Robust procurement system key for healthcare: ICMR DG

Neelu Vyas

In an exclusive conversation director general of ICMR- Soumya Swaminathan talks about the status of healthcare in the country, especially how medical services in public sector hospitals are managed.

Dr Soumya, also talks about events or situations that lead to the death of many children in Gorakhpur hospital and the future of medical research in India.

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Director General of ICMR- Soumya Swaminathan in conversation with RSTV

Here are some excerpts from her interview to RSTV’s Neelu Vyas on To The Point

Q: My first question to you is related to the Gorakhpur tragedy that happened recently. There is confusion as to what exactly happened. 70 deaths happening at such frequency. What exactly went wrong?

Ans: I think they have to look at the Gorakhpur episode that has been covered extensively in media from a longer perspective…. Young children first getting the fever then getting sick with convulsions then going into unconsciousness…many of them end up dying. This has been an annual feature for many many years.

Earlier investigations have shown that a disease called Japanese encephalitis which is a virus that spreads through mosquitoes. At that time in 2006, the government started a vaccination program. So there was a mass vaccination program which was repeated a few years later and from 2011 or so the Japanese encephalitis vaccine is now given to all children. There are two injections given…one at 6 months and one in two months.

Q: With regular immunization happening, have the figures really come down?

Ans: So the strange things is that Japanese encephalitis has come down as the vaccination coverage has improved and today we are seeing a vaccination coverage of about 50% children getting two shots and about 70% getting at least one shot.

However, the number of cases of encephalitis has not really reduced and neither has the number of deaths. So this is the mystery that what the infections that are causing this are and our research over the last few years has shown that there is an infection called scrub typhus. it’s a bacterial infection which spreads through mites that live on rats and other animals and that are also found in the scrubs…it’s called scrub typhus because these mites are found in the bushes and they possibly are biting these children.

So up to 60% children in the BRD medical college are coming with this type of syndrome are now positive for the scrub typhus infection.

Q: So this scrub typhus infection…is it restricted to the Gorakhpur belt and surrounding areas or is it spreading across the country?

Ans: It’s actually a very widespread infection. There are reports from all over the country….Uttarakhand, Tamil Nadu, Assam, Karnataka, and Odisha. It’s quite widely prevalent. But what is peculiar here is that the scrub typhus infection is resulting in this fairly large number of children developing neurological problems. That’s not commonly seen in the rest of the country. And so we need to understand the other risk factors, other things happening there that are aggravating the neurological problems of scrub typhus.

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Director General of ICMR- Soumya Swaminathan in conversation with RSTV

Q: Talking specifically of Japanese encephalitis.Why is it really a mystery when it comes to research on Japanese encephalitis because recently there was an announcement on a research facility which is going to be soon started in Gorakhpur? Don’t you see this as coming too little too late? How would you really see it?

Ans: I think that a lot more comprehensive research needs to go into it. Gorakhpur is one area where we have sort of a hotbed of all kinds of infections going on, so this research unit that we set up in Gorakhpur a few years ago by the ICMR was essentially focused on children coming in and dying of encephalitis.

In fact last year we really had a lot of preparatory activities with the state govt on developing clinical algorithms, how can doctors and primary health centres diagnose and treat scrub typhus so that they can prevent children from actually developing the neurological illness….and also other preventive and education measures.  So that’s focusing on this problem.

Q: When you talk specifically about what happened in the Gorakhpur…another side of the story is that apparently the oxygen supply was cut off. Let’s not go into the merits of exactly what happened because the inquiry is still on but when it comes to procurement part, payment to the vendors, payment for devices, consumer bills, why is it such a messy affair?

Ans: You have touched on a very important issue. It’s true that periodically one comes across instances of a supply chain breakdown, whether it’s a diagnostic kit or a vaccine or a drug and so on. But it doesn’t have to be like that.

Establishing good procurement system is key for uninterrupted medical supplies. States like Tamil Nadu, Rajasthan have done it, they have made systems to know exactly how much stock you have. Because of a transparent tender process, Corruption comes down…

I think that all states really should move to this kind of system. There is no need for ad-hoc kind of procurement which leaves a lot of scope for not only malpractices but also situations like this.