With lack of tertiary level hospitals at taluk-level, adequate beds and healthcare staff, districts in north Karnataka are struggling to tackle the coronavirus pandemic.

COVID-19 exposes lack of beds inadequate facilities in north KarnatakaPTI/Representation Photo
Coronavirus Coronavirus Thursday, June 18, 2020 - 19:39

The COVID-19 pandemic has exposed India’s healthcare system, with state governments across the country scrambling to increase beds, hire epidemiologists and other specialists and purchase lifesaving equipment like ventilators. In Karnataka, the novel coronavirus has laid bare the state’s north-south divide.     

Karnataka has a total of 22,872 beds to treat COVID-19 patients, but the state’s health infrastructure is disproportionately distributed with more facilities in its southern districts – a testament to decades of political patronage.  

“The number of health centres in the southern districts is more than northern districts. Southern districts have more Primary Health Centres and Tertiary Health Centres and the population is also more here,” said Omprakash Patil, Director of Karnataka Health and Family Welfare Department. But it’s not just a question of more, the quality of healthcare is also better in southern districts. “The tertiary level hospitals are also better equipped in southern districts. The big problem in north Karnataka is that taluk-level government hospitals are not well equipped like the ones in the south. The northern districts have fewer oxygen beds and ICU beds compared to southern ones,” Omprakash added. 

So, how many beds are there in Karnataka?

According to data obtained from the Health and Family Welfare Department, Karnataka currently has 84,712 beds across all the government and private hospitals. Of these, only 27% – or 22,872 beds – have been allocated to tackle the COVID-19 situation. The state has 18,874 isolation beds, 2,075 ICU beds, 6,702 oxygen beds and 999 ventilator beds. This is spread across designated hospitals for those who are severely ill; designated health centres for those with moderate symptoms; and COVID Care Centres for those with mild symptoms. 

As many as 62.62% of beds allocated for COVID-19 in the state are concentrated in south and south-central Karnataka districts. Unsurprisingly, Bengaluru has the most number of beds for COVID-19 in the state, at 14.6% of the total. 

In contrast, eight remote districts of north Karnataka account for just 21.97% of the total beds available in the state. This includes Raichur, Uttara Kannada, Gadag, Koppal, Yadgir, Kalaburagi, Vijayapura and Bidar. Further, most of these beds have been set up in COVID Care Centres, with the district administration converting hostels, schools and colleges into isolation facilities, where doctors and medical staff from government hospitals monitor patients on a rotational basis. Deputy Commissioners in northern districts are following the triage protocol – assigning patients to a facility based on the severity of their symptoms.

Remote districts like Gadag and Koppal have a meagre 276 and 227 beds in total respectively. Raichur has 752 beds and Vijayapura has 424 beds. Kalaburagi fares better with 1,905 beds for COVID-19, out of which 36% are in the two designated hospitals. The remaining beds are located in hostels and colleges. 

Now compare the health infrastructure in these districts to Karnataka’s COVID-19 caseload as of June 16. 

Out of the 2,824 COVID-19 patients who are admitted in hospitals across the state, nearly 40% are from the northern districts of Bidar, Raichur, Kalaburagi, Dharwad, Yadgir and Ballari. In south Karnataka, Bengaluru (413), Udupi (134) and Dakshina Kannada (225) have the most number of patients. 

The worry, however, is that with lockdown restrictions easing, the case in the north have jumped – and can increase further – as migrant workers return from states like Maharashtra. Yadgir Deputy Commissioner Kumra Rao said, “Jobs in north Karnataka are hard to come by. The reason why the number of cases are more in northern districts is because people who went to Maharashtra in search of jobs, are now returning to their homes. Hence, the number of cases in northern districts is more than those in southern districts. In areas like Mysuru and Bengaluru, migrant workers are leaving these places.”

But unlike the south, northern districts have only one or two designated COVID-19 hospitals to treat those who are critically ill. Deputy Commissioners that TNM spoke to say that if a situation arises where the number of COVID-19 cases increases, they would have to look to private hospitals for assistance. 

“Even if patients are taken to private hospitals, they will have to bear hospital costs. In rural areas, most people do not have insurance cover and this could become a problem,” a senior Health Department official said. 

For instance, in Raichur, which is one of the backward districts in the state, the district administration has had to house low-risk patients with COVID-19 in hostels and colleges that have been converted into isolation facilities. 

