In the ICU, public health sector in Uttarakhand waiting for booster shots
‘In the pink of health’ is an idiom that militates against the health of public health sector in Uttarakhand.
On March 8, Prem Singh Dhoni, a resident of Kukna village in Nainital district complained of severe abdominal pain. Sensing an emergency, the villagers prepared a makeshift stretcher and decided to carry him to the nearest medical facility, located 7 km away. Since the village isn’t connected with a road, the journey had to be made on foot, over stony mountainous path.
Prem Singh died on way to hospital. His wife and two unmarried daughters survive him.
In October 2017, a woman was forced to deliver her child on a bridge in the Chakrata region of Dehradun district because the nearest primary health centre (PHC) was locked and no staff was available there. In April the same year, another pregnant woman was forced to deliver her child outside a health centre in Tehri district because the facility was locked.
These aren’t isolated cases. Such stories abound Uttarakhand, a state that was formed with a hope to usher development in the Kumaon-Garhwal region.
High hopes, but alas…
In this backdrop, when last year chief minister (CM) Trivendra Singh Rawat kept the health portfolio with himself upon forming government, many hoped that things will finally change. After all, the CM was apparently taking personal interest in the department.
But, as the Rawat government completes one year in power on March 18, not much has changed on ground. Of course, the government did make some efforts, but in the end, it is the results that matter, and they are not very heartening.
Facts speak for themselves
In February, the NITI Aayog released a report on the quality of healthcare services in the country. The report revealed that 60% of the posts of specialist doctors in Uttarakhand are vacant, while 20% posts of nurses are yet to be filled. It adds that none of the 13 districts has a functional cardiac centre.
Dr Archana Srivastava, director general, health, says that the actual figure of vacant posts can be higher.
Touching on other parameters, the report said that the sex ratio at birth in the state has declined from 871 in 2014-15 to 844 in 2015-16; under-5 mortality rate increased from 36 to 38 and neonatal mortality rate from 26 to 28, in the same period.
The findings of the National Family Health Survey (NFHS)-4, that were released in January, were no different.
The report states that between 2005-06 and 2015-16, the overall use of family planning methods has decreased by 10%, female sterilisation by 15%, and male sterilisation by 61%.
Few takers for hill postings
There are 2,725 sanctioned posts of doctors in the state across all hospitals, but only 40% of them (1,071) are filled at present. To fill the vacant posts is the biggest challenge before the government. Most of these vacancies are in remote locations in the hills where people are unwilling to serve.
To check this, the government introduced subsidised MBBS courses in government medical colleges, but with a rider attached. The condition was that students will serve at least five years in the hills on completing their course. As a deterrent, they were made to sign a bond and the amount varied from Rs 20 lakh to Rs 1 crore.
To the surprise of the health department, nearly 200 students refused to serve in the hills, despite the bond. The department has now issued notices against them.
“We have given them some time to join duty. Some of them have agreed. Strict action will be taken against those who fail to do so,” says Dr Srivastava.
To increase the strength of doctors, the government also tried to rope in retired army doctors, but the plan did not materialise. The CM also approached army chief General Bipin Rawat, requesting the army to take over the Government Medical College in Srinagar. It was turned down by the central government.
However, to the credit of the department, 481 doctors, which include 86 specialists and 193 women doctors, have recently been selected. They will be given appointment letters on March 18 during the government’s one-year celebration programme. Besides, the health department says that 600 doctors have also been hired on contractual basis.
“All these doctors will be posted in the hills,” said Dr Srivsatava.
It, however, remains to be seen how many among the 481 will actually join and serve in the hills.
Poor maternal healthcare
Besides filling vacant posts, Uttarakhand also faces the challenge of improving the quality of maternal health facilities. The infant mortality rate in the state is 40, while the under-5 mortality rate stands at 47.
The NHFS-4 states that around 25% births of children under 5 years of age is yet to be registered. Further, only 11.5% women have full antenatal care, and the percentage of children who received a health check from a professional within two days of birth is just 19%. Besides, 43% pregnant women and 55% children aged 6-59 months are anaemic in the state.
“Uttarakhand has been included in the high-focus states by the Centre largely due to poor maternal healthcare facilities. It is a big challenge and we are taking measure to improve it by proper implementation of National Health Mission and Janani Suraksha Yojana (Maternal Healthcare Scheme),” said Dr Srivastava.
Ill-equipped health centres
In 2017, the Uttarakhand statistical directorate commissioned a study to understand the burden of diseases on hospitals. It was found that most hospitals in the state are poorly equipped.
“Doctors are not against serving in hills. But what will they do when there is no medical infrastructure and trained staff at the health centres,” asks Dr Anand Shukla, vice-president of Uttarakhand Medical Services Association, an umbrella body of government doctors.
He added: “The problem is of infrastructure. You send a surgeon to the district hospital in Chamoli when there are no anesthesia specialists. How can he/she serve there? The same is true for other specialists too.”
Speaking about the role of private players in promoting healthcare, Virendra Kalra, co-chairperson, PHD Chambers of Commerce and Industry, Uttarakhand chapter, said, “Owing to the limited resources with the government, the public-private partnership is the only way out to improve public healthcare in the state. But the government needs to ensure that it provides land and basic infrastructure. Clearances consume a lot of time, this needs to improve if private players are to be encouraged.”
He added that the state can also use IT to improve health services. “We need more pathology and screening centres. The consultations with experts can be facilitated through internet,” he said.
Good news: Achieving almost 100% immunisation
Meanwhile, on the positive front, the NITI Aayog report states that Uttarakhand has achieved 99.3% complete immunisation. The percentage of institutional deliveries has also increased from 32.6% in 2005-06 to around 69% in 2015-16, according to NHFS-4.
“The entire credit for an improved immunisation rate goes to the hard work done by Asha workers and ANMs. We have ensured that quality training is imparted to them. However, Haridwar and Udham Singh Nagar are two districts where the situation is bad. We are working on it,” said Dr Bharti Rana, state immunisation officer.