Policy Talk is an interview series conducted by K Yatish Rajawat, a policy analyst with Centre for Innovation in Public Policy and a commentator based in Delhi. The focus of the series is the economic and social policies of state governments. In this episode, Mr Rajawat speaks to Bihar’s Health Minister Mangal Pandey on his government’s efforts to tackle the health emergency triggered by the Covid-19 pandemic. Mr Pandey says despite its healthcare infrastructure woes, Bihar has done well in most parameters such as Covid-19 testing, positivity and caseload numbers. Edited excerpts:
The entire country is struggling with the Covid-19 pandemic. How bad is the situation in Bihar?
In this crisis, the most important question is about the level of Covid-19 testing. Bihar conducts 1.25 lakh tests every day on an average. We have already conducted 2,94,00,000 tests in the state so far. We are performing 1500 more tests per million above the national average. We are at the third position in the country in terms of testing.
The second most important number is the positivity rate of the tests. Bihar’s positivity rate is approximately 2%, compared with the national average of 9%. In terms of recovery rate also, we are way ahead of other states. Our recovery rate is 95%, while the national average is just 91%. The state has witnessed 5424 deaths due to Covid-19 so far. The fatality rate is about 0.6-0.8%, while the national average is 1.1%. In all parameters, Bihar has done better than most other states.
As of today, we have just above 13,500 active cases in the state. About four week ago, the caseload was 1,15,000that has fallen drastically. We have managed to control the spread of the pandemic to a great extent.
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You said Bihar’s test positivity rate is just 2%. But there is a grave concern about the number and location of tests conducted. Where are you testing, in rural or urban areas? Your data has district -wise numbers, but there is no separate data for rural areas. The Prime Minister has told a meeting with the chief ministers that until we report figures from rural/village areas, we would not know about the condition there…
You were absolutely right. Our vision encompasses all sections of society. The Prime Minister has directed our attention in that direction and we are acting on his suggestions. Along with chief minister Nitish Kumar, we conducted an extensive survey of all the districts. We conducted a review meeting with all districts. In the last five weeks, we have conducted four such meetings. As 88% of Bihar’s population lives in the villages, these meetings focus a lot on rural data.
We publish our data every day to ensure transparency. The composite figure for the state is arrived at after scrutiny of data from all districts. These days, 60% of the positivity rate (new cases) belong to rural areas. Even during the peak when the positivity rate jumped to 16%, the ratio remained the same. This clearly shows that the fall in positivity rate and the rise in recovery rate happened equally in rural and urban areas.
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So, are you saying that more than 60% of your state’s Covid-19 testing are taking place in rural areas?
No. I am saying that more than 70% of testing is happening in the rural areas. There are two types of testing.
That’s not the question. Which type of testing are you conducting?
RT PCR testing is also conducted in rural areas. Samples are taken from villages to 20 RT PCR labs across the state that have been assigned to different districts and blocks. From there, the reports are collected. The results of the antigen tests are provided on the spot. We conduct 35,000-40,000 RT PCR tests every day. Bihar’s data favourably compares that with other states in the number of RT PCR tests. We also conduct 80,000-90,000 antigen tests every day.
You are conducting 35,000-40,000 RT PCR tests and approximately 80,000-90,000 rapid antigen tests every day. This means Bihar is conducting more rapid antigen tests than all other states. Other states like Delhi, Haryana and Punjab are doing more RT PCR tests as they are cheap, and states are facing shortage of antigen test kits. You’re saying that you’re conducting more rapid antigen tests. Then, Bihar is doing better than Karnataka and all smaller states that have better resources. You have only 20 labs catering to the state’s 12 crore population?
Right.
Delhi has a population of 4 crore and has 250 labs.
You should be aware of Bihar’s infrastructure. As I have already said, Bihar’s infrastructure and dynamics cannot be compared with more advanced states in the country.
