“On paper, we are following what the Centra l government and other State governments are doing: persisting with COVID-19-related lockdown measures even while planning for a staggered reduction. But our biggest worries are about the colossal lack of basic public health infrastructure, which does not even measure up to minimum requirements. The experience across India has shown that nearly 70 per cent of COVID-19-related deaths are on account of comorbidities, and in such a context public health systems are very important, especially if you also happen to be one of the most populous States in the country.” A senior official in the Uttar Pradesh Department of Medical Health and Family Welfare made this comment to Frontline on May 31 immediately after Chief Minister Yogi Adityanath addressed an online press conference detailing the plans to extend the lockdown until June 30, although with revised guidelines signalling a staggered relaxation of restrictions.
The official, who is also a specialist medical practitioner, had in the past too underscored the relationship between robust public health facilities and effective COVID-19 relief. Talking to Frontline earlier, the official had pointed out that addressing comorbidities was a key component of COVID-19 treatment, and the return of the migrant workers would unravel the State’s deficiencies on this count.
Field reports from different parts of the vast State in the last fortnight of May and early June clearly point towards these deficiencies. Several small towns and villages, especially in Bundhelkhand and Poorvanchal, considered to be among the most backward regions of Uttar Pradesh, have recorded hundreds of incidents where migrant labourers who had returned were left to fend for themselves without even basic medical care. The social activist Manoj Singh of Mahoba town in Bundhelkhand said that a survey his team conducted in two taluks of Mahoba districtshowed that over 50 per cent of the migrant labourers had not been provided with even basic support in terms of rations or health care. “Of course, a majority of these labourers have gone through the initial temperature test, but that’s about all. Detailed COVID-19-related inspection has not been carried out. And effective quarantining is unimaginable in the kind of conditions that people are living in in many of the small towns of the district,” he said.
According to the Health Department official, there is nothing surprising about these field reports. “The records of not only the State and Central governments but also international bodies like the WHO [World Health Organisation] point towards the pathetic conditions that exist in Uttar Pradesh on fundamental parameters such as access to clean drinking water, primary health care and availability of doctors.” He quoted some statistics from a Union Health Ministry document of November 2019: Uttar Pradesh has the worst patient-doctor ratio in the country and has a huge shortfall of doctors in its primary health centres (PHCs). The State requires 3,621 doctors for its PHCs but has only 1,344. The senior official also pointed out that the State had a sanctioned strength of 4,509 doctors. “So, in actual terms the deficit is to the tune of 3,165 doctors,” he said.
The Union Health Ministry’s report also says that 942 of the State’s 3,621 PHCs are working without electricity and regular water supply and they also do not have all-weather motorable approach roads. “The WHO standard for doctor to population ratio is 1:1,000. In Uttar Pradesh, this ratio is 1:3,767, while the national average is one doctor for approximately 1,400 people. It is these conditions that have resulted in the field reports that have been cited,” the official said.
Manoj Singh said that he and his associates had received field reports from many parts of Bundhelkhand and Poorvanchal suggesting that many of the labourers were contemplating an early return to their former workplaces in Kerala, Karnataka, Telangana and Andhra Pradesh since the situation in their villages was such that they did not feel safe. “One has heard these sentiments being expressed even from many villages in Gorakhpur, the home district of Chief Minister Yogi Adityanath,” said Uttam Kumar, a Varanasi-based social activist working among agricultural labourers and carpet weaver artisans.
As the first batch of labourers were returning to the State, the Chief Minister announced a clutch of schemes for providing them social security and ensuring their general welfare. It was also stated that there would be a drive to map the skills of the migrant workers and see how they might be employed locally. While making these announcements, Yogi Adityanath had even said that other States would have to seek the “permission” of the Uttar Pradesh government if they wanted to re-employ workers from Uttar Pradesh. But the public expressions by labourers that they wished to return to the south Indian States as early as possible say something about how they view these grand pronouncements.
Samajwadi Party leader Juhi Singh told Frontline that it was evident right from the time the pronouncements were made that there was not a great deal of planning behind them. She said: “In any case, attention to detail is not considered one of the Chief Minister’s strong points. The lack of detail was also evident in the failure to recognise the push-and-pull factors that led to migration in the first place. While the declaration that all migrants will be provided with employment within the State may grab headlines, the track record of the government inspires no confidence in the potential beneficiaries. Again, there is no road map as to how the government is going to accomplish this. A delineation of the road map was vital as several government departments, investor summits, schemes such as ‘One District One Product’ have failed repeatedly in the past in generating gainful employment for the local population. The State government has adopted a bureaucratic style of functioning by conflating the constitution of commissions, schemes and funds (much like the Central government) with a solution to the problem.
“The Chief Minister is being led to believe by his counsellors that appointing a group of bureaucrats or pro-government experts guarantees outcomes. Limited non-agricultural employment options coupled with depressed agricultural wages and incomes, close to no social security and a general lack of life opportunities have come together to create a complicated problem which cannot be addressed by government bodies working in silos. Over and above all this, the Yogi Adityanath government seems to have been led to believe that labour laws were the only obstacle to investment in Uttar Pradesh. Labour laws were suspended without anyone taking the time to understand the protections they offer and the other, much more acute barriers to investment the State faces today. Evidently, this approach is not one that will generate confidence among the migrant workers who have returned.”
Notwithstanding its deficiencies in combating COVID-19-related distress, especially at the level of providing relief to the poor and the marginalised, the State government is going ahead with plans to come out of the lockdown in a phased manner. This would involve reopening government offices with 100 per cent attendance with three staggered shifts: 9 a.m. to 5 p.m., 10 a.m. to 6 p.m. and 11 a.m. to 6 p.m. There would also be relaxations for malls, restaurants, religious places and inter-State travel from June 8.
Evidently, Uttar Pradesh is following the Union government’s directives rather blindly without taking into consideration its own unique conditions in terms of primary health care and other associated facilities. Cases of infection are mounting even though the official machinery’s tabulation may not reflect the real situation, especially in the oft-cited absence of aggressive testing and contact tracing. Amidst all this, the worries of earnest COVID-19 warriors such as the senior Health Department official this correspondent spoke to continue to rise, at times to alarming proportions.
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