 Hello everyone and welcome to NewsClick. Today we have with us Dr. Eskasi, General Secretary of Doctors Forum for People's Health, to discuss about the issues the Tamil Nadu public health sector is facing. Welcome sir. Tamil Nadu has slipped six places down in the health index report published by Neethi Ayok. So what is the reality? That is the reality. And previous years, usually the Kerala and Tamil Nadu go and under first or second places, usually occupied by Kerala and Tamil Nadu in the first decade. For the past five or six years, we are seeing this decline. And last year, in 2015-16, it has slipped to third position. And now it has slipped to six positions down and it has reached the ninth, this in the ninth position. There is some discrepancy and interpretation problem that is claimed by the state health authorities. Even then, that is common for all. It cannot be declared to Tamil Nadu alone. And what they say, if they calculate the infant mortality rate, for example, that means the infant mortality rate means the rate of number of children dies, number of newborns or the infant's die out of a thousand live births. So they have taken the denominator as the expected numbers with the exception of numbers. What the Tamil Nadu government official says, the actual numbers they have ignored. That is the discrepancy. We are not going to, no need to go into that detail. That is not 100% correct. And since we, the Tamil Nadu and Kerala have reached highest position and maintaining that position itself needs a lot of struggle or strength or good initiatives. And two or three things they have pointed out, India's IOC report has pointed out. And which tells very clearly that in the past five or six years, or we can say up to one decade also, we can say, but the past five or six years it is more acute. For example, the immunization coverage. Immunization coverage, the problem with immunization is already we have reached close to 100% some five or six years back. And the government was not honest in publishing. If anything, vaccine related incidents happen. All vaccines can create, gives some adverse reactions. But the government should be honest and can be trusted to give the correct figures of complications or adverse reactions. And they should go to the people and explain it. It's not abnormal. It's everything. No need to panic like that. And the classical, I can quote two examples. In 2008 or 2009, in Thiruvallur, there was a three deaths out of measles vaccination. Even till now, the actual cause of death are actually the offenders of that incident. They have not been brought to limelight. And what actually happened that's also not given by the government. And also compensation also not given adequately. So this was opaque, this one. And another incident in 2016 by February or March, they have conducted the school camps with for MR vaccination. That is measles and tropella vaccination. It's one of the five states, Tamil Nadu was the one of the five states which implemented the pilot project of the Sunil government health department. But even then, there was no, they were not created any public awareness about that vaccination, need for that vaccination, why we are giving like that. Just like that, they were started. They asked the all the schools to give the vaccination. And a lot of criticisms have come in. And also because of this latest WhatsApp and other latest thing and all these falsehood information have spread fully. The government was not in a position to clarify doubts or they did not do anything properly. That's why they lack, they lost the public trust. That's the reason for all of it. Another thing, the all these vaccinations are not entered properly. After this, once they sense the vaccination coverage is going down. And after this Thiruvallur incident, they were given a separate, they were given an order. The primary health centers and routine thing is every Wednesday, the village health will take the coat off their need of supplies, vaccines, they will go to the villages, the subcenter, they will give the vaccination. It was the routine, obviously, and no major death and all never reported so far. But after this Thiruvallur incident, what they revised the strategy, everybody should bring the child to the primary health center, which may be 10, 5 kilometers, 10 kilometers away from their hamlet, their village. So they have to, necessarily they have to, the people have to bring the kids to the primary health center and the vaccination has to be given in the presence of a doctor. They were wasted. And that's why the coverage was not adequate. So many problems, they may not come on time, they may not come. They could not transport facilities. They delay lacking in the villages and they may be the daily wage... Coolies. So they have to go for work now. For vaccination, they cannot cut one day's salary like that and so it wasn't dropping heavily. And another thing, whatever, even after introduction for four years, six years back they vaccine, PentaVac vaccine. That is five vaccines in one vaccine. It's a combo vaccine. Before, only three