Misplaced goverment priorities ail health centres

Several state surveys show that less than 25 per cent sub-centres are able to deliver at full capacity  
auxiliary nurse-cum-midwife Sunita Yadav works at a primary health sub-centre that doubles up as an anganwadi centre for pre-schoolers in Balpura, Rajasthan | EXPRESS
auxiliary nurse-cum-midwife Sunita Yadav works at a primary health sub-centre that doubles up as an anganwadi centre for pre-schoolers in Balpura, Rajasthan | EXPRESS

NEW DELHI: For Sunita Yadav, an auxiliary nurse-cum-midwife (ANM), manning a primary health sub-centre in Balpura near Jakhrana in Alwar, Rajasthan, is a daily struggle for a strange reason. She is supposed to distribute basic medicines to patients, administer vaccine shots to infants and check pregnant women for issues like high blood pressure and anaemia. But her constant worry is to ensure that toddlers at the centre do not swallow drugs lying on a table in the room.The health sub-centre runs from a primary school that doubles up as an anganwadi centre for pre-schoolers.

Bishan Parmar, a farmer who has come at the centre to ask for a medicine for common cold, is not satisfied either. “For past so many days, the ANM has been saying there is no Cetrizine. This sub-centre hardly fulfills the needs it promises to,” he says grumpily. Barkha Gupta, medical officer at the health centre at Jakhrana who is responsible for overseeing six sub-centres in the block, says while the supply of medicine has improved over the past few years, only three-four patients visit every day. 

“Even pregnant women who go to the sub-centres are often disappointed that there is only a partially trained ANM who will see them,” she says. “Most of the sub-centres do not have buildings of their own and are run from anganwadi centres, where even keeping medicines safely is a major concern.” When asked if the Union government’s ambitious plan to upgrade 1.5 lakh sub-centres, which act as smallest units of healthcare delivery machinery, into wellness centres looks realistic, Gupta just smiles.

First in the national health policy last year and then in the Union Budget this year, the Centre promised that wellness centres throughout the country would be developed to provide comprehensive healthcare with a bouquet of 12 services.“The role of the doctor and specialist will be extended from making a diagnosis and treatment plan to ensuring medication compliance for chronic illnesses and follow-up care delivered close to home,” a senior official in the Ministry of Health and Family Welfare said. 

But nobody knows from where the magic wand will come that will transform sub-centres like the one in Balpura.The district-level household survey (2015-16) showed that 22 per cent of India’s health sub-centres do not even have ANMs and about 56 per cent never have all the medicines or vaccines listed. Several other surveys in states have shown that less than 25 per cent sub-centres are able to deliver at the full capacities. 

“This plan is looking extremely problematic to me from the word go,” said Jashodhara Dasgupta, public health expert and co-ordinator of NGO Sahyog. “When the sub-centres have not been able to deliver the two basic services — immunisation and maternal care — due to lack of staffers and resources, how are they being touted to provide other facilities? Where are the doctors and where is the money?”  

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