Public
Health System
In Madhya Pradesh;
Planned To Collapse!!
By Sachin Kumar Jain
11 September,
2008
Countercurrents.org
Primitive Tribal Group in Gwalior-Chambal region – Saheriya, faces enormous health problems and while responding to these critical lives threatening conditions, State provides them – Dreams. In a very recent micro study by Saheriya Mukti Morcha, gives a bleak picture of state health services in rural areas. In a period of 3 months (15th July 08 to 15th October 08), out of total 165 children under the age of 6 years, due to preventable disease in 10 villages of Karahal block in Sheopur district of Madhya Pradesh, but no political agitation seen. In the span of 35 days in June-July 2008, Kahrahal Community Health Center (according to NRHM guidelines which should have all facilities for deliveries) has just been referring the cases to District Hospital, which has resulted 5 women delivered their child in the buses. There is no body that has seen the ambulance under Janani Express Yojana, but hoardings of this scheme are there on each and every corner.
Three out of the four positions of doctors at the Community Health Center are vacant. There is no gynecologist or even women doctor. Karahal block officially has a mobile health van on the paper to reach out to inaccessible areas. There are just 166 beds in all the government hospitals to cover the population of 5.60 lakh in 533 villages. The supply of actually needed medicines is a big dream here. Above all; there is no state health policy available in the Madhya Pradesh, there is a draft document for last eight years, but health ministry shown interest in making and finalizing medicine purchase policy first, as it has clear target to eat the money in a systematic manner.
The controversy regarding the discrepancy and issues should not remain limited to statistics because the medical infrastructure in the state clearly reveals a far bleaker scenario. An analysis based on state government figures shows that one hospital bed is available for every two villages. There are 18 lakh births in the state every year and out of that 8.84 lakh births take place in poor families, but out of that only 3.5 lakh could be covered under the maternity schemes. And various macro studies show that the expenditure on health is a biggest cause of indebtedness among the tribal people. The government provides only Rs 160 per person per year as health budget, of which Rs 126 is spent on salaries and other infrastructure costs.
In the collapsed health system even doctors do not want to work, interestingly in last 4 years average post of 39 CMHOs have been filled by in charge doctors, so that they could be exploited by the authorities. Only 137 posts of gynecologists and obstetricians are approved in the entire state, many of which were vacant for years. After a long battle, the government began the process of filling the vacancies last year: 78 posts of gynecologists and obstetricians, and 112 posts for anesthetists. But only 31 applications were received for the former and only 12 anesthetists’ posts could be filled. Expenditure in health services has increased enormously in comparison to any other services because it is essential but not fully provided by the Government. Alarmingly provision for Health sector has been stagnant to 2.40% of the total Madhya Pradesh budget expenditure; it simply means that strengthening public health sector is not a priority for the Government. Presently Madhya Pradesh allocates approximately 900 Crore rupees for the State Health services, for the population of 6.50 Crore. It means only an amount of Rs. 138 has been allocated per person per year. Interestingly, even out of this amount Rs. 114 just goes in Salary and overheads account and one person gets Rs. 2 for medicine, checkups, investigations and other care.
There has been a need to create more and more infrastructure and new institutions in the State, but again not a singe Primary Health Institution has been created in last five years in the State. The state of Madhya Pradesh needs 478 PHCs and 1528 Sub Health Centers for last 8 Years, but no improvement could be seen. Normally data does not give a very real picture, but here it will!! According to population we require 916 Medical Specialists, but only 49 in place, out of 4708 posts of Medical Officers 1659 are laying vacant, there are only 216 pharmacists in Health department against the need of 1421, and 1098 posts of ANM are still to be filled. The reality on political side is very depressing, because political parties or even peoples representatives never came out on road for people’s right to Health Care. It very difficult to say that now doctors will come and join the state health services at any COST, because now they are bound to spend Rs 25-35 Lakh to become a doctor, and a salary of Rs. 40 thousand will not support them to pay the interest against the education loan. In other words, if Government have human character and wants to provide genuine health services to poor, they will have to subsidies and control the medical education.
Recent incidents, especially Income Tax department raids on top level health department officials, shows the truth, shockingly an amount of 200 crore has gone into the pockets of officials and leaders. Corruption in sectors like Health and Women-Child Development is not merely an example of eating money by the authorities, but this corruption eats the Hundreds thousand lives every year, especially in the poor and the most marginalized sections of the society. One needs to co-relate the levels of corruption and bad health indicators. Madhya Pradesh is the biggest contributor all together in Infant, Child and Maternal deaths in the world. Pervasive corruption at all levels is making conditions far more dangerous for pregnant women. This is partly rooted in the government's new policy of centralized purchase of medicines. As a result, most of the Rs 700 provided to a pregnant woman under the Janani Suraksha Yojana (Protection of Mothers Scheme) is spent on bribing the local health staff. In these circumstances poor community is forced to opt the option of private health care, which limits the options of freedom in the life.
Despite unreliable data, government statistics show that out of 14.7 lakh maternal deaths and deaths due to reproductive health complications in the world every year, 97,000 are from Bihar, Madhya Pradesh, Rajasthan and Uttar Pradesh, also known as the four BIMARU states, and the three newly carved ones of Jharkhand, Chhattisgarh and Uttaranchal. This figure has been corroborated by the World Health Organization (WHO). Half of the maternal deaths in south Asia are contributed by India's states of Rajasthan, Madhya Pradesh, Bihar, Uttar Pradesh and Orissa.
A debate is on over the issue but lack of political commitment is apparent. There is need for a comprehensive policy and coordinated effort for child and maternal health care instead of grandiose schemes to please the politicians. There is a need to make a call to the middle class of the society that they should not discard the need of public health services. It is very essential for the poor today and they (middle class) will also need it badly tomorrow.
