In a conversation with South First, Gundu Rao explains the state's medical infrastructure, the plans for improving it and implementing measures to make healthcare affordable for all sections of society.
Published Jan 01, 2025 | 5:04 PM ⚊ Updated Jan 05, 2025 | 11:19 AM
Karnataka Health Minister Dinesh Gundu Rao. (South First)
The recent maternal deaths at the Ballari District Hospital in Karnataka highlighted the fragility of the state’s public healthcare system.
The state health authorities suspected that the condition of these women deteriorated after administering them the Ringer Lactate solution IV fluid, which is supplied to the government hospitals by a West Bengal-based company.
However, the Karnataka Drug Action Forum (K-DAF), an advocate for rational drug policies and usage, released a report suggesting that similar maternal deaths may have occurred in other districts of the state.
A few days after the incident, Health Minister Dinesh Gundu Rao told the state legislative council that caesarian sections are on the rise in corporate hospitals.
The minister even went to the extent of saying that private hospitals recommend C-sections to charge more money from the patients.
In a conversation with South First, Gundu Rao explains the state’s medical infrastructure, the plans for improving it and implementing measures to make healthcare affordable for all sections of society.
Q. Healthcare in Karnataka was a major topic during the recent legislative sessions. Do you believe the state is facing a healthcare crisis?
A. I wouldn’t say there is a crisis but there is always scope for improvement, and I think we can do more to improve healthcare.
Karnataka is doing well compared to the national average but compared to neighbouring states like Tamil Nadu and Kerala, there is definitely more to be done.
Q. With increasing maternal deaths and public concerns over safety in government hospitals, how would you reassure people about the quality of care in these hospitals?
A. The Ballari maternal deaths incident was unfortunate and they caused mistrust in government hospitals. Investigations showed that it wasn’t the doctor’s fault but due to other reasons. The approximate Maternal Mortality Ratio (MMR) in Karnataka is around 65 compared to Tamil Nadu’s 45-50 and Kerala’s 19-20. In South India, the fastest decline in Maternal Mortality Rate (MMR) is in Karnataka. However, we must do more.
Every maternal death must be audited. A more vigilant hospital system is needed, and I think people are worried due to reported deaths. Newspapers reporting absolute numbers don’t show the right picture.
We are evolving a new policy to achieve zero preventable maternal deaths. Committees are identifying gaps in the system, and a policy will be out in January. Restoring trust is crucial, and I am confident we will achieve that.
Q. The recent Ringer lactate drug issue that caused maternal deaths exposed several gaps. How do you plan to address the substandard drugs, weak drug laws, and gaps in drug testing?
A. We should improve our medical supplies corporation to ensure better drug quality checks. Sometimes drugs are found substandard by one lab but cleared by another, and this inconsistency needs a third-party mechanism.
More random checks are essential, and manufacturing facilities must meet higher standards. India’s drug regulatory system is weak and doesn’t hold pharma companies accountable. There must be zero compromise for supplying Not of Standard Quality (NSQ) drugs.
We have written to central authorities about creating a national database of blacklisted companies. Pharma lobbies often shield companies, but we want accountability for the Karnataka incident. Discrepancies in manufacturing were found, and though production has stopped, there’s no guarantee it won’t restart without stricter measures.
Q. Is there any law by which the government could stop the drugs found with discrepancies?
A. If a drug is declared NSQ [Not of Standard Quality], then the supply has to be stopped. If it is a government supply, we can ask the pharma company to replace it and stop the supply. We can take legal action as well.
We have instructed our department to action according to the law if a drug fails any random checks twice.
However, it is unfortunate that India doesn’t have a system of drug recall. If a drug is substandard and has gone into the market, we don’t have a system to recall it. There has to be a methodology for bringing such drugs back from the market, especially if they are going to cause grievous consequences.
I have told my department to look into a methodology to bring back such drugs, a recall system. A proper protocol is being put in place.
Q. Regarding maternal mortality, evidence suggests that investments must be made throughout the life course to address modifiable factors contributing to deaths. What is the government’s plan to tackle this issue?
A. We have been discussing this issue even before the recent maternal deaths occurred. When someone becomes a mother, there must be a process to build their confidence and prepare them for pregnancy.
Although the rates of C-sections are unacceptably high, many people perceive them as an easy option. They are less taxing for doctors, requiring less effort and yielding less income in comparison to natural births. Hospitals, on the other hand, earn more through C-sections, creating a double advantage for them.
We are exploring ways to incentivise normal deliveries, even within government sectors. In government hospitals, normal deliveries are provided free of charge under AB-ArK (Ayushman Bharat-Arogya Karnataka), whereas C-sections are eligible for monetary coverage. Similarly, in private hospitals empanelled under the scheme, C-sections are covered by our insurance.
Accessibility has also been a key point of discussion. With recent incidents being reported, doctors might now feel more apprehensive, thinking, “Why take a chance?” and may opt for C-sections instead. This fear needs to be addressed. We must bolster doctors’ confidence while ensuring they are held accountable.
Furthermore, we are considering measures to bring women to hospitals earlier than their expected delivery dates in areas lacking proper healthcare facilities.
