The Good Doctor : August 2018

I was born in Bidar, the crown tip of Karnataka: with five rivers flowing through it; the Nanak Jhira, the birth place of Bhai Sahib Singh of Panj Pyare and with a significantly higher Sikh population compared to rest of Karnataka, Bidar is called Punjab of Karnataka. There ends the similarity. Bidar even today is amongst the most backward districts of Karnataka and none of the development indices (Human, Social, economic, educational & industrial) are comparable to developed districts of old Mysore region (OMR) of Karnataka.

Growing up the only constant in our lives and that of majority of people in North Karnataka was migration; in search of a better future. I was lucky as in one such village to which my family migrated (and my extended family has settled down even to this day); the school master noticed that I was good at math & had a good memory. He pushed my father to migrate to Bangalore for my education and everything changed after that.

Bangalore was manna to us; it gave us (and all those who migrated) opportunities which we did not have in our region due to geographical discrimination of North Karnataka by the powers that be in Bangalore probably due to the “tyranny of distance and discrimination”.

The question is: has the tyranny of discrimination against North Karnataka decreased and evanesced in the last 30+ years?

To eschew my own native bias arising out of past experience; I have tried to adopt modified composite factors of development; analysing HealthCare delivery, Education facilities, Employability after education, Employment availability, Industry & investment in infrastructure. I have steered clear from Human development indices as they take time to change albeit changes and improvement in quality of life are in place.

For proper assessment of typology of development, it is important to study not just the quantitative change in the last three decades in North Karnataka but also the qualitative aspects of development as revealed by the level of technology utilisation in everyday life by common man, Health and nutrition, Individual sanitation, Ease of living parameters like access to uninterrupted electricity, access to good roads and means of safe transportation versus their compatriots in old Mysore region (OMR).

Healthcare parameters^1,2,3,4,5,6:

Factors which interested us and which we sampled were:

1 Number of people who are sick and need HealthCare support ^1,2,3,11,12:

In OMR it was 95 to 98 per 1000 while in Northern Karnataka it was 95 to 102 per thousand. The problem area was Yadgir which did not have even a decent secondary centre and sick people had to go all the way to Kalburgi or Raichur even for something as common as assisted delivery in bad obstetric patients which is taken for granted in OMR of Karnataka. Doctors spoken to along with NSSO data of NITI ayog, reported more nutritional issues and geriatric issues in districts of North Karnataka versus reporting of the same from OMR. Almost 90% of people of North Karnataka have to move more than 100 Kms from their homes when anyone in the household requires tertiary care making whole households lose income while in the OMR region the comparative number was 57% ².

2) Out of pocket expenditure^1,9:

OMR being relatively developed the penetration of insurance, ESI and Public Funded Insurance Programs and other programs are significantly higher. Bidar, Gulbarga, Raichur, Yadgir, Chitradurga, Bellary, Koppal , Karwar, Chikkamagalur, Bijapur have woefully worse penetration of individual/family insurance and also the comparative per capita reach of public funded insurance is bad due to ignorance about the same, among people. Upon sampling in both North Karnataka and OMR we found that nearly 40 to 60% of patients are in the verge of catastrophic poverty due to out of pocket healthcare expenses in the above mentioned districts of North Karnataka verses their compatriots in OMR. As per survey conducted by us with doctors and hospitals we found that, Individual/Family private insurance penetration was nearly 25% in OMR and nearly 40% in urban areas of Bangalore, Mysore & Mangalore compared to 0.6% in Yadgir, 1% in Koppal to 3% in Bellary. Need we say more?

3) State expenditure in HealthCare ^1,2,4,9:

Karnataka government at 3.8% of its aggregate expenditure spends the least for healthcare among all southern states of India. Even among this, the amount spent for healthcare facilities in the three districts of Bangalore, Mysore and Mangalore exceeds the combined expenditure in the rest of districts of the state. All the state owned tertiary centres in the state are concentrated in these three districts. Recent Addition of Jayadeva Hospital branches in Raichur are just ornamental as doctors and specialist staffs visit once a month to such centres. State needs to own up responsibility and open centres of excellence in healthcare in the districts parched for healthcare.

4) Percentage of girls married before 18 yeras of age^{4, 10}:

We found this as a great marker of overall quality of life index. Families with access to remunerative employment, education & insurance invariably married their girl children late after educating them while those families which are poor looked at the girl child as a burden and married them early. Girls married early give birth to unhealthy kids; the family stayed less educated and poor with poor access to health services and government programs compared to girls married at the right age.

You will be surprised to know that nearly 35% of girls were married before they reach the age of 18 in all districts of North Karnataka. In OMR the same was between 6 (Mangalore & Bangalore urban) to 21% in different districts except Chamarajanagar which was 35%. This index alone is conclusive evidence of the tyranny of discrimination and continuous neglect which North Karnataka has faced till now.

Education ¹⁷:

Both the quality and number of educational institutions especially state owned institutions in North Karnataka are bad as compared to that in OMR. Bangalore with its IIM, IISc and various centres of excellence in education attracts talent and retains them as compared to say a Bijapur or Gulbarga. Government on its part has never made any attempt to bridge the gap in education resources for the people of North Karnataka proving the adage “tyranny of discrimination”.

Employment after Education ¹⁷:

In a survey conducted among private industry in Bangalore it was evident that a student who has studied in educational institutions of OMR has higher chances of employment as compared to someone who has studied in districts like Koppal, Bidar etc., with equivalent degree. Employment in Semiskilled & unskilled blue collar jobs does not subscribe to this discrimination.