That’s remarkable. You’re only saying that we can’t compare the infrastructure. Then, how can the Covid-19 testing rates be higher than other states with better infrastructure?
Who said it is higher? We do just 35,000-40,000 tests.
You said 1.25 lakh tests…
All of the 1.25 lakh tests aren’t RT PCR. Overall, we do 1.25 lakh tests, of which 35,000-40,000 are RT PCR tests and the remaining 80,000-85,000 are rapid antigen tests. When did I say there are 1.25 lakhs RT PCR tests?
You are stating there are 20 labs for RT PCR tests… For a single test, how much time does it take to get back the results? What we know from anecdotal reports is that there is a huge delay in getting back results from the labs.
The statistics you have is a few days old. We faced a problem in Patna. During those 4-5 days, the data entry operators working in the labs got infected in huge numbers. Then came a week when labs in Patna took 2-3 days to give results of RT PCR tests. But at present, we provide results within 24 hours of tests.
Tell me the procedure of rapid antigen tests. How many tests have been conducted by the state so far? And how many kits are you procuring and from where?
There have been 2,94,00,000 tests in total. I don’t have the exact number of antigen tests and RT PCR tests. But I’ve given you a ratio of the testing happening in the state. The kits are being purchased by a corporation that follows a procedure. There’s competitive bidding and a tender process. The one quoted the lowest rate wins the tender as per the government’s procurement procedure.
You must have developed some unique solution for this as your rapid antigen tests are more than other states…
No, no. You check the entire country’s statistics. If you see the antigen tests taking place in various states, then the situation will be clear to you.
You made an announcement at the beginning of the month that you have ventilators in sufficient numbers, but you have a scarcity of anaesthetists. Then, you allowed the district magistrates to hire anaesthesiologists on a temporary basis for the next 2-3 months. What has been the impact of this move? How many anaesthesiologists have you been able to hire?
You are absolutely correct. In our state, there are about 1150 ventilators in Bihar hospitals. Within this, around 500 ventilators are in private hospitals. You require anaesthetists to operate ventilators. Last year when Covid-19 struck, the demand for ventilators rose in the entire country, not just in Bihar. All the states were supported by the central government. Bihar too got aid from the Centre and we received 600 ventilators.
In order to operate these ventilators, we need anaesthetists. In the previous one year, we tried to recruit twice through the Bihar Technical Service Commission. and once through walk-in interviews. In the entire country, there is a lack of anaesthetists. In our medical colleges, we have functional ventilators and doctors. But in the remote areas, where there are district hospitals, 13-14 hospitals are facing the shortage.
Then we conducted interviews to recruit 1,000 doctors across the state. As per the available data, more than 600 doctors have joined. This number includes anaesthetists as well. As a result, only 12-13 district hospitals are unable to operate ventilators.
For the past 2-3 years, the Bihar government has not revealed the number of sanctioned vacancies of doctors. What, according to you, is lacking in sanctioned posts and appointed posts?
See. The vacancy we have right now, let me state the vacancies with us. For specialist doctors, there are 641 vacancies for gynaecologists, 18 for microbiologists, 360 for physicians, 635 for paediatricians, 111 for E&T, 75 for ophthalmologists, 86 for pathologists, 188 for radiologists, 16 for psychiatrists, 935 for anaesthesia, 84 for dermatologists, 568 for general surgeons and 42 for orthopaedics.
In total, there are 3706 vacancies for specialist doctors at present. Apart from this, there are 2632 posts for medical doctors. In the last one year, around September, we did recruit approximately 4000 doctors. And this time as well, we have put out an advertisement through the Bihar Technical Service Commission. There are 6,338 vacancies to be filled. The recruitment process is ongoing. We’ll try to recruit as many doctors as possible through this procedure.
