uttarakhand is the only state in the “aspirant” category with the least area and population and that creates doubt about the work executed in healthcare by the BJP led government of CM Trivendra Singh Rawat. Uttarakhand’s overall Index score in 2017-18 was 45.22 which fell to the score of 40.20 in 2018-19, indicating that the there is not only the stagnancy in political and administrative level but also an unawareness of the good governance.

The crucial and sophisticated front which faced the downfall in the year 2018-19 were Total Fertility Rate, where the index fell from 2.0 in 2015 to 1.9 in 2016. Low Birth Weight (LBW) also increased in the index from  7.3 to 8.2 , which is indicative of malnutrition in pregnant mothers, a prime factor for this. Uttarakahand’s performance in 2017-18 in immunization coverage was 99.3 which fell to 95.0 in 2018-19. The report also concludes that there is severe loss in the index of successful treatment of Tuberculosis i.e with a base year of 2017-18 the tuberculosis successful treatment index fell from 86 to 77.6 in the year 2018-19. Another domain at which the report was judged was the governance of administration and the legislations, in which Uttarakhand lost is ranking in availing the occupancy of district Chief Medical Officer (CMO) from 13.96 months in 2017-18 to 10.1 months in 2018-19.  The depreciation of the healthcare facilities in Uttararakahnd is magnified when the indicator of “key Inputs” that the number of Medical Officers at PHC’s has drastically depreciated from 12. % to 69.2% vacancies.

The report also provides an insight into the availability of specialists at district hospitals, at which Uttarakhand again lost its ground from 60.3 % to 68.0 % vacancies.

The Health Index also shows that there is a great technological glitch and gaps in payment of salaries to the medical staff by human resource management information system.  In this section, Uttarakhand stands at a failure at 0.0% index whereas Kerela has attained 100% digitization of Data Management System. But the best performer was also the BJP led state of Haryana. Haryana has achieved 100 % Human Resource Management information system in the year 2018-19 as compared to 0.0 % in the year 2017-18. Hence, it is easy to find the political unwillingness of the government to create a rigid healthcare system. Even after the launch of Atal Ayushman Yojna, Uttarakhand is lacking in the functional first referral health units as the index fell from 95 to 65 units in the region. The transfer of NHM funds from the state treasury to the implementing agencies has also increased from 27 days in the year 2017-18 to 109 days in 2018-19, which certainly has to lead to a lag in delivering of a quality healthcare facility in remote areas of Uttarakhand. 

But there was a substantial increase in cardiac care units, registration of births in the region, the notification rate of tuberculosis, proportional of institutional deliveries. The state also lost its floor in the section of neonatal mortality rate, which increased from 20 in 2017-19 to 30 children among 1000 birth in the year 2018-19. The under-five mortality rate in Uttarakahdn also increased from 38 to 41 in  2018-19 children per 1000 births. 

The situations that arose in the year 2018-19 regarding the strikes of the Doctors, Nurses, and staffs in the region has also affected the index, the strike of 108 ambulance services in Uttarakhand has also severely affected the healthcare system in the Garhwal and Kumaon region. The loopholes like access to real-time data is the prime tool that Government of Uttarakhand must avail to the PHC’s and CHC’s. The modern machinery build upon Artificial Intelligence must be provided to the District Hospitals to overcome the deficiency of Medical specialists in the region.

The report compiled by Niti Aayog has clearly stated Uttarakhand as a failed aspirant in the Health and wellbeing section of Sustainable Development Goals. And it will be curious to see what an “aspirant” like Uttarakhand will achieve in the year 2019-20.

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