The condition of the sub-centre in Laharwari village, around 70 km from Delhi, is a good indication of the state of healthcare in Haryana’s Nuh district.
Sitting near the entrance of the building, two buffaloes leisurely chew their cud in the winter afternoon. Next to them, a clothes line with garments drying on it stretches across the gate of the sub-centre. To the right of the gate are two jhuggis where the family of Mohammad Younis, a daily-wager, live.
The 55-year-old is staying outside the sub-centre with his family, including eight children, after he was recently told to vacate the building, which had been illegally occupied by him for decades.
Mr. Younis said that he lived in the single-storey building for 33 years before the authorities asked him to vacate it three months ago. The building remained unused for over two decades before a nurse started visiting it five years ago, he said, adding that despite this they continued to stay inside.
“A nurse named Sonia visits the sub-centre once or twice a week. A couple of months ago, she asked us to vacate the building, so we settled outside it,” said Mr. Younis.
Dominated by Meo Muslims, Nuh is Haryana’s only district to figure in the Niti Aayog’s list of 111 most-backward districts of India. Poor performance on health and nutrition front is one of the reasons for the backwardness of the district, which ranks 30 on the list.
Major challenges
Family planning, child immunisation, nutritional status of women and children, and maternal and child health have been cited as major challenges in the area.
According to the National Family Health Survey-4, conducted by the Ministry of Health and Family Planning Welfare in 2015-16, only 15.5% people in Nuh practise family planning with just 2.6% using condoms.
Despite being aware of methods of contraception — through TV shows — 30-year-old Harish, who has four children, said he did not use any. Maksood, a truck driver, said his grandfather had 25 children, his father had 18 and he had only six. He offered this as evidence that there was no need to adopt means of family planning.
Laharwari Sarpanch’s father Shafi Mohmmad, a Haryana police sub-inspector, however, said there was growing awareness about family planning and the people were now keeping smaller families due to rising inflation and lack of job opportunities.
“Earlier, it was common for a family to have 7-10 children, but now it has come down to 4-5. And in some cases even 3-4,” he said, adding that more children were getting immunised and maternal care facilities had improved. He, however, said that several challenges still remained.
Lack of facilities
“The nearest Primary Health Centre (PHC) is in Punhana, around 6 km away. But there are only small facilities; there is no senior doctor and only a couple of nurses. They mostly refer serious cases to Nalhar, around 40 km, or Mandikhera civil hospital, around 25 km away. Those who can afford it prefer private hospitals in Hodal, or Alwar district in Rajasthan. The private hospitals charge thousands of rupees, so not many can afford it,” said Ramzan, a confectioner.
Shahzad (22), a painter, recalled how he had to rush his wife to Punhana around midnight three months ago when she went into labour. The staff there asked him to take her to Nuh. He then returned home and the baby was delivered with the help of an untrained dai (midwife).
Mr. Mohmmad pointed out that there were very few private hospitals in the area and the locals were dependent on government healthcare infrastructure. He said that “outsiders” were not interested in opening private hospitals in Nuh due to widespread poverty.
“Over the past few years, many local youth have procured MBBS degree and opened their hospitals in the area,” he said.
Dependent on quacks
In the absence of credible public and private healthcare infrastructure, locals have become heavily dependent on quacks, with at least 3-4 present in each village.
“They are of immense help in case of an emergency, especially at night. With the nearest PHCs at Nagina and Badkali being 6-7 km away, everyone rushes to the quacks in case of an emergency,” said Mohammad Arif (30), Sarpanch of Ganduri village.
He said that locals urgently need a healthcare sub-centre with round-the-clock doctor.
Hasan, a quack in Ganduri, said he took admission in a two-year Complementary and Alternative Medicine (CAM) course in West Bengal. He, however, admitted that he never attended classes. “I don’t even have the certificate,” he said.
The 36-year-old came to Nuh soon after completing his senior secondary school and settled in the village after learning the “art of medicine” from his elder brother, also a quack.
“I mostly treat patients suffering from fever, mild illness and piles. I attend to 8-10 patients daily. Two more quacks are operating in this village. Almost every village here has quacks,” said Mr. Hasan.
