A Primary Health Centre in Maharashtra did not have a doctor or ambulance. Things changed, but sadly, it took a tragedy for the change to come.
The World Health Organisation recommends a doctor to people ratio of 1:1000. In India, the existing figure is 1:1800. For doctors in government practice, this figure is 1:11082. While it is a well-known fact that the country faces a dearth of allopathic doctors, it is the rural population that is particularly affected by this dearth. Many a time, it is not just the lack of doctors but the reluctance of doctors to work in rural areas that amplifies the problem. According to government data, 1,974 Primary Health Centres (PHCs) do not have even one doctor. PHCs, which cater to populations ranging from 20,000-30,000 persons are the only accessible health centres with doctors, labour rooms and essential drugs in rural areas.
Chaugaon village in the Brahampuri block of Maharashtra’s Chandrapur district has one PHC, and it caters to 35,000 people from 29 neighbouring villages. According to the government, by December 2017, all PHCs in Maharashtra had at least one doctor. But this was not true for Chaugaon until June 2018. The doctor’s chamber had been lying vacant, and the centre had not had an ambulance service for two years.
Unfortunately, it took a tragedy to change things.
The death of an old man, which could have been avoided had there been an ambulance and a doctor, riled the community who had been asking for their ambulance service to be restored for two years.
“We have been asking for an ambulance for two years now. We used to have one but it broke down and had to be sent to the service centre, but the officials in-charge did not clear the bills and the service centre did not release the vehicle”, said a PHC worker.
Community Correspondent Krupakar Chahande visited the grieving family, and spoke to the community and the PHC staff. He then documented the problem by shooting and editing a brief video on his tablet. The video then went “viral”, in the words of Shailesh Chougane resident. Through messaging apps like WhatsApp, the video reached the local administration and the local press; the former was quick to act this time, owing to the video evidence.
Krupakar then visited the Panchayat and the Zila Parishad with the community, and the Zila Parishad agreed to convene on the matter. “We recognised the issue as a serious one and asked for a doctor to be appointed immediately”, says Deepali Mishram, a Parishad member. The Parishad, along with the Block Medical Officer of Health, took action within a week.
For now, the PHC has a temporary doctor who agreed to work there during his leave period. It also got a round the clock ambulance service.
“I will make sure that more staff, and another doctor, is appointed soon. I am also making sure that the ambulance service works efficiently”, says Dr. Nakade, the doctor appointed at the centre.
Doctors’ reluctance to work in rural areas has often been cited as a problem by governments and hospitals. In an attempt to address the problem, the Maharashtra government introduced incentive packages to encourage doctors to work in villages. Chandrapur was one of the districts the proposal was rolled out in. The offer worked and many some doctors were even earning 200,000-500,000 rupees through incentives above the monthly salary of 300,000 rupees. It is unfortunate that it takes so much to ensure the presence of a doctor in a village facility. It is equally unfortunate that it takes a death to rouse the authorities from their slumber.
While the PHC in Chaugaon now has a doctor, he is not there on permanent duty. Neither is one doctor enough to cater to 35,000 people. This is 35 times less than the recommended ratio of 1:1000. For now, even this small step is an achievement in itself. But India has a shortage of 600,000 doctors. For the country to match up to nationally and globally recommended standards of healthcare access, there is a long, long way to go.
Video by Community Correspondent Krupakar Chahande
Article by Alankrita Anand, a member of the VV Editorial Team