To understand the root of the recent high number of deaths at GMC Nanded, of which around half were sick newborns, we need to first recognise the inadequate provision of specialist health care services throughout the public health system in Nanded district, as well as neighbouring districts in the region. Out of 20 secondary-level public hospitals spread across the Nanded district, only the women’s hospital has a sick neonatal care unit, while all others including six sub-district hospitals and 12 rural hospitals lack specialised facilities for treating sick neonates. This absence of adequate specialised neonatal and paediatric care in public hospitals within the district, as well as adjoining districts such as Parbhani and Hingoli, leads to frequent direct referrals of numerous critically ill newborns and children to GMC Nanded, considerably straining this already overstretched hospital.

The civil hospital in Nanded has just 100 beds though it serves the district’s population of over 3.4 million, drastically falling short of the required bed capacity of at least 500 beds at the district level, the benchmark set by the Indian Public Health Standards. This district-level hospital has only one paediatrician and no dedicated paediatric ward. The women’s hospital houses another 100 beds including a 12-bed sick neonatal care unit, but there seems to be a lack of a structured referral system to guide patient inflow from peripheral hospitals. In this situation, most neonatal cases get referred straight to GMC Nanded, overloading this specialised facility.

Of the 24 deaths during that fateful period, 11 were of newborns. This prompted examination of the Neonatal Intensive Care Unit (NICU) at GMC Nanded which has 20 cradles although around 60 newborns are usually admitted. Hence more than one newborn often shares a single cradle. The nurse-to-patient ratio falls far below recommended standards, with only two-three nurses per shift instead of the required 10 nurses per shift as per norms for intensive care. This staffing shortage is combined with inadequate supplies of essential medicines such as crucial antibiotics, with implications for quality of care and added stress for the medical staff.

The Pediatric Intensive Care Unit (PICU) at GMC Nanded has 35 beds but recorded 613 admissions in the last month, implying that treatment capacity was exceeded by around three times.

With only three nurses per shift instead of the required 10, sanitation staff shortages, and bed-sharing among patients to cope with scarce resources, the PICU strives to deliver quality care amid serious constraints. Furthermore, the entire GMC hospital is overburdened, accommodating around 1,100 indoor patients despite a bed capacity of 500. The staffing shortage and reported involvement of some senior specialist doctors in private practice further strain the hospital’s resources for providing specialised care.

Nanded city boasts of around 480 private hospitals and clinics, but very few are empanelled under the PMJAY-MJPJAY health insurance schemes. In Nanded, these much-hyped schemes engage only nine private hospitals for paediatric medical care, and just two for neonatal care, leaving many families with no choice but to seek care for sick children at GMC. Some private hospitals have also been accused of “dumping” terminally ill patients at GMC Nanded, contributing to the hospital’s mortality figures.

Short-term factors such as seasonal rise in illnesses, declaration of free public health care services, and “long weekend” reducing the availability of care at other hospitals have also contributed to the worsening of the patient load-capacity mismatch at GMC Nanded.

The root cause underlying the first three factors is a lack of political priority and insufficient resources allocated to public health services, combined with policy orientation preferring health care privatisation.

The excess deaths at GMC Nanded are symptoms of a deeper malaise – the public health system being majorly under-resourced and overstretched, heading towards a crisis. Urgent actions now required include conducting a participatory public audit of the incident in GMC Nanded, improving staffing and expanding infrastructure at GMC, expanding specialist health care services in public hospitals across the district, and implementing community-based monitoring and social audits to hold health services accountable. There is an urgent need to increase the state’s health budget, which should be doubled from ₹1,800 per capita (below the national average) to ₹4,000 per capita, along with establishing a state health human power policy, immediately adopting a transparent, effective medicine procurement system, and critically reviewing health insurance schemes linked with the private health care sector.

These tragic deaths must serve as a wake-up call for politicians as well as the people of Maharashtra, prompting a holistic overhaul of health policy and increased political commitment to public health. This is the right time to raise the demand for enacting major health system reforms linked with implementing the Right to Healthcare in Maharashtra.

Abhay Shukla, a public health specialist, assisted activists from Jan Arogya Abhiyan in preparing the fact-finding report mentioned in the article. The views expressed are personal