THE CONTEXT: On the night of November 15, 2024, a devastating fire broke out in the Neonatal Intensive Care Unit (NICU) of Maharani Laxmi Bai Medical College, Jhansi, Uttar Pradesh, claiming the lives of 10 newborns and injuring 16 others. The incident has drawn attention to critical issues in India’s healthcare infrastructure and fire safety. The NICU was overcrowded, housing 49 infants in a space designed for 18, and initial investigations point to an electrical short circuit exacerbated by oxygen leakage as the cause of the fire.
UNDERLYING ISSUES IN HEALTHCARE INFRASTRUCTURE:
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- Overcrowding in Neonatal Care Units: The Jhansi NICU was operating at nearly three times its capacity, a situation uncommon in India’s public hospitals. Overcrowding leads to continuous operation of life-support equipment, increasing the risk of overheating and electrical failure, as seen in this case. The doctor-patient ratio in Uttar Pradesh (1:2,158) is far below the national average (1:836), barely meeting the World Health Organization’s recommendation of 1:1,000. This shortage exacerbates overcrowding and compromises patient care.
- Neonatal care units across India faces similar challenges. According to a study conducted in Maharashtra, neonatal mortality remains high despite efforts to improve care through Special Newborn Care Units (SNCUs). Overcrowding, lack of resources, and insufficient staff training are common barriers to effective neonatal care.
- Healthcare Facilities in Underdeveloped Regions: Maharani Laxmi Bai Medical College is the primary healthcare facility for Bundelkhand, an impoverished region spanning Uttar Pradesh and Madhya Pradesh. Despite serving over 5,000 patients daily, several hospital wings are dilapidated. This reflects broader issues with healthcare infrastructure in rural India. According to the National Health Profile, India has only 0.9 hospital beds per 1,000 people, with rural areas particularly underserved.
FIRE SAFETY CONCERNS:
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- Possible Causes of the Fire: Initial reports suggest that the fire at Jhansi Hospital was triggered by an electrical short circuit caused by excessive load on life-support equipment. Oxygen leakage from an overheated concentrator accelerated the spread of the fire. Witnesses reported that safety protocols were not followed; for instance, there was only one exit door in the NICU instead of two as required by fire safety norms.
- Fire Safety Statistics in Uttar Pradesh: According to National Crime Records Bureau (NCRB) data, Uttar Pradesh ranked fourth in fatalities due to electrical short-circuit-induced fires in 2022. Across India, approximately 25,000 people die annually from fire-related incidents, with women accounting for about 66% of these deaths. Many fires could be prevented if proper safety measures were implemented.
- National Fire Safety Scenario: India’s fire services are poorly organized and underfunded. A 2019 parliamentary report revealed that India has only about 3,377 fire stations, against a requirement of over 8,500. Furthermore, many hospitals nationwide lack essential fire safety equipment such as smoke extraction systems and sprinklers.
BUDGETARY ALLOCATIONS AND HEALTHCARE EXPENDITURE:
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- Union Budget Allocations for Healthcare: India’s public health expenditures remain critically low compared to global standards. In FY2024-25, only 1.75% of GDP was allocated to healthcare—well below the National Health Policy target of 2.5%. In contrast, countries like Brazil and South Africa allocate around 8-10% of their GDP to public health.
- The healthcare budget for FY2024-25 saw a modest increase to ₹109,551 crore from ₹104,683 crore the previous year. However, experts argue this is insufficient given India’s growing population and healthcare needs. The Indian Medical Association (IMA) has called for healthcare spending to be raised to at least 2.5% of GDP to address critical infrastructure and human resources gaps.
- Comparison with Other Developing Countries: India’s healthcare spending lags that of developing nations like Brazil (10% of GDP) and South Africa (8%). While India has made strides through programs like Ayushman Bharat—which aims to provide health insurance coverage to over 500 million people—there are still significant gaps in access to quality care.
- India’s reliance on out-of-pocket expenditures further exacerbates inequities in healthcare access. According to NFHS-5 data, nearly 40% of women reported being unable to access medicines or healthcare providers due to cost or distance.
THE WAY FORWARD:
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- Increased Healthcare Spending: Raising public health expenditure to at least 2.5% of GDP is essential for improving infrastructure and reducing overcrowding.
- Strengthening Fire Safety Norms: Hospitals must have modern fire safety systems such as smoke extraction units and sprinklers.
- Improving Rural Healthcare: Greater investment is needed in rural areas like Bundelkhand to ensure equitable access to quality care.
- Public-Private Partnerships (PPPs): Encouraging private sector investment through PPPs can help bridge gaps in medical education and infrastructure development.
THE CONCLUSION:
The tragic fire at Jhansi Hospital highlights the fatal intersection of neglected sectors—healthcare infrastructure and fire safety—in India’s public policy framework. Overcrowded hospitals with inadequate safety measures directly result from chronic underfunding and poor governance.
UPSC PAST YEAR QUESTION:
Q. Appropriate local community-level healthcare intervention is a prerequisite to achieving ‘Health for All ‘in India. Explain.
MAINS PRACTICE QUESTION:
Q. “Governance failures and lack of accountability are major contributors to recurring tragedies in India’s public healthcare system.” Analyze
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