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Public Health in Jharkhand: One Crumbling Health Centre for 8000 People

Reports on maternal and child deaths come in from different parts of the country everyday: no surprise given that the public health infrastructure is in shambles.

“It is a 50-year-old building. What if the roof falls on someone’s head one day? It will be a major disaster”, says Mamta Devi, an auxiliary nurse midwife (ANM) in a Sub-Health Centre in Jharkhand’s Koderma district.

ANMs are frontline health-workers and Mamta’s job involves a 9am to 6pm duty at the centre, where she attends to at least 15 patients a day. She is also expected to conduct a minimum of three deliveries in a month, and to go to people’s homes to conduct deliveries in case of emergencies. Mamta was single-handedly managing the day-to-day work at the Sub-Health Centre which caters to a village with a population of 8000 until another ANM was appointed recently.

To add to her list of duties, she has also been writing applications to officials at the block and district levels since 2007 to get the dilapidated building repaired. “This year, we sent an application in June, right before the monsoon. People came, took photographs and left, but no action was taken”, she says. Tired of the laxity that the officials had displayed, she got some minor repairs done out of her own expenses, but she feels that the Centre should be shifted to another building altogether.

“But what can you do when you’re so helpless?”

When Community Correspondent Vinti Vishwakarma visited the Centre, she was shocked by the state of the building. “The toilets have no water, and the only source of water is a handpump nearby. With the leakage and the plaster falling off in places, there is little hygiene and no designated space for deliveries like a labour room. There are electricity problems too.” Vinti adds that government healthcare in the region, overall, is in poor shape. “Since the Sub-Health Centre in this village has only Outpatient Department facilities, residents have to travel to Public Health Centres in neighbouring villages or to the district hospital in Koderma when they have more serious ailments. Public transport is not so efficient and private vehicles are hired, often at very high costs. But what can you do when you’re so helpless?” When asked about ambulance services, Vinti says that the service is very tardy, which is the case for many places in rural India.

Sub-Health Centres are a provision under the government’s National Rural Health Mission (NHRM), a scheme already under fire for scams, even in Jharkhand. According to the guidelines under Indian Public Health Standards, Sub-Health Centres are divided into two types- A and B. The Centre where Mamta works falls under Type A, which is supposed to have all facilities except labour rooms, but the ANM is expected to carry out deliveries in case of emergencies, at the centre or in homes.

“This year, the government has directed that there should be at least three deliveries per month at each centre. But how will I manage that, especially in the monsoon? When patients come for delivery, I have no place to take them”, says Mamta.

The guidelines also state that if a Type A centre is located in a remote, hilly, difficult, desert or tribal area where transport facilities are poor, the centre should be identified and upgraded to Type B which is equipped with more staff and better delivery services.

Presently, the pregnant women even have to dispose the placenta themselves because of the poor conditions of the Centre. “In the rains, problems of accessibility, power and water only shoot up, putting the patients at risk”, says Vinti. Basic facilities like power are crucial to healthcare.

Koderma ranked lowest in the number of facilities that received NRHM funds for Sub-Health Centres.

“In a village with a population of 8000, the government should fix the existing infrastructure at the very least. And then they must upgrade the services,” Vinti adds. According to government rules, each Sub-Health Centre should cater to a maximum of 5000 people, 3000 in case of tribal populations. In Jharkhand, the 2012 average was 8,260, the figure for Koderma an alarming 11,575. Koderma also ranked lowest in the number of facilities that received NRHM funds for Sub-Health Centres.

Vinti now plans to screen the video at the village, and then approach the Civil Surgeon of Koderma with the video and follow up on the application Mamta had sent. To ensure that the problem is resolved, call the Civil Surgeon Harendra Prasad Tiwary at +91-9534538161 and urge him to move the Sub-Health Centre in Bariadih Village to a safer building.

Article by Alankrita Anand

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