The spate of deaths once again puts a question mark over the Gujarat model of development.
New Delhi: Eighteen newborn babies have died at the Ahmedabad civil hospital in the span of three days, prompting the Gujarat government to order a probe into the circumstances and causes of their deaths. Nine infants died within six hours on Saturday – between 6 am and noon, Indian Express reported.
Five of the babies who died on Saturday were brought to the civil hospital from “distant places” and suffered from “extremely low birth weight” complications, while some suffered from life-threatening diseases and were in a critical condition, the government said in a release on Sunday. Of the 18 who died within three days, nine had been transferred from elsewhere and nine were born in the hospital.
The hospital superintendent, Dr M.M. Prabhakar, initially denied that the deaths had taken place, but changed his stance and released an official statement once BJP state spokesperson Bharat Pandya intervened, Indian Express reported.
“Of the nine deaths in 24 hours, five babies were referred from distant places – Lunawada, Surendranagar, Mansa, Viramgam, Himmatnagar – and were having severe life threatening conditions such as extremely low birth weight (around 1.1 kg), hyaline membrane disease, early onset septicaemia and disseminated intra-vascular coagulation,” said the government’s release.
In addition, four babies born at the civil hospital “died due to lethal complications such as severe birth asphyxia and meconium aspiration”, the release said.
The average number of deaths of newborns in the Ahmedabad civil hospital is around five to six per day, Indian Express quoted Prabhakar as saying, so nine deaths in a day is “only slightly more”.
A committee under R.K. Dixit, deputy director of medical education, will inquire into the circumstances and causes of death, the government said.
“Chief minister Vijay Rupani today held a meeting in Gandhinagar with senior health officials to take stock of the situation,” principal secretary, health and family welfare department, Jayanti Ravi said on Sunday. She said the condition of some of the babies had deteriorated and they had to be referred to the civil hospital here from distant places as doctors there might still be on Diwali vacation. The committee will look at the prima facie reasons for the deaths and is expected to submit its report in a day, she added.
“We have formed a committee to take steps, if there is any negligence in service that has resulted in the deaths of children. The committee’s report will come soon. According to the information I have gathered, no child has died for lack of medicine, lack of treatment or any facility in the hospital. But, since nine children have died in a day (on Saturday), the state government has considered it serious and appointed the inquiry committee. Since last night, we have sent top health officials, the health secretary and health commissioner to the hospital,” Rupani told the media on Sunday, according to the Indian Express.
The Congress party questioned the BJP government’s claims on the state’s healthcare infrastructure. “The BJP government has been bragging about effective healthcare being put into place. So why are deaths of newborns taking place in such a huge number. The reality on ground as far as medical sector is concerned is far different from what is being claimed,” NDTV quoted Congress spokesperson Manish Doshi as saying. Members of the party also staged a protest at the hospital.
The Gujarat model of development
The spate of deaths once again brings into focus the controversial ‘Gujarat model of development’ which has been called out by several economists and activists. The model of development that was at the centre of then chief minister and now Prime Minister Narendra Modi’s campaign for years, has been critiqued for focusing on economic indicators at the cost of social welfare and human development indicators.
As the chart above shows, the infant mortality rate (deaths per 1,000 births) has been steadily declining in Gujarat, at pace with the decline in the numbers for India as a whole. The numbers are much lower in states like Kerala and Tamil Nadu, which have followed a rather different development trajectory. In addition, the numbers for Gujarat reveal a social gap in the state. In 2015, Gujarat had the fifth highest rate of neonatal deaths among tribals. While the national average for tribal neonatal deaths is 39.6 per 1,000 births, this number is 56.5 for Gujarat.
Maternal mortality also continues to be a big problem in Gujarat – and one that is actually on the rise. According to a comptroller and auditor general report published in March this year, the maternal mortality rate in the state has been going up for the last three years. “The state had achieved success in reducing infant mortality rate (IMR) and neonatal mortality rate (NMR). However, the MMR changed unfavourably from 72 in the year 2013-14 to 80 in 2014-15 and finally to 85 in 2015-16. Considering the pace and direction of achievement of the goals, it would be difficult for the state to achieve the target of 67 by March 2017,” the CAG report said. In its audit of the Centre’s Janani Shishu Suraksha Karyakram, the CAG also found several other problems in Gujarat, saying that the scheme’s implementation was “fraught with many deficiencies and gaps”. The number of free ambulances and round-the-clock primary healthcare centres is far below the scheme’s targets, the report said.
UNICEF has also pointed also several shortcomings in Gujarat human indicators. In 2013, the agency said on its website, “Almost every second child in Gujarat under the age of five years is undernourished and three out of four are anaemic. Infant and maternal mortality rates have reduced very slowly in the last decade. Also, the preliminary results of Census 2011 show that while there has been a slight improvement in the child sex ratio (0-6 years) from 883 in 2001 to 886 today, the overall sex ratio in the state has declined from 920 to 918 (during the same period).”
Whether or not Gujarat has done enough on social indicators sparked a heated debate between economists Jagdish Bhagwati and Amartya Sen in 2013 (a year before Narendra Modi, then Gujarat chief minister, was to contest the national elections). Bhagwati said that he “likes” the Gujarat model because it has brought about social progress. “I don’t know what his (Modi’s) model is. What has happened in Gujarat is that relatively rapid growth has taken place. He has actually been very good about getting license cleared very fast, he has added to electricity supply which is a big problem…All of which is exactly the way development takes place and then I also find that social progress has taken place,” Bhagwati had said.
Nobel laureate Sen disagreed, saying that Gujarat’s social indicators did not portray progress, rather the opposite. “Gujarat is behind, particularly on the social side – lower educational pace, lower life expectancy, greater gender inequality, a busted healthcare system and that has not worked so well. What has been rather efficient in business has not been so efficient on things that we are trying to concentrate in India – to have a healthy educated labour force,” he said.
Political scientist Christophe Jaffrelot wrote of the Gujarat model in 2015:
…But economic growth is a means to an end, and the end is, or should be, development, understood as meaning an improved quality of life for people. The puzzle about Gujarat is that successful economic growth has not translated into comparable improvements in indicators of the quality of life (or ‘human development’). Over the same period in which the state was so successful by comparison with others with regard to growth, in terms both of the extent of poverty and of female literacy (important measures of human development), Gujarat remained in the middle of the list of 28 states, in fourteenth and fifteenth positions, respectively; it did show improvement in its ranking with regard to infant mortality, from nineteenth place to seventeenth, but this still meant that it remained in the bottom half of the list; and in terms of monthly per capita consumption, it actually slipped from tenth place to twelfth. The base and final years for these rankings, computed by the Rajan Committee, are 2004–05 and 2011–12, or 2005 and 2011, except in the case of female literacy where the base year is 2001 and the final year, 2011.View all notes From the point of view of quality of education, too, according to the measures of the Annual Status of Education Report, Gujarat figured amongst the states towards the bottom of the list. All these measures are reported by Kotwal and Chaudhuri, ‘The Perplexing Case of Gujarat’, note 4. A substantial critique of the ‘Gujarat model’ is found in Indira Hirway, Amita Shah and Ghanshyam Shah (eds), Growth or Development? Which Way is Gujarat Going? (Delhi: Oxford University Press, 2014).
Gujarat’s growth performance also conceals wide disparities. In fact about one third of society did not benefit from this ‘model’ of growth, with rising inequalities. Among those who did not benefit from Modi’s chief ministership, the Muslims, the Dalits and the Adivasis stand out. Their socio-economic situation compares poorly with the levels achieved by some other state governments.
(With PTI inputs)