Employment opportunities in North Karnataka ¹⁷:

In a survey conducted among family members, extended family members, their friends and families which included 316 youth, we found that 276 youngsters had moved to Bangalore for job, 6 to Mysore, 2 to Belgavi, 7 went abroad for further education, 8 to Mumbai, 13 to Chennai, 4 to Delhi to study for IAS. None of the youngsters stayed back in their native districts. This is a stark commentary on the state of affairs as far as employment opportunities are concerned. That places like Hubli, Belgavi themselves are suffering should be a wakeup call for the powers at Bangalore.

Industry and Investment ^{13,14,15,16,19,20,23,24}:

Since this heading alone requires an expansive treatment and is beyond the scope of this article, I will try to summarise this heading in Industrial output. All the districts of North Karnataka give less than 1% of industrial output of OMR’s industrial output. Bangalore alone generates nearly 90 times the output of all north districts combined. This includes state and national PSU sector & private enterprises. IT & BT which have ministries under the government have near zero output outside of OMR. All the districts of North Karnataka can be classified as industrially backward. Some like Koppal, Yadgir and Bidar do not have any industry at all. State government appears least concerned about industrialisation of these areas.

Asset Index ^7,
8:

As a proxy for wealth, we constructed an asset index using information about household characteristics including source of lighting, number of lights in a household, source of energy for cooking, source of drinking water and type of latrine along with multidimensional poverty indicators (MPI) taken from NSSO poverty survey ¹⁸.

Applying this Asset index to households across Karnataka we found that OMR households are nearly 3 times asset rich with better MPI data indicating better per capita expenditure, higher protein + calorie consumption and higher education levels compared to households of North Karnataka ¹⁷.

Some very broad sociodemographic and economic statistics of importance were considered too. We noted that there is significant 12 per cent increase in monthly per capita consumption expenditures of the households over the last 10 years even in districts of North Karnataka. There is also a big improvement in the literacy rates with a massive decline in the percentage of illiterate population from 42 per cent to 31.5 per cent over the last 10 years. Directly from a health viewpoint, it is also important to note that significantly more number of households gained access to latrines over this decade in India. This number is has risen sharply after 2014 when the Swachch Bharat Abhiyaan (Clean India Mission) was launched nationally. The other major development in this time frame has been the rapid expansion of health insurance in the country; hopefully Ayushman Bharat changes the dire state of healthcare in districts of North Karnataka. One common issue is lack of information. Many people are not aware of their coverage and how to benefit from insurance ^{9, 11, 12}.

Whilst as noted above, good quantitative changes did take place in the last few decades in North Karnataka, however; when we did the typological assessment of development, we found OMR region is far ahead of districts of North Karnataka in factors like; use of technology in everyday life by common man, Health and nutrition, Individual sanitation, Ease of living parameters like access to uninterrupted electricity, access to good roads and means of safe transportation. These factors are easy to note and were picked up by common citizens too which has led to feeling of vexed indignation and resentment bordering rancour against the state government in them ^{17, 22}.

The other most important issue which we noticed was the concentration of government departments, central and state PSUs in OMR. Starting from agriculture to industry to water & sanitation all are situated in Bangalore or OMR. The bureaucrats needs to be posted in areas where they are needed, what is the point of Karnataka water development board being situated in Bangalore when water is needed in arid areas of North Karnataka or why should Karnataka industry development board be in Bangalore and not relocated to say Koppal¹⁹ where industry needs to be developed? 99.9% of government offices, boards & PSUs are in OMR ²¹.

With the above analysis of available data, I conclude that North Karnataka faces severe discrimination even today after 30+ years of my family moving out of Bidar to Bangalore. The situation needs to be addressed immediately to stop further deterioration and stop an acrimonious battle for a separate state.

Dear politicians and bureaucrats of Karnataka, we are not interested in your centralised handout and welfare model distilled out of Vidhana soudha, what we want is better educational institutions, better jobs and increased industrial production at par with OMR in North Karnataka. We do not want to migrate to Bangalore or Mysore or Mangalore in search of opportunities, we want better opportunities in our place. Start by moving the government departments and bureaucrats to Koppal, Yadgir, Kalburgi, Bidar and other areas in the region where they are needed, do not keep them around Vidhana Soudha congesting Bangalore.

I pray the central and state governments to respect our sentiments, to put in extra effort and work to improve the quality of life of people of North Karnataka because Home is where heart is.

References:

1) https://www.karnataka.gov.in/hfw/kannada/Documents/Karnataka_Integrated_Public_Health_Policy_2017.PDF

2) https://azimpremjiuniversity.edu.in/sitepages/pdf/Karnataka-Roadmap-to-Improved-Health-A-Report.pdf

3) Distance to the nearest tertiary care centre as reported by government Doctors from different parts of Karnataka in a survey

4) https://www.business-standard.com/article/elections/karnataka-govt-s-per-capita-investment-in-health-lowest-among-south-states-118051100163_1.html

5) HEALTH AND FAMILY WELFARE STATISTICS IN INDIA 2017

6) http://www.mospi.gov.in/sites/default/files/publication_reports/Manual-Health-Statistics_5june15.pdf

7) Census Handbooks of all districts of Karnataka state

8) http://shodhganga.inflibnet.ac.in/bitstream/10603/108172/14/14_chapter%206.pdf

9) https://www.brookings.edu/wp-content/uploads/2016/12/201612_health-and-morbidity.pdf

10) https://www.icrw.org/wp-content/uploads/2016/10/District-level-study-on-Child-Marriage-in-India.pdf

11) http://mospi.nic.in/sites/default/files/publication_reports/nss_rep574.pdf