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Home » Governance » Bihar is struggling to improve the lives of the poor even after 27 years of backward caste rule

Bihar is struggling to improve the lives of the poor even after 27 years of backward caste rule

The district hospital of Muzaffarpur, 100 km north of Patna, Bihar’s capital, is struggling with a shortage of doctors.

With 160 beds and an estimated inflow of 500-600 new patients each day, the hospital should have 48 full-time doctors and 52 nurses, said one of its administrators. What it has, instead, is 12 full-time doctors, 24 part-time doctors and 28 nurses. The Intensive Care Unit should have four doctors but has just one. The unit for newborn babies, which should have four pediatricians, is managing with just one.

Given such understaffing, the hospital doesn’t meet the district’s healthcare needs.

When Madina Begum, a resident of Ratnauli village, took a neighbour with a temperature of 104 degrees Fahrenheit to the hospital, she said, “All the doctors did was give her a bottle of saline. Nothing else. No medicine.” The woman’s companions had to put wet clothes on her all night to cool the fever down.

That is the story across Bihar. Seventy years after Independence, the state’s healthcare infrastructure continues to be grossly inadequate. Seventeen of the 38 districts in the state have no more than three government doctors for every 100,000 people. One district, Siwan, has just one doctor for 100,000 people. The highest, Sheikhpura, has eight doctors per 100,000 – or one for every 12,500 people. To put that in perspective, the WHO-prescribed level is 1:1,000.

In the same way, while the Right To Education law mandates student-teacher ratios at 30:1 in primary schools and 35:1 in upper primary, the ratio in Bihar districts hovers between 43:1 and 96:1. As a result, learning outcomes are poor in the state.

All of which echoes what we saw — in relatively greater detail — in the state’s remarkably inadequate response to both arsenic contamination of groundwater and the rising incidence of dengue. Embedded in all this is a paradox. In the last 12 years under chief minister Nitish Kumar, as the article says, Bihar has notched up large improvements in law and order, road connectivity and electricity supply. But its performance on issues crucial for the poor – like health, education and land redistribution – remains weak.

Which is odd. In the last 27 years, the state has been ruled by backward caste leaders, who rose to power by appealing to the poor. Given that, why is Bihar’s track record on crucial issues that most affect the poor so underwhelming?

Out today is the first of a three-part answer to that question.

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