Even after two decades, acronym ‘BIMARU’ used to define underdevelopment and poor social indices in Bihar, Madhya Pradesh, Rajasthan and Uttar Pradesh seems to ring true as a recently published study by IIM Ahmedabad has picked holes in the health care facilities provided by the states. The study by Indian Institute of Management (IIM) mainly discusses aspects of infrastructure, manpower and operational challenges faced in effective provisioning of specialist services through rural health facilities in these states. “The findings reveal significant dearth of specialist doctors with their concentration at the district level,” said the study done by assistant professor ShreekantIyenger at Institute of Law in Nirma University and RavibndraDholakiya, professor of economics at IIM -Ahmedabad.
“Moreover, there are severe misallocations of the specialist doctors and lack of manpower support, equipment and basic infrastructure within the public health system causing serious challenges in effective provisioning of specialist services for maternal and child health care,” said the study. It pointed out that the efforts made by the government for providing additional manpower support for these services are also not giving desired results. One area where the BIMARU states lag significantly is availability of all four specialists including Gynaecologist, Paediatricians, Surgeons and Physicians at Community Health Centres (CHCs) or District Hospitals (DHs). “While it is observed that Bihar (34.3 per cent) has a relatively greater proportion of such CHCs, all other states like Rajasthan (8.3 per cent), MP (1.2 per cent) and UP (one per cent) perform quite poor in terms of presence of all four specialists at CHCs,” said the study.
As on March 2014, Bihar and UP have only 0.83 and 2.91 specialist doctors per million population in the CHCs, DH and Sub district hospitals (SDHs). While, states like Rajasthan (11.52) and MP (4.36) were in a relatively better condition when compared with national average of 3.98 specialist doctors per million population in CHCs. “It is found that number of Community Health Centres per million people is relatively low in UP (3.87) and significantly low in Bihar (0.67) but is higher in MP (4.60) and almost double in Rajasthan (8.26) as compared to the national average (4.43),” said the study. “It is also observed that all these states including Bihar (17.83), MP (7.53) and UP (3.91), except Rajasthan (61.19) are below the national average (20.74) in terms of total and rural government hospitals per million people,” it said.
“The percentage of district hospitals having HIV test facility in MP (60.9 per cent) and with ultra-sound facility in Bihar (17.6 per cent) and MP (56.5 per cent) are relatively lower,” it said. Moreover, except Rajasthan (84.4 per cent), all the three states including Bihar (52.9 per cent), MP (39.1 per cent) and UP (58.3) have relatively lesser district hospitals with operational blood banks, it added. The study also revealed poor health care facilities for new-borns in the BIMARU states.
“The percentage of CHCs with new born stabilization units are found to be significantly lower in Bihar (1.43 per cent) and MP (17.4 per cent) and CHCs with new born corners were found to be significantly lower in Bihar (31.4 per cent) and relatively lower in Rajasthan (66.1 per cent) and UP (74.3 per cent) again as compared to the national average,” it said. Bihar (20.92 per million population) and UP (26.55 per million population), in terms of paramedical staff at all levels, and MP (14.78 per million population) in laboratory technicians and nurses (60.13 per million population) perform poorly as compared to the average of the nation (62.16 per million population) in government health care centres. The acronym BIMARU was used by an eminent economist Ashish Bose in a report submitted to then Prime Minister Rajiv Gandhi in 80s, stating poor performance of the four northern states affecting the growth of the country.