Plan to upgrade PHCs have failed, increasing burden on district hospitals manifold

When a man dies in a road accident, it becomes an issue or at least people talk about it, but even if 20 women die every day during childbirth, no one is concerned.

This quote said it all about the fate of pregnant women and the new born children in the country. More than 63,000 women die every year in India from pregnancy-related causes and a woman in India is 60 to 70 times more likely to die in pregnancy or childbirth than a woman from a developed country. It is an irony that one life should be lost in the process of creating another.

This in spite of numerous initiatives taken by the Centre and State governments to encourage institutional deliveries including the special focus on the National Rural Health Mission, and the just launched Janani-Shishu Suraksha Karyakram. “The government has created a huge demand for health facilities for reproductive and child health care but failed to provide the facilities as a result of which people have lost faith in the system,” explains Nabin Pati, member of the White Ribbon Alliance-India, (in Orissa) a loose conglomerate of civil society groups working for mother and child health in the country.

Grim conditions

Mr. Pati has a point when he says the district hospitals are overburdened. A drive down Balangir — one of the most backward regions of Orissa in the Kalahandi-Balangir-Koraput (KBK) region — endorsed Mr. Pati’s observation. The gynaecology ward of the District Hospital here is bursting at the seams at any given point. It has a capacity of only 25 beds but on an average, 75 women are admitted here. Women have to wait for hours before delivery because the labour room can accommodate only three patients at a time and once out of the labour room, women are kept in the leaking and damp corridors with new-borns because of non-availability of bed. Women are not surprised when they are discharged from the hospital within hours of having delivered to accommodate new cases and neither do the family members mind because they would get the money under the Janani Suraksha Yojana as would the Accredited Social Health Activist for bringing the women to the hospital. The lactating mother may die even before reaching home due to post-natal complications but it would be counted as an institutional delivery. “All they give us on arrival is a bed, without bed-sheets. Everything else has to be purchased which is a huge burden on the poor families,” said another ASHA who had just brought a woman for delivery to the hospital.

The NRHM’s ambitious plan of upgrading the Primary Health Centres and the Community Health Centres to tackle delivery cases have fallen flat as a result of which the burden on the district hospitals has increased manifold while there has been no improvement in the infrastructure and human resource leading to a compromise on the quality. Ambika Patra, working as an ASHA at Chattapeepal village said the nearest PHC was 15 km away as was the district hospital but she preferred to take the women for delivery to the hospital since the PHC has no facility for deliveries and would be referred to the hospital in any case. Those who are able to afford go to a private facility. According to her, no delivery has ever been conducted at the PHC since it was set up in 2007, though there is a doctor and other staff but no one wanted to take responsibility and there were no facilities.

Last month, two childbirth related deaths were reported from Guna and Jamut blocks, both of which are cut-off in the rainy season. A young woman, Champeshwari Baira, died in the district hospital last year. A verbal autopsy revealed that the family was unable to arrange the three units of blood demanded by the hospital at the time of her admission even though there are strict instructions by the State government that the families of delivery cases and road accidents would not be asked to arrange for blood.

Admitting that there is no proper Maternal Death Review to ascertain the cause of maternal death, B.K. Kindo, Chief District Medical Officer said, in addition to reported maternal deaths, there were as many as 27 cases of pre and ante natal deaths which were not recorded. “There are many missing cases also but these can be recorded only if there is a proper tracking system which would be introduced shortly. However, 10 per cent of delivery cases will go wrong even with the best of facilities, he explained.