‘Respondents also complained of getting only a few medicines'

On an average more than one third of the health services personnel was observed missing during duty hours in Primary Health Centres (PHCs) in Tonk district of Rajasthan according to a study. Absenteeism was as high as 36 per cent among doctors while in five categories of health service providers it was found to be 27 per cent on an average.

The study, conducted by CUTS International in partnership with Transparency and Accountability Programme (TAP) of the Results for Development (R4D), based in Washington DC, also found 69 per cent of respondents (citizens) complaining of either not getting any medicines or getting only a few.

The findings were presented in a State level dissemination cum advocacy meeting here in the presence of experts, policy makers and people's representatives including MLA Rao Rajendra Singh, Shyama Nagarajan, Health Specialist, and World

Bank Shiv Chandra Mathur, Executive Director, Rajasthan Health System Resource Centre and Priyanka Singh, Seva Mandir, Udaipur.

CUTS employed the PATP (Participatory Absenteeism Tracking Process), along with the Citizens' Report Card (CRC) tool, among 902 people served by 30 of the total 45 PHCs in Tonk to know their perception about the status of health service delivery. In the study, civic engagement and community monitoring aspect of National Rural Health Mission (NRHM) were kept as the central point.

In all, 900 unannounced on-spot observations were made for 35 consecutive days except on Sunday from August 2009 by 150 monitors selected from the catchment of the Primary Health Centre (PHCs), Om Prakash Arya, the Project Coordinator who presented the key findings, said.

George Cheriyan, Director, CUTS International, while presenting the overview of the project, said that absence of governance and

accountability was the major obstacle in the process of service delivery. One of the reasons behind absenteeism could be the poor infrastructure facilities in the area for the serving personnel, he noted.

The study observed that on average 12 per cent posts of health personnel in PHCs remained vacant. The unfilled posts ranged from 5 per cent in the case of male nurses to 25 per cent in Lady Health Visitors. The situation was of both service deliverers and the end users remaining unhappy and dissatisfied.

As for the end users, 44 per cent of the respondents were not found satisfied with health service delivery. As many as 47 per cent said they did not know about VHSC(Village Health and Sanitation Committee) while a whooping 82 per cent reported that they had no knowledge of any existing grievance redress mechanism. Thirty two per cent of them said they did not receive any cash assistance under Janani Suraksha Yojna (JSY).Thirty seven per cent complained of 24-hour delivery facility lacking in their PHC. Thirty four per cent said no one ever visited their home to know their health status.

The PHCs lacked facilities like clean drinking water and toilets. The study found that 30 per cent of the PHCs had either poor or no proper drinking water facility. A 10 per cent of the PHCs lacked toilets and 13 per cent, electricity. Perhaps to understand the level of satisfaction/dissatisfaction of the service providers one should consider theses findings of the study as well: 12.5 percent of them are unhappy with their jobs; 25 per cent of them complained of not getting leave on demand and 41 per cent pointed out that there is shortage of staff.


  • Study was conducted by CUTS International in partnership with TAP
  • ‘Absence of governance and accountability major obstacle in the process of service delivery'