by Sachin Kumar Jain
Village Sarari Khurd, Sheopur - has a primary health centre but no doctor. Since when it does not have doctor, even villagers can't remember the same. The centre is opened by hardly fours days a week by local nurse. It neither has any facility nor any equipments and hardly has been cleaned ever. This is not the situation of one health centre, 20 kilometers of Sarari Khurd is Karahal. Karahal has community health centre. Though it opens every day but three positions out of the four to be posted there are vacant. Karahal block officially has a facility of mobile health van to reach out to inaccessible areas. But it has just one mobile health van. If the same works daily it will reach the same village after a gap of 35 days (please note if it works daily). And there is nothing to take care of a pregnant women and children. Even in case of unavailability of medicines, village level health staff is sailing the various kind of medicines to the Villagers.
There are 533 villages in the Saheriya primitive tribe dominated Sheopur district with a population of 5.60 lakhs. The total number of bed available at the one district hospital and other hospitals is only 166, of which 148 beds have not been changed during the last 13 years. During the last two years, several big claims have been made about promoting safe motherhood but just like last six years, three out of four posts of doctors in the Karahal block are still vacant. There was no improvement in the medical facilities during this period and even a single gynecologist and obstetrician could not be posted.
Anganbadi worker from Gothra Kapura village of the district, Bilasi Devi speaks from experience and asks as to why should one go to hospital? No one even speaks properly there and everyone right from doctors to nurses to sanitary workers asks for money to take any action. Government claims that anyone going for institutional childbirth would get Rs 1700 worth financial aid, transport fare and free medicines, but Babhuti was taken for childbirth to a hospital and her family had to pawn their land for completing the process.
In such situation, the Government of India has recently released figures related to maternal mortality for the first time since 1998, which claims that the Maternal Mortality Rate (MMR) has gone down from 498 (per lakh childbirth) to 379 during the period. But the report of the GoI (Maternal Mortality in India: Trends, causes and risk factors - 1997-2003) is itself facing some basic technical questions. The biggest question is as to whether the government is trying to veil the ground situation by some statistics under some pressure.
One important point is that this study of MMR has been conducted by considering only limited number of cases in specific situation. The survey was conducted over a period of six years and the low MMR is reported in MP and Chhattisgarh (365) although during this period about 103000 cases of maternal mortality were reported in the two states. The second point is that all these cases (365) are those that have been registered in official records while analyses tell that only one out of three maternal deaths get officially recorded. The problem is that in the district hospitals, community health centers and the lower level of health set up, the deaths during childbirth are recorded as general mortality.
The next question is that the Madhya Pradesh Government (GoMP) had in 2003 pointed out through the State Family Health Evaluation made it clear that in the rural areas of the state, the MMR is as high as 763, which clearly tells that the situation is far graver than the analysis by the union government. This study by the GoMP was done on 25 percent populace of each district and not only a selected group yet the union government is releasing contradictory figures for the same period.
The controversy should not remain limited to statistics because the health facility condition in state clearly brings forth the ugly face of the situation. The analysis of recent efforts of state government does not bring any good news.
In the state, only one hospital bed is available per two villages. Total 17 lakh childbirth occur in the state every year and 40 percent of state populace is below poverty line, yet the government provides only Rs 150 per person per year as health budget of which Rs 126 is spend on salary-allowances and other infrastructure costs. Only 137 posts of gynecologists and obstetricians are approved in entire state and of these 38 are vacant since several years. After a long battle, the government started the process of filling up the vacancies last year but no doctors are willing to take up government jobs owing to lack of facilities including diagnostic implements, medicines and general sanitary facilities. In such situation, doctors often have to face the wrath of the family members of the patient in case of death.
Government started the process for filling up 78 posts of gynecologists and obstetricians but only 31 applications were received. A total 112 posts of anesthetists were to be filled up but only 12 took up the job. Corruption at all levels is making conditions far more dangerous for the pregnant women. Corruption has begun in the medicine purchase under the new medicine policy, as now in the new medicine policy all the purchase will be done centrally and the Rs 700 of financial support under Janani Suraksha Yojana is all spent in giving bribe to the local health staff.
Despite unreliable data, statistics say that out of 1.47 lakh maternal deaths in the country every year, 97000 are contributed by the five BIMARU states and the three newly carved states. The World Health Organization also accepts this. The half of the maternal deaths in South Asia are contributed by the states of Rajasthan, MP, Bihar, UP and Orissa in India.
In such situation the statistics need to be manipulated to show lower MMP so that the policies foreign investments and privatization of services could be justified. MMR is directly related to social disparity, exploitation and poverty. The government has limited the scope of poverty around hunger and this has limited the rights of the women for safe motherhood. On one had health services have been hugely privatized and on other government's accountability for rights of community to health has reduced. Due to poverty, more than 40 percent below poverty line families are not able to seek benefit of private health services.
Actually this is the time to sincerely implement the efforts for safe motherhood. A political debate has started on the issue but lack of commitment is easily perceptible. The fear is that the rights of women might get entangles into a web of schemes. Government provides cheaper food grains but it is ironic that a women suffering from childbirth pains has to prove that she is poor as per government guidelines to get free medical care and medicines. The government needs to chalk out a comprehensive policy and coordinated effort for child and maternal health and not keep churning out irresponsible and discrepant schemes just to please some political leaders.