Staff crunch
Ganduri resident Nafis, who works as a lab technician in a private hospital in Bhiwadi, said that laboratory facilities and staff were not available at government hospitals, forcing the patients to get most of the tests done outside at exorbitant rates.
“Some tests are conducted and patients are told to visit again a few days later for the rest of the tests. Sometimes, they conduct a few tests and fabricate results for other tests. In my wife’s case, I found that they had given an estimate of cholesterol level without measuring it. I later got the test done at Bhiwadi, and the cholesterol level was found to be normal,” said Mr. Nafis.
With the delivery charges ranging from ₹6,000-7,000 in private hospitals, majority of the population here is dependent on government hospitals which lack proper infrastructure and staff.
Krishan Kumar, a physician at Al-Afia Civil Hospital in Mandikhera, said that lack of support staff and residential and other facilities for the doctors and their families were major challenges. Posted at the hospital over 10 years ago, Dr. Kumar said there were residential quarters for only eight doctors at the civil hospital. The rest of the 30 doctors were forced to reside in houses meant for Class IV staff.
“Also, there are no good schools for our kids here. Even drinking water is not available. This is the reason why doctors are not interested in being posted in Nuh,” he said. He claimed that he was not politically well-connected and therefore could not get a transfer outside the district.
Dr. Kumar said that the situation has improved a ‘great deal’ over the past five years, but there is still a long way to go. A woman gynaecologist has finally been hired on contract a month ago but there is no radiologist at the hospital, he said.
Poor nutrition
Shafiq R. Khan, founder of NGO Empower People, said the state of nutrition in Nuh was a major challenge and that widespread extreme poverty and lack of awareness about nutritious food were the two major factors contributing to the problem.
“Government surveys have revealed that a majority of pregnant women in Nuh are anaemic. Our own survey found that 40% women do not use sanitary napkins with many of them claiming that they do not feel the need for it. This shows the state of affairs,” said Mr. Khan.
He said the government could play a proactive role by creating awareness about the importance of nutritious food and improving the quality of mid-day meals served in schools. He added that water scarcity was also contributing to the poor nutrition with each household forced to spend ₹700-1,000 per month on water. Mr. Khan said that the district administration must take healthcare to the doorsteps of the residents by conducting its own health survey, providing enough iron and protein tablets, and holding special medical camps in villages.
He said the issues of poor nutrition and family planning were connected with large families failing to spend enough on nutritious food. The government was not focussing on propagating family planning methods in the region, leading to large families, which in turn adversely affected their financial status, he said.
Child marriage was also prevalent in the region and nearly half the women in the area were married before the legal marriageable age leading to early pregnancies and health issues, added Mr. Khan.
What officials say
Nuh’s Chief Medical Officer (CMO) Rajeev Batish conceded that the menace of quacks was widespread, but agreed that the problem existed due to the failure of the government to provide adequate health services.
He said that the administration had tried to initiate action against the quacks several times, but the villagers themselves were against it.
“In many cases, the villagers came to the administration demanding that no action be taken against the quacks,” said Dr. Batish.
He also agreed that several sub-centres and PHCs were actually encroached upon by the locals and in many cases the health department had to seek the help of the police to evict them. “I myself spoke to the Superintendent of Police to clear the encroachment in many buildings,” said Dr. Batish.
Nuh’s deputy CMO Lokveer Singh told The Hindu that lack of infrastructure and staff was one of the reasons for the poor state of healthcare in the district.
Mr. Singh said though Indian Public Health Standards (IPHS) mandated the need for one sub-centre for every 5,000 people, there were only 94 such centres in Nuh, against the need for 300. Similarly there were only 170 Auxiliary Nurse Midwifes in the district, against 600 required as per the standards. There are only 18 PHCs, against the need for 50, and only three Community Health Centres, when 12 are needed.
He also pointed out that there were several vacant posts of doctors, medical officers, staff nurse, multipurpose health workers, radiologists and lab technicians.
“The number of sanctioned posts is far less than the IPHS and still a large number of them are lying vacant. The situation was bad till a few months ago. Now the government has filled some of the vacancies after the district appeared on the Niti Aayog list. It has led to improvement in health services. Earlier, the immunisation rate was 13%, now it has come up to 47%,” said Dr. Singh.
