ISSN (Print) - 0012-9976 | ISSN (Online) - 2349-8846

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Alarm Bells for Maharashtra’s Health System

Recent surges in the deaths at public hospitals across Maharashtra prompted an investigation by the Jan Arogya Abhiyan into excess deaths at Dr Shankarrao Chavan Government Medical College and Hospital Nanded, revealing a complex convergence of systemic factors and underscoring the urgent need for political will to upgrade public health services.

The author gratefully acknowledges numerous nurses, doctors, health officials and social activists from Nanded who provided information to the Jan Arogya Abhiyan (JAA) fact-finding team, as well as the contributions of JAA team members and health experts who were involved in the fact-finding process, which forms the basis for this article.

Recent incidents of excess deaths in various large public hospitals across Maharashtra—including in Nanded, Aurangabad, Thane, and Nagpur have been widely reported by the media. (Wire Staff 2023; Akhef 2023; Chakraborty and Deshpande 2023; Express News Service 2023). Much of the news coverage highlights possible proximate factors responsible for these deaths, such as shortage of medicines or alleged negligence. With limited focus on immediate factors, the deeper, structural causes are largely ignored and are likely to remain unaddressed. This grim context serves as an occasion to look beyond the visible tip (excess deaths) and recognise the underlying iceberg (the growing systemic crisis of public health services) which has become evident in Maharashtra today. Jan Arogya Abhiyan (JAA)—a statewide coalition of civil society groups and health professionals working on public health issues in Maharashtra—recently conducted a fact-finding into the excess deaths reported at the Dr Shankarrao Chavan Government Medical College (GMC) and Hospital  in Nanded, and the emerging report1 probed into interrelated causative factors at various levels. This article briefly describes these findings and analysis, which have serious implications at immediate as well as long-term levels, and have both local and wider significance.

On 1 October 2023, in a 24-hour period, 24 deaths occurred in GMC hospital in the Nanded district, located in the Marathwada region of Maharashtra. This was over double the average number of daily deaths occurring in this hospital, which is usually in the range of 9 to 12 deaths daily. The JAA team conducted a comprehensive investigation by visiting both the medical college hospital and other public hospitals in Nanded, where informants included patients, nurses and doctors in public health facilities, private doctors and social activists. This in-depth investigation revealed the convergence of multi-level causes shaped by powerful systemic constraints, which con­tributed to the observed excess deaths
at GMC Nanded.

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