in one. That's a DPT vaccination was given. The PentaVac was given in that place. That's a good move only. Even after after introducing introduction of this PentaVac vaccine, what has happened? Some problems, some adverse reactions happened and deaths were also reported, not by the government, by the media and people or some other. So it has in the government's duty, when the government failed in their duty to clarify or tell the people what was actually happening. And after some time they told the not people, they were told the government was coming with explanation that this is not due to this vaccination, it's something else. Some other reason they have died. They are all, everything has been to vaccination like that. Next important thing what they reported is the government is well performing in IMR. There is infant mortality rate and IMR also. But the thing is the under white babies born out of mothers, unnatal mothers, that is increasing. Proposing the percentage is increasing. Actually it should go down. So that indicates that in the underweight children, the mothers in the rate of underweight babies indicates the chronic malnutrition in the mothers, the pregnant mothers. So it indirectly exposes the problems with the or lapses in the anti-natal care. Our government is spending a lot. We have to acknowledge that. But spending a lot, but whether it is benefited the targeted community, targeted people, that's the question. Because Mathilashmi, Reddy scheme and all, previously it was 12,000 per pregnancy. Now it is increased to 18,000. But they are giving it as a cash. But whether the cash is going to the unneeded anti-natal mother, nobody knows. In the Tasmakara, we were told by some of the gynecologists, the husbands want their wives to produce more babies, to get more money from the scheme. It's a pathetic situation. So that's why year after year they are becoming pregnant. There's no spacing. So it's take the toll on the mother's health. That's the second thing which pulled down the index. And third one is the identification and notification of tuberculosis patients and treatment centers and other things. It is also one of the thing which has pulled down the index. That's also true because in other states, the public sector is very much limited. Private sector is dismal. In our Tamil Nadu, it is both are relatively well developed. But treatment is being taken but it's not reported correctly. That's why that index has gone down. The fourth and most important one is, which has pulled down the index, is vacancies in primary health centers. That's one of the reasons they have given. So why there is suddenly acute vacancies in primary health centers? In the Tamil Nadu, it was more than nearly 100 percent some five years, ten years back. Even now in northern states, some of the northeastern states is only up to 60 percent, 50 percent like that. But we have reached the more than 98 to 100 percent one decade back. But even now, there's a drop. Why? There are two reasons. One is they have abolished the service doctors quota in the postgraduate seats. That was the only incentive or only attraction towards government service in nowadays. It's not the salary. What the government salary is, due to that, even as an ordinary due detector will get from the hospitals, private hospitals. That's not an attractive salary and all. But only attraction was the service doctors quota. 50 percent of the MD, MS seats were reserved for service postgraduate seats. Those who are in service, they can come to, come into the, they can get the seats very easily. Relatively, they can, for lesser marks. It was reserved for them. That quota after this postgraduate need examination, that was abolished. And more so, in Super Surality, what has happened for the past six years? Because of the Supreme Court ruling, Supreme Court ruling. All 100 percent of seats are in the Anil Gapoli. So no reservation for the government doctors. So that's why there's acute vacancies and also the new Indian, a new pension scheme for the government employees. And also the recruitment also they have changed. Tamil Nadu particularly. There's a recruitment previously it was done through Tamil Nadu Public Service Commission, which is a full-fledged service. And once they become permanent, it's a permanent service like that. Not now. The MRB is taking doctors or staff nurses or all other professionals as a contact worker. So on contact basis, two years, three years only, they will be seeking and to this. And since there is no attraction now, the MRB will find it difficult to get doctors also for the primary health centers. That's why there is acute vacancies. So because of this, this type of vacancies will arise in the medical colleges also, prevailing medical colleges also. And the government is now itself, even now it struggles to get more faculties in the existing government hospitals. So in the future, in the near future, five or ten years down the line, our health system particularly the education will collapse just like that. That's an indication. That's what the downslide of index is indicating.