Can Didi set a healthy example?

The bylanes of Kalighat, one of the oldest and most densely populated neighbourhoods of Kolkata, the white cotton sari with a slim border and flip flops (more bluntly called bathroom slippers) — Mamata didi has successfully converted these into hot talking points. Now, one eagerly waits for her to do the same to West Bengal’s healthcare system.

Elder sister or Didi’s unannounced visits to various hospitals in her state and her plans to revamp the health services have predictably attracted an avalanche of publicity — some of it good and some of it bad. During one such visit to a Kolkata hospital, excited onlookers reportedly rushed in behind her into the hospital premises. A verbal joust is reported to have broken out between Didi and the hospital director, leading to the latter’s suspension. Many theories are doing the rounds as to what really happened and the underlying reasons. Not having been there, I would not hazard a guess, except to say that generally speaking many of the points that Mamata didi, candidate of change-turned-chief minister, has been making about hospitals are unexceptionable. Nobody would question the need to keep hospitals clean, to manage medicine stocks better, to have staff coming to work on time and treating patients with a smile. However, Didi would be better advised to keep a check on the enthusiastic throngs that tail her, particularly while visiting hospital wards.
Whether it is publicity or good politics that spurred Didi to personally check out the state of hospitals in her state is not that relevant. What is of greater importance is her firm focus on the pages of history and rebranding Bengal. On that lies hope.
These are early days. So far, most of Didi’s observations about the healthcare system in the state have been commonplace and uncontroversial. While setting up a recruitment board for health workers, she said that local boys and girls should be given preference, that senior health officials should spend more time in the field rather than in the office, that better coordination is necessary between health officials to implement government policies etc. She has announced the setting up of four super-speciality hospitals across the state, plus one in Kolkata, that 3,000 beds will be added to various hospitals and medical colleges will have more seats. How this is done and how soon remains to be seen.
To put things in context — West Bengal is not one of the worst states in healthcare. In fact, in recent years, it has seen improvements in several health indicators — infant and child mortality rates have come down, more babies are now born in hospitals than before, more children are being immunised. However, as Mamata didi surely knows by now, a lot more needs to be done. For example, although West Bengal’s infant mortality rate (infant deaths per 1,000 births in the state) is much lower than in India as a whole (33 against India’s 50), it is still higher than in 13 other Indian states. Among the bigger states, Tamil Nadu, Kerala and Maharashtra still do better than Bengal in savings their infants. Within the state, there are huge disparities as well — the highest anaemia rates (86 per cent) are found among Scheduled Tribe children. Given this background, it is to Didi’s credit that she has picked healthcare as a priority area for reforms.
The rest of India and others are keenly watching how West Bengal shapes up under team Mamata. It has a unique opportunity in showcasing itself as a healthy state that can be an inspiration for others in the country. The surprise visits by Didi have revealed what many of us already know — rampant absenteeism among doctors, attendants and others, unfilled vacancies, inadequate medical equipment and so on. The solutions call for resources, but money alone will not change anything. What ultimately matters is political will and determination to translate plans into practice.
Didi’s lack of ideology and fixed notions combined with grit and that famous, can-do spirit could just be what is needed.
Most analysts are waiting to see if Didi will walk the talk and bring back industry and jobs to Bengal. That is of utmost importance, but a wealthier Bengal will not automatically be a healthier Bengal. Economic success is necessary but not sufficient for better health indicators. Look no further than the United States, which continues to be a wealthy country despite an economic downturn. Many Americans, however, have health indicators that are similar to, or in some instances, even worse than those found in developing countries. A new study by the Institute for Health Metrics and Evaluation at the University of Washington, published in the online journal Population Health Metrics, found that in hundreds of US counties, average life expectancy rates are falling though the national average is at an all-time high. Five counties in Mississippi, for example, have the lowest life expectancies for women — below 74.5 years. This puts them behind developing countries such as Honduras, El Salvador and Peru. Interestingly, the US spends more per capita on healthcare than any other nation in the world. The researchers point to high rates of obesity, tobacco use and other preventable risk factors as the leading drivers of the gap between the US and other developed nations.
If West Bengal can show that it is possible to have healthy people without being the richest state in India, it will inspire others and add to the sheen of Brand Bengal.
India, as a country, has some of the worst health indicators in the club of emerging economies. In its latest economic survey of the country, the Organisation for Economic Cooperation and Development (OECD) pointed out that India spends one per cent of its gross domestic product (GDP) on health, and that only seven countries in the world devote a lower share of their GDP to health expenditure.
The vast majority of Indians have to pay out of their pocket for illnesses and millions across the country fall into deep debt doing so. Less than 20 per cent of the population is covered by health insurance. Sometimes, it is a heartrending choice — to let a family member die or to go bankrupt trying to save him or her.
This is a matter of great shame. Didi has dazzled the country and made history by felling the world’s longest-running democratically elected Communist government. She can stun her admirers further and win over the sceptics by demonstrating that Bengal can shake off its proverbial lethargy and shake a leg in the health as well as wealth stakes. Go, Didi, go...

The author writes on development issues in India and emerging economies and can be reached at patralekha.chatterjee@gmail.com