We should congratulate Union Finance Minister Nirmala Sitharaman for the ‘Paanch Sootr, Ek Lakshya, Gyarah Sankalp’or the BJP election manifesto for Bihar, which was released by her this week.
India has been taken by storm by the promise of a free Covid vaccine for every resident Bihari, once the Indian Council of Medical Research (ICMR) approves a vaccine for mass manufacture. It’s a historic first in a democracy, with Joe Biden following suit in the US. The BJP, the world’s largest political party, has made India’s costliest healthcare election promise.
Bihar, with its estimated population of 12.5 crore, will need approximately 25 crore doses, while Bharat Biotech’s current annual capacity to manufacture Covaxin is around 15 crore doses. The BJP would have done well to promise a state-of-the-art vaccine manufacturing facility in Bihar instead of the next-gen IT industries listed in the 11 promises for the state.
The people of Assam, Kerala, Puducherry, Tamil Nadu and West Bengal are now excited about their prospects of getting a free vaccine next year and probably want the Election Commission to fast-track polls in their states. I am sure senior citizen groups and diabetic patient associations would now want the government to declare new states of ‘Buzurg Pradesh’ and ‘Shakkargarh’ and democratically elect the BJP to govern them.
As a public health specialist, I am elated at the seven points listed under the health agenda in the BJP’s Bihar manifesto. It is highly unusual for any political party to make health a priority for state elections. Bihar has 1,899 functional Public Health Centres (PHCs), which means one for every 65,000 people, which is much better than Yogi Adityanath’s Uttar Pradesh (one for 81,000 people). The BJP’s promise to appoint 10,000 physicians is, well, promising. If we assume that a large majority of them are for primary health, then all we will need is to build another 2,000-odd primary health centres in Bihar to house them and meet the population norm of 30,000 people for every PHC.
The BJP also promised that 50,000 paramedics will be placed against the 85 per cent, 70 per cent and 44 per cent vacancies of pharmacists, lab technicians and nurses respectively in Bihar. Since Nirmala Sitharaman has been elected to the Rajya Sabha from Karnataka, this promise seems a wise move on her part. Karnataka has 671 nursing schools against only 16 in Bihar, and 374 pharmacy colleges against 14 in Bihar. Piyush Goel can be requested to sanction a permanent train from Patna to Bengaluru, to ferry Bihari students or help students from Karnataka find jobs in faraway Bihar.
The BJP promise to give six crore people a health coverage of up to Rs 5 lakh under the Ayushman Bharat scheme is laudable. It is rumoured that the current Bihar Chief Minister hasn’t been too keen on the scheme with only 53.7 lakh cards issued to date. Further, only 871 hospitals are empanelled in Bihar under the prestigious scheme, out of the 22,796 hospitals empanelled across India. Biharis continue to throng Delhi or Vellore in search of treatment under Narendra Modi’s pet scheme. Maybe that is why the BJP has announced that the AIIMS campus at Dharbhanga will be operational by 2024. The Laheriasarai campus of the Dharbanga Medical College was founded in 1946 and branding it as AIIMS deeply resonates with the Bihari people, because they dominate the corridors of AIIMS in New Delhi.
The BJP can even incentivise the Apollos, Fortis, Medantas, Max and Narayanas to set up shop in Bhagalpur, Purnia, Siwan, Sitamarhi and other districts to meet the demand that will be generated by the largest government-sponsored healthcare programme, else the private sector is unlikely to step in.
Quite an expense
Of all the promises the BJP has made in Bihar, I am most impressed by the Matritva Vandana Yojana, which aims to give a Bal Suraksha Kit to every mother post-partum, with an aim to reduce infant mortality. Bihar ranks with Kenya, Malawi, Eritrea, Senegal and Uganda with an infant mortality rate of 32 per 1,000 live births.
As per my calculations, 1 lakh children die in Bihar every year before their first birthday and just under another lakh die before their fifth birthday. In contrast, COVID has killed 1,026 people in Bihar, mostly elderly and those with co-morbidities. When 161 children died of Acute Encephalitis Syndrome in 2019, hyped in the media as the ‘litchi disease’, it brought disrepute to the fruit that can boost Bihar’s GDP growth, especially if the thousand-odd farmer producer organisations get their act together. Promising the Covid vaccine, while forgetting the children who died because they apparently ate litchi while hungry, highlights misplaced priorities.
Delivering the Covid vaccine to every resident Bihari (there will be many more when migrant workers return for promised jobs) seems to be a greater priority for the BJP than covering the nearly 39 per cent children who haven’t received full immunisation in the state, as per the National Family Health Survey-4. After all, children, who constitute 40 per cent of Bihar’s population, can’t vote. Spending Rs 5,400 crore on vaccinating all resident Biharis, about 50 per cent of the total health budget of the state of Bihar, means the state has to now manage immunising children against measles, polio and diphtheria, building a 1,000 PHCs, conducting 30 lakh deliveries, treating 3.3 crore cases of childhood diarrhoea, and paying the new health staff with the remaining Rs 5,000-odd crore. Of course, the BJP will have to find more money to treat an estimated 30,000 children with congenital heart disease under the Bal Hriday Yojana, another health scheme announced in the BJP manifesto.
I am very empathetic to the challenges faced by the BJP and Union government. Nirmala Sitharaman has to balance the demand on the coffers of the country reeling under economic distress due to the pandemic with the inflows, which have been affected due to an ‘act of God’, in her own words. In such conditions, is it wise to play god to crores of Biharis by promising them the Covid vaccine for free? Will it not create a conflict of interest when the government sits down to prioritise who should get the vaccine first, when available? Election promises are always treated with suspicion, even if they are about good health. The free Covid vaccine for all resident Biharis fits the bill to a T.
Dr Anand Lakshman is a public health specialist, and founder & CEO of AddressHealth. Views are personal.
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