You were saying there is a shortage of 6,338 doctors of various specializations. You told us how you attempted several times to fill this gap in the previous year as well. Is there some problem with the procedure? In the rest of the country, people are seeking government jobs. Bihar, on the other hand, is unable to find doctors…
If you look at the root cause, the discussion will turn political, which I don’t want here. The cause is that our country has been ruled by Congress for a long period. And the members of the Congress party never tried to open better medical colleges in the country. As a result, we have very few doctors. Not only Bihar, but in the entire country, there is a dearth of doctors. Since the Narendra Modi government took over, a large number of medical colleges have been established in the country…
According to you, the reason why the Bihar government is unable to hire those 6000 doctors is due to the lack of medical colleges. For the first time, your cabinet passed 2500 MBBS seats last month. It took a whole one year for your government to do this. If your government too isn’t serious about this crucial issue of shortage, how can you blame the past governments? Is that fair?
I am saying that the 50,000 doctors that you are mentioning are MBBS. I was talking about PG doctors. We have 3700 vacancies for PG doctors. We also have 2,632 vacancies for MBBS doctors. The number of PG seats is way lower than UG seats.
In our country, 49,840 MBBS doctors graduate every year, whereas in the United States, the number is around 18,000. This means we graduate thrice more doctors here. India churns out more doctors than China every year. And sir, you are saying there’s a shortage of medical seats. There isn’t a lack of either medical seats, MBBS doctors or post graduate doctors. The problem lies with recruitment, salaries or something else. No state in our country can just say that there aren’t doctors applying. You can see the AFMC test numbers, every year, around 1.5-2.5 lakh doctors apply for the AFMC test. Why do they? Because it’s a government job. However, in Bihar, even 2500 seats cannot be filled…
Rather than deliberating on this, I would just like to say that there is a recruitment process. On the basis of the recruitment process, we constantly try to employ doctors. We give them salaries. We give them increments as and when due. Despite all this, the issue persists not just in Bihar, but in all the states across the country. Doctors couldn’t be recruited in the government service. If there is a need for a more academic discussion on this topic of how doctors could be recruited in government services, then you can organize a separate discussion panel and I would join.
Okay sure. Let’s focus on your Primary Healthcare Centres and their status. Recently a series was published in Dainik Bhaskar which said that there are several PHCs where cows are tied and are in dismal situation…
Firstly, I would say if you have the article with you right now, please check it. It must be primary healthcare sub centres instead of centres. Primary Healthcare Centre is at the block level while Healthcare Sub Centres are in villages. And in Bihar, we have more than 10,800 Healthcare Sub Centres. These Healthcare Sub Centres are running on rented houses where the government does not own any land and hasn’t constructed any building yet. So, there’s a possibility that out of these 10,800 Healthcare Sub Centres, this might be a story of one of them which got published in the newspaper.
The media is an eye opener. You guys show us the path, highlight the drawbacks and point out the problems which we then solve. Most definitely, this has reached our attention and we are looking into the matter. I accept that in comparison with well-developed states of our country, Bihar has a weak medical infrastructure. We need to improve it and under the leadership of Chief Minister Nitish Kumar, we have constantly attempted to improve it.
How much have you allotted this year for the health sector in the budget? Of this, how much has been allotted to primary, community and the district healthcare centres?
The budget earmarks an overall amount to the health sector. Previous year, we had Rs 10,900 crore for the health sector in Bihar. This time, it has increased to Rs 13,200 crore. We use this budget only to give salaries and to improve infrastructure in hospitals. We provide equipment and instruments also. In our hospitals, the poor are given more than 250 medicines free of cost.
You increased the budget by 22% from last year. Do you think this 22% increase is enough to improve the conditions of the Primary Healthcare Centre and the Community Healthcare Centre and to elevate it to the level where Bihar can be compared to the well-developed states of the country?
Most definitely, we must increase spending further. Expenditure will depend on factors such as income of the state government. You know what is happening to the national economy in the last 1.5 years. Despite this, we should spend more to improve the health infrastructure of Bihar.