Though the Defence Ministry is in control of the areas, public health comes under State list; Both Ministry, Zilla Parishad shirk responsibility and the result: no PHCs or anganwadi
Eleven-year-old Nisha Kamble plays outside her house with children half her age but looks like one of them. When she should have been four feet and four inches tall, her actual height is just three feet and five inches. Against an ideal weight of 36 kg, she weighs merely 16 kg.
The story of the children living in the slums in the Dehu Road Cantonment, 30 km from Pune, is no different.
57.62% children malnourished
According to a survey done in 2008 by a local NGO, Sadhana, 57.62 per cent of the children surveyed in the 0-5 age group were malnourished. Ten of these were in Grade four, the most serious grade. The percentage of malnourished children here has gone up over the years; 54.08 per cent were found malnourished in 2006.
According to Savita Jadhav of Sadhana, malnutrition has been on the rise in urban areas apart from Maharashtra’s malnutrition ‘hubs’ such as Nandurbar and the Melghat region in Amravati. “However, what sets the Dehu Road apart,” she says, “is the complex governance structure that ensures that none of the government’s public health schemes reach the people.”
Being a cantonment, a permanent military station where troops are quartered, the place comes under the administration of the Ministry of Defence. The civil areas in the Cantonment are administered by the Dehu Road Cantonment Board (DRCB), also under the control of the Ministry of Defence. But health is a subject under the State list and so there is confusion regarding whose responsibility it is, with the result that neither the DRCB nor the Zilla Parishad pays any attention to public health.
No binding proviso
Maharashtra has the second-highest number (7) of cantonments in India after Uttar Pradesh (22). Ms. Jadhav says that the Cantonments Act of 1924 does not make it mandatory for cantonment boards to make provisions for public welfare. “The Act says that the boards are supposed to make ‘reasonable provisions as long as funds permit,’” she says. On the other hand, the health department of the Pune Zilla Parishad shirks responsibility saying that the DRCB “is an independent body.”
As a result of the confusion, there is no Primary Health Centre (PHC) in any of the four villages that form the civil area of the Cantonment. There is no anganwadi either to run the Integrated Child Development Services (ICDS) programme, which is meant to cater to pregnant mothers and children in the 0-6 age group, and combat child hunger and malnutrition.
Largely poor population
“The civilian population in the slums largely consists of poor people originally brought by the military to work in its depots as class four employees or as domestic help in their households. The population in the villages consists of people whose agriculture land was acquired by the military,” says Ms. Jadhav. A majority in both these groups have little access to adequate nutrition and health services.
“Cases of child and infant mortality and deaths of pregnant mothers go unrecorded,” says Ms. Jadhav. “In fact, when we did our first survey on malnutrition in 2006, the Zilla Parishad called for our data, indicating that neither the Zilla Parishad nor the DRCB had any database of its own.”
Health state ‘pitiable’
As per the admission of Dr. Vijay Patwardhan, resident medical officer at the Cantonment General Hospital, the state of public health in the Cantonment is “pitiable.”
“We participate in health activities of the State government,” he says. “But from the point of view of community outreach, we are understaffed.”
According to several slum-dwellers, facilities at the General Hospital itself are inadequate too, forcing them to make long trips to hospitals outside the Cantonment.
There are five doctors and nine nurses at the General Hospital apart from the visiting doctors. For community outreach, there is just one auxiliary nurse midwife for the four villages under the Cantonment. “The Zilla Parishad should take more responsibility and give more staff, while it is possible for the DRCB to ask for more funds from the Defence Ministry,” he says.
“Dissolve the boards”
Ms. Jadhav suggests that cantonment boards be dissolved, civilian areas be taken out of the Cantonment and brought under the administration of the Zilla Parishad.
Meanwhile, how the Zilla Parishad and the DRCB could be made to coordinate so that residents of the Cantonment could receive the services of something as basic as a PHC or an anganwadi remains an unanswered question.