Madhya Pradesh is continuously releasing news related to mother and child mortality. Health surveys conducted by various organizations are also proving poor health status of the State. Now disaster of malaria, dengue is also being faced. Government Hospitals of the State are failed in improving health of children, women and people of all category…….. Why? Why is it that the image that leaps to the mind when the words ‘government hospital’ are mentioned is of a filthy and foul smelling centre where ill-mannered behaviour of staff and corruption are the norm? Why can I never believe that if I or any of my relatives fall ill there is no need to worry because we can go to the government hospital to get our life back?

It is not as if we are looking for something special in a hospital but our faith in that institution continues to diminish. At the same time, why exactly are quality health services moving further and further beyond the reach of the common people? Is the government really committed to providing the people with such quality services?

Around 80% of births now take place in hospitals or health centres in Madhya Pradesh. But 54% of the posts for women’s health specialists currently lie vacant and around 5,000 women continue to die every year of birth-related complications.

Death is the final episode. But even if women do not die they are dogged by birth-related problems throughout their lives.

Madhya Pradesh today tops the country with its dismal infant mortality record. For every 1,000 live births, as many as 67 infants die before they reach the age of 12 months. The problem is obvious and evident. Everyone understands it and even at the political level there is wide acceptance that the state faces serious challenges in maternal and infant healthcare. If the situation is to be improved it is crucially important to revitalize and strengthen the healthcare system. The high maternal and infant mortality rates have called into question our development policies and high-sounding claims.

There is an intimate link between health indicators, the government’s intent and the distribution of the required resources. If quality health services are not free to the people the health indicators of the state would be dismal.

Is this situation a reflection of the state’s intent, concerns and perspective? It would certainly seem so because the system can never be changed without active state intervention. According to the guidelines set by a high-level expert group, Madhya Pradesh should spent Rs1,500 per capita per year at 2008-09 prices on health under the National Rural Health Mission, but the actual expenditure was a meagre Rs352. That left Rs1,148 unspent.

Currently, the per capita health spend is the lowest in Madhya Pradesh. Kerala spends Rs1,061, Tamil Nadu Rs1,104, Maharashtra Rs1,355 and Haryana Rs1,226. Against the standard annual per capita health expenditure of Rs2,000 for special category states, Arunachal Pradesh spends Rs3,563, Goa Rs3,148, Mizoram Rs4,500 and Sikkim Rs3,049.

In 2001-02, Madhya Pradesh spent Rs13 per capita on medicines, the total public expenditure amounting to Rs792.1 million. In that year the national average was Rs18, with Kerala spending Rs38.9. Ten years later in 2010-11, Madhya Pradesh spent a total of Rs1.22 billion, the per capita expenditure being Rs17.1. This amount would suffice for a three-day dosage of medicine for a common fever. The national average in that year was Rs43, with Kerala spending Rs72.3 and Tamil Nadu Rs65 According to the high-level expert group set up by the Planning Commission in 2011, there should be 5.1 doctors for every 10,000 people, or one doctor for every 1,952 people. The group points out that Madhya Pradesh currently has 11 medical colleges for its 50 districts, and needs a further 18 to meet its requirement of doctors. But the government does not seem committed to investing in medical education. In the past 15 years, the total number of seats available in medical colleges has increased by only 20%. This year’s budget has announced the opening of another five medical colleges, none in the government sector, which shows that medical education is now becoming big business for the private sector.

Sri Lanka has one hospital bed per 1,000 persons while China has three. The figure for India is 0.9. Madhya Pradesh has 32,000 hospital beds for its 72.59 million population or one bed for every 2,268 persons, or 0.44 bed for every 1,000 persons. The situation is even worse in rural areas where the availability is 0.25 bed per 1,000 persons.

The Planning Commission itself admits that the privatisation of health services is one of the main reasons for the indebtedness of the poor. But it is the agency that is stopping health from being declared a basic right.

In 2011-12, the Madhya Pradesh high court, responding to two petitions about the dismal state of maternal healthcare facilities, ordered the government to improve the condition of its hospitals, make the required medicines available and ensure that proper medical examinations were carried out.  It said the facilities should be up to the accepted standards, pointing out that it is the government itself that sets these standards and then flouts them.

This is the biggest challenge – that the government becomes accountable.