In one of the most macabre and tragic incidents in recent times, 70 children died in BRD Medical College Hospital in Gorakhpur in the span of two days. The supplier allegedly cut supply of liquid oxygen after multiple unpaid bills. Many other theories are floating around too. Blame is being ascribed to the government, hospital authorities, the supplier, and some are even saying this isn’t about the oxygen shortage at all. Essentially, everyone involved has found someone to blame.
The children, however, are dead. Their families will have to live with this irreparable loss and immeasurable sorrow all their lives. Making things worse is the knowledge that this was avoidable. This happened because of one reason — utter mismanagement, a hallmark of government-run services in India.
Those who remember the pre-cellphone era days will recall the harrowing experience in obtaining a landline connection. Government-run hotels and airlines are usually of far poorer quality than their private counterparts.
When it comes to the Indian government, one thing is clear — it just can’t do complex services well. When the operations require constant interaction with lots of customers, quick decision-making and a certain amount of quality control, the government is simply terrible at running it.
Of course, mismanagement at MTNL meant you wouldn’t have a phone, and at Air India would mean your flight would be delayed. When things are bungled up in a hospital, you can die, en masse in this case.
The purpose of this article is not government bashing, something enough pieces have done. It is to make the government understand and accept its limitation — it just can’t do complex services well. The reason is simple. Most government staff adopt a ‘cover-their-backside’ approach to work. For government employees, there is no upside for initiative, creativity or improving things. In fact, if their ideas go wrong, they will suffer for it. Hence, the typical babu’s approach is this — do nothing new. Repeat, until retired.
This is why nobody acted on something as basic as oxygen in Gorakhpur. Ideally, the oxygen supplier should be on autopay. The hospital should also have an oxygen inventory system. Any meaningful drops should trigger an order, with automatic payments. Every hospital should have a line of credit for pre-approved emergency items. These are fairly obvious, implementable things. However, who will do this? Anybody suggesting so won’t get a raise, or a promotion or even recognition. However, if for some reason there are hiccups, the person will be blamed and punished (by perhaps a bad transfer or a stalling of his promotion). Hence, do nothing.
The bigger solution is to change this management style — across every government entity. Our government officials need to be empowered or incentivised to improve things.
The government can also take note of its limitations. While it doesn’t do complex services well, it does run fairly decent financial institutions. Money is a simpler product to handle (than, say, liquid oxygen and life-saving medicines) and routine systems are enough to keep things going. LIC is one of India’s top insurers. A better direction for the government would be to improve India’s medical insurance, and be less involved in running hospitals. Do note that some of India’s best doctors are in government hospitals. Talent does get attracted to government jobs and they can stay. However, it is the running of the hospitals —cleanliness, supplies, logistics and payments where the government falters. Get out of that. Insure more people. Give them a good coverage plan. Keep good doctors. And let more private players run the hospitals.
Some efforts like the Rural Health Insurance Scheme have been modestly successful, but have not transformed the medical sector. The insurance coverage given under such schemes is paltry. A new comprehensive medical insurance scheme (and it doesn’t have to be free) that offers Indian’s good medical coverage across the private and public health network may work better than the government running thousands of large hospitals. If there can be Obamacare, why not Modicare?
One also needs to relieve the excess pressure on the public health system. While some fault lies with poor management, some of what happened is due to overstretched healthcare facilities. Whether through insurance or new hospitals, we do need to spend more on healthcare (as a percentage of GDP).
Nothing can lessen the pain of the people who lost their kids. What we can hope is to learn lessons from this horrible incident and reform our healthcare system so Gorakhpur never, ever happens again.