Even as the malicious anti-vaccination propaganda in Malappuram has been eroding the State’s health gains, the weakening public health system and its inherent shortfalls in the district must be seen as the larger reasons for the lessening public confidence in the system, public health experts point out.
Instead of firefighting by all and sundry whenever diseases surface, the health system needs to arm itself with more human resources, organise better vaccine logistics and sustained field activities over long-term if it has to bring about any change in the attitudes and practices in Malappuram, they say.
Shortage of staff for basic field activities and supervision of primary care activities in the district, one of the largest and most populous districts – Malappuram has a population of 43.8 lakh – has been a complaint that has remained unaddressed by the Health Department since long, officials admit.
Despite continuing reports about the waning routine immunisation coverage and resurgence of vaccine-preventable diseases in Malappuram, the district has continued to have the lowest penetration of primary care services, which is worsened by the acute shortage of field-level workers too.
National standard
The national standard for primary care, fixed decades ago, says that there should a sub-centre for every 5,000 population and a primary health centre (PHC) for every 30,000 population.
However, in Malappuram, one sub-centre serves 13,000-17,000 population while one PHC has to serve about 50,000-1,00,000 population. Instead of the required 900 sub-centres, the district has just 578.
“Every sub-centre should have one Junior Public Health Nurse (JPHN) and one Junior Health Inspector (JHI). The former comes under the national RCH programme and but the male JHIs should be appointed by the States. The State has been reluctant to increase the number of JHIs because of the financial commitment involved. There are hardly any districts which have these workers in 1: 1 ratio. The JPHNs thus remain an overworked lot, who are expected to bear the entire burden of primary healthcare activities in districts and still be roped in for the community activities of all other departments too. This leaves them with little time for home visits and field-level activities, which would have helped them link with the community better and gain their confidence,” says Mohammed Shaffi, a public health professional.
Vacancies
“There are innumerable vacancies of JPHNs in the district and we don’t get people to serve here even on ad hoc basis. Right now, 40 JPHNs have gone for six months’ mandatory training, leaving a huge gap,” a senior Health official confided.
Unless the Health Department sets its own house in order, it would be in no position to put up sufficient resistance against the anti-vaccination lobby, experts say.
