Down to Earth investigation shows health care crisis in Punjab - serious and chronic diseases on the rise with public health care system in a state of neglect

  • Down to Earth finds evidence of a growing crisis in the state – rise in diseases and poor state of health care system

  • Chronic and serious diseases such as hepatitis C, cancer, reproductive disorders, depression, arthritis, among others, are prevalent in Punjab

  • ‘Cancer Express’ continues to take cancer-affected people to Bikaner, Rajasthan, for cheaper and better care

  • Reports indicate growing number of vacancies in public health system, but reduction in number of primary health centres (PHCs)

  • Private care five times more expensive than care in public health facility, finds study

Punjab is no longer a state of health and prosperity it is believed to be. A recent investigation by Down to Earth (DTE) has shown the state has a growing health crisis – an ever-increasing number of people suffering from severe and chronic diseases but with a state public health system that has crumbled badly.

Poor health status
DTE has found that the current health status of people in the state is alarming. While the state had done well in reducing maternal mortality rate (MMR) and Infant Mortality Ratio (IMR), it was currently struggling with a new generation of crippling diseases which are widely prevalent. These include diseases like hepatitis C, learning disabilities, cancer and reproductive disorder, high prevalence of cerebral palsy, arthritis, among others. Arthritis is reported by young people as early as in their twenties. A large proportion of elderly people are reported to be suffering from depression while as many as 50-60 per cent of young people in the 16-35 years age group are addicted to drugs, according to the state health department.

Health care system
The surge in diseases has not been countered through preventive measures or the public health care system. DTE has recorded experiences of people who have sold their properties or wealth to raise money for the expensive private treatment for their family members. The report says that Muktsar district, known as the “cancer capital” of Punjab, has “a cancer story” in almost every village. In one of the villages, Kotkapura, nearly all households have had at least one cancer patient. Many have seen the death of their loved ones. One of them, Nistar Singh, lost his 27-year-old wife, Amarjeet Kaur, to brain cancer last year. He sold off all his possessions—land and jewellery—to save her. Once a farmer, Singh now works as a bus conductor.

DTE mentions a train – also known as Cancer Express – which is used by the cancer patients of Punjab to travel to the neighbouring state of Rajasthan to get treated at a charitable hospital. The train was written about in 2005 and the situation continues.

While the disease burden has been mounting, the state’s public health infrastructure has not been strengthened. On the other hand, it has deteriorated. The DTE report states that the number of primary health centres (PHCs) in the state remained stagnant at 484 from 1992 to 2007, and dropped to 427 between 2007 and 2015. A report by a government taskforce in 2013 studied the standards of public health facilities in three districts—Fatehgarh Sahib, Mansa and Tarn Taran. It showed glaring vacancies—26 per cent for the post of general doctors, 38 per cent for specialists and 31 per cent for nurses.

Expensive private care 
The report states that along with the government’s neglect of public health care, there has been an emergence of private health¬care in the state. According to NSSO data, 70 per cent rural population in Punjab avail private healthcare, a figure which is substantially higher than the national average of 58 per cent. “The private sector has grown more in Punjab than in other states. However, there is no data on private healthcare facilities, according to a report by erstwhile Planning Commission. The DTE story quotes from a study by PGIMER, Chandigarh, which states that a case of trauma costs Rs 40,000 in public hospi¬tals “but the same would cost a whopping Rs 2.15 lakh in a private hospital in the state”.

Putting onus of healthcare on public 
In October 1995, under the health reforms system of the World Bank, the Punjab government established an autonomous Punjab Health Systems Corporation to bridge the gap between public and private health¬care. The World Bank gave the funding on the condition of “self-sufficiency”. To achieve this, the corporation started charging from patients for services that would otherwise be free in government hospitals. This further pushed people away from public health care, says the DTE report.

Following the publication of the story, CSE director-general Sunita Narain has written a letter to the Chief Minister of Punjab, Prakash Singh Badal, drawing his attention to the DTE report and asking him to act urgently. A copy of the magazine was also enclosed by Ms Narain along with the letter.

Narain in her letter said that much of the growing disease burden was attributable to contamination of water, food and soil as well as lifestyle changes. “All this points to the next generation of health burden as India modernizes, without attention to prevention and environmental management,” she said.

The detailed DTE story can be read here: http://cseindia.org

For further information, please contact Anupam Srivastava,