“In Raichur, the taluk hospitals are not equipped with oxygen beds, ICU beds and ventilator beds. As of now we have two hospitals in the district, namely the Raichur Institute of Medical Sciences and the Rajiv Gandhi OPEK Hospital, where COVID-19 patients are housed. Since a large chunk of patients are asymptomatic, we came up with a plan to convert colleges and hostels into isolation centres and manage with what we have,” said R Venkatesh Kumar, Deputy Commissioner of Raichur district. 

Similarly in Kalaburagi district, which has 442 patients presently, there are 354 beds for COVID-19 patients in designated hospitals, which include the Gulbarga Institute of Medical Sciences and the ESIC Hospital. “We have four medical colleges in Kalaburagi city and there are more AYUSH, nursing colleges. The contingency plan is to identify 7,000 beds in COVID Care Centres. We are identifying such places where there will be a minimal staff,” Kalaburagi DHO MA Jabbar said. 

Uttara Kannada has only 180 beds at the designated COVID-19 hospital, meant to treat patients with severe symptoms with 15 ventilators across the district. 

“We are looking at increasing COVID Care Centres. If patients are asymptomatic, they need a bed and a doctor’s assistance but it is not necessary for all patients to be hospitalised. In such cases, a hostel is better than a hospital to treat patients. Health workers can monitor the patient’s oxygen saturation and shift patients to hospitals if necessary,” said Uttara Kannada Deputy Commissioner Harish Kumar. 

However, in southern districts like Dakshina Kannada and Bengaluru, where the infrastructure is well developed, the district administrations have not had to convert hostels and colleges into isolation facilities. Dakshina Kannada, for instance, has eight medical colleges, in addition to Wenlock Hospital, which is currently the only one housing COVID-19 patients. Dakshina Kannada also has 67 private hospitals, which the government can convert into designated hospitals or health centres in case the need arises. 

Bengaluru meanwhile has a total of 19,359 beds across all hospitals, of which 3,324 have been dedicated for the purpose of COVID-19. In case of a surge in cases, Bengaluru too has several private and government hospitals to fall back on, as the data above suggests. 

“We will also need hospitals to treat those who do not have COVID-19 and all private hospitals cannot be roped in,” reminded Omprakash Patil. “In addition, works are underway in Raichur, Vijayapura, Bidar, Yadgir, Uttara Kannada and other districts in the north, where piped oxygen supply can be provided to all taluk hospitals. These works have been fast tracked so that those from economically weaker sections, who require critical care, can also undergo treatment at government hospitals since most taluk hospitals lack tertiary level infrastructure,” 

Lack of investment in public healthcare

Successive governments have allocated meagre sums of money to the Health and Family Welfare Department. Moreover, most of these funds were diverted towards the developments of healthcare facilities in Bengaluru city and the southern districts like Mysuru, Tumakuru, Ramanagara, Dakshina Kannada and Udupi. While population is one reason, there are also political motivations for the same. Congress and JD(S) governments, whose vote banks are primarily in the south, in the past neglected the northern districts to retain their vote banks.

In the 2020-21 fiscal, the Karnataka government allocated only 4.6% of the total expenditure to health. This allocation is less than the national average of 5.3%. Of Rs 10,296 crore allocated for health, only Rs 1,413 crore was allocated for development of health services in rural areas. 

Similarly in the 2019-2020 budget, only 4.4% of the total expenditure of Rs 2,34,153 crore, was allocated for the health sector. The 2018-19 fiscal, 4.3% of the total expenditure of Rs 2,18,488 crore was allocated for health. 

Are there enough doctors? 

A shortage of beds is only part of the issue. According to the Health Department, there is a 30% shortage of healthcare staff in Karnataka currently. Under the National Health Mission, there are 23,000 healthcare employees across the state including doctors, specialists, paramedical staff and lab technicians. This number excludes Accredited Social Health Activists or ASHA workers, who at the community level, track health indicators of residents. 

“We are now going to hire approximately 1,000 specialist doctors, 400 General Duty Medical Officers and more paramedical and lab technicians. The shortage we are facing is for nurses, doctors and lab technicians,” said Omprakash Patil. 

Officials with the Health Department said that despite super specialty hospitals constructed in districts like Kalaburagi and Raichur, not all districts have such facilities run by the government. In addition, the number of healthcare staff appointed in northern districts is very low. “Specialist doctors are not available here. They may have the infrastructure but these districts lack physicians, pulmonologists, cardio-thoracic surgeons, and other specialists that southern districts have,” an official said.