Q. Despite spending crores of rupees on upgrading KC General Hospital in Bengaluru, a recent Lokayukta raid revealed its poor condition. Have you followed up on this? What actions are being taken?
A. A lot of work has been happening at that hospital, but certain things that the Lokayukta looks into will always have discrepancies.
For instance, some expired medicines might be kept there; the hospital staff might not have removed them. Certain medicines that are not for sale might also be found there and there are some medicines that we allow hospitals to get from outside since we are not able to supply them ourselves. Such medicines won’t have markings. However, it is important to note that Lokayukta is functioning in the public interest.
For example, in Belagavi recently, a woman was shifted from Hukkeri to Belagavi, and she passed away. Why was she shifted from Hukkeri? It was because the anaesthetist and gynaecologist had been staying in the district headquarters and not the taluk headquarters as required by the law. Many of our doctors do not stay in talukas. These are the issues that need to be fixed.
Q. The shortage of medical staff in government hospitals is a critical issue. What steps are being taken to tackle this?
A. We are now augmenting human resources; 220 specialists and doctors will be recruited. ANMs (Auxiliary Nurse Midwives, frontline healthcare workers who provide basic medical and maternal care services in rural and underserved areas), PHCOs (Primary Health Care Officers who manage and coordinate services at primary health centres PHCs) and Health Information Officers (HIOs who handle data collection, analysis, and reporting related to health services) — about 1,600 in total — are being hired.
Right now, we are taking them on contract, and as recruitment happens, they will replace the contract workers. That permission has been granted.
We also want to increase the salaries of MBBS doctors and specialists. We have written to the Government of India seeking funds under the National Health Mission (NHM). Not to increase the total component they are giving us but to allow us to allocate more funds to pay these doctors better. Hopefully, they will agree to this.
When hiring on contract, the low salaries offered are often discouraging.
We also want to ensure a proper triad. For instance, if there is a gynaecologist, there should also be a paediatrician and an anaesthetist in the same hospital. This triad should always be complete. There is no point if each of them is in different places. Wherever there are high delivery rates, we want to ensure this triad is available. We are also looking at doubling this triad so that we can run services 24/7.
Facilities at the taluk level also need to improve. Many times, there is a trust deficit because there are no doctors. Word of mouth itself can create problems. If people can reach Taluk hospitals easily and have confidence in the system, they will rush there immediately.
Q. States like Tamil Nadu have been voicing vehemently against NEET (National Eligibility cum Entrance Test) for admission to medical courses. What is your take on it?
A. Though it is not directly under me, I feel that there are advantages and disadvantages to every system. For people from rural or semi-urban areas or disadvantaged families, qualifying NEET is very difficult.
You are not only expected to do well in your exams but also to prepare for competitive exams and attend good coaching institutes. That is affordable only for those who can pay.
This is taking away their right, and that is the problem.
Q. Karnataka’s Gruha Arogya scheme is a promising initiative. How is it performing so far?
A. We want to make it a good scheme, but it has challenges. We have started it in Kolar, and we want to implement it across the entire state. It focuses on preventive healthcare. Our focus has always been on the curative side.
There are hundreds of people doing curative care — medical colleges, hospitals, etc — but no one is focusing on the preventive side. There is no money in it. Some well-meaning NGOs and foundations are working on this but they can’t operate at a larger scale. Only governments can do this across the state, and that should be our focus.
The challenge with preventive healthcare is that there is no immediate return to the government. (Smiles!) For instance, if I start something, the benefit will be visible only after many years. Political leaders want to showcase immediate achievements.
We are also working on maternal and child health. We need to bring our numbers to par with other states. That will be our focus.
We also want specialists to do the work they are trained for. For example, if there is a dentist, they should be performing complicated procedures. If it’s an orthopaedic surgeon or ophthalmologist, they should be doing surgeries. We want to train them and ensure they are performing these procedures.
The Puneet Rajkumar scheme will also be extended to the entire state. We don’t want to start anything new but ensure we successfully run what we already have.
Q. What’s your take on EVM manipulation and electoral reforms?
A. Electoral reforms are a subject that definitely needs attention. We saw how electoral bonds have been used for open corruption. But the cost of elections is going up. How do we create a transparent system now? We can’t say we will go back to the old system of raising funds through cash. We need a newer system.
Also, the way the Election Commission is working — their independence needs to be maintained. Unfortunately, we see that it is being compromised. I have not so far found evidence of how EVMs [Electronic Voting Machine] can be tampered with on a mass level. If I get access to an EVM, I can manipulate it, but we don’t get that access, so I don’t know how it can be manipulated.
Many countries have reverted to ballots because we know that any electronic method can be tampered with. Even if five or six out of 100 machines are tampered with, that isn’t good, right? That is the problem. But I wouldn’t say that all elections are won by tampering! (Laughs)
Q. Are you looking forward to a cabinet reshuffle and a different portfolio in case of a leadership change? You have been in the office for one and a half years now.
A. No, no, definitely not. I am happy with my department and would definitely want to continue. That is on my mind. In another year or two, I can carry it forward, and then someone else can take it from there.
I am very happy with the current department as it connects directly to the people. I don’t know about a reshuffle; it is left to the high command.
(Edited by Muhammed Fazil.)
