A 60-year-old woman washing soiled bedspreads and pillow cases at a hospital with bare hands would be shocking a scene. But this is what happens at most of the health centres in rural areas of Madurai district.
Though doctors at these centres are well aware of the health hazard of washing used bed linen of patients in such a manner, they are helpless owing to fund crunch.
Madurai district has 88 health centres - 30 Urban Primary Health Centres (UPHC), 13 Community Health Centres (CHC) and 45 Primary Health Centres (PHC).
The Karungalakudi block CHC in Melur taluk, which is one of the oldest health centres in the district, serves about one lakh people. But it is saddled with old building and equipment. It makes do with ₹5,000 it receives from the government for the overheads. “With only three beds in the maternity ward, no further improvements could be carried out in terms of equipment and other facilities,” says Block Medical Officer P. Shanmuga Perumal.
The CHC, with about 38 buildings, has only three workers and two Reproductive and Child Health (RCH) midwives. “As the workers are assigned various works such as registering outpatients, distributing medicines, assisting doctors, the works get delayed, causing inconvenience to patients,” he says.
They want an improvised labour ward and operation theatre to perform Lower Segment Caesarean Section (LCCS).
Dr. Perumal says, “Out of the 1,456 deliveries performed in a nine-month period till September of last year, 992 were normal and 464 LSCS - that is 1 LSCS for every three normal deliveries.”
“If the CHC is upgraded with an operation theatre for performing LSCS it will be very helpful for about 70% of the population from poor economic backgrounds as they need not have to spend on travel and other expenses. And the pregnant women need not travel all the way to private hospitals in Melur, Singampunari, Thuvarankuruchi and Natham,” he says.
As the fund alloted by the State government is meagre, they rely on funds from the Union government under LaQshya programme, under which funds are given annually or biannually to improve labour wards.
When the criteria for the grant includes proper compound wall, clean wards, spacious labour rooms, hygienic surroundings, a health centre cannot spend on all requirements with the bare minimum alloted by the State government to meet the assessment criteria.
Failed thrice
Looks are deceiving: Many of the PHCs in Madurai district look perfect from outside but many make do with bare minimum facilities, like this one at Mannadimangalam. | Photo Credit: R. ASHOK
When such is the case with CHCs, the PHC in Mannadimangalam near Sholavandam, which was established only in 2014, failed to get the grant for three consecutive years since it did not have a compound wall.
Assessments such as National Quality Assessment Standards (NQAS) and Kayakalp of the Central government, gives some funds to selected hospitals. A doctor at Mannadimangalam PHC says they could not get a good score as they were unable to meet certain criteria like safety and clean environment.
Works like modifications in building structure, buying equipment, etc., cannot be managed with the general fund, so they remain untouched. “Last month, a villager who mistook the PHC for a veterinary hospital brought his sick dog for treatment. On realising his folly, he left the sick dog to die there,” the doctor says.
These are things that cannot be glossed over as minor irritants as they reflect the problems at the macro level. “Shortage of medicines is a perennial problem in all health centres in rural areas. We are forced to compromise on dosage with the hope that it would somehow cure the patients,” the doctor says. If they completely run out of stock, their only option is to refer them to a nearby hospital which is about 10 km away.
The Mannadimanglam centre takes the credit of performing the most number of successful deliveries among all PHCs in the district. It can do better if sufficient health workers are posted, the doctor says. As the two to three health workers employed in every PHC are deputed for works like visiting villages for identifying sick people and for immunising people through vaccination camps, they are unable to handle all the chores to the desired level.
“This is the case with doctors too. As most of the PHCs have only one doctor, they find it impossible to attend to all the work. This leads to stress and other health issues for the doctors. If the government increases manpower, the efficiency of every PHC will certainly improve,” he says.
Moreover, many of the PHCs are in urgent need of a facelift. But, due to various issues, their pleas have been put on hold for years together.
Near a ‘kanmoi’
No compound wall: The Primary Health Centre building at Kanjarampettai in Madurai district is in an unstable condition as it is located on the fringes of a ‘kanmoi.’ | Photo Credit: R. ASHOK
Kanjarampettai PHC building which stands on a precarious condition near the bund of a ‘kanmoi’ witnesses water seeping into the building every now and then. The PHC, which serves over 48,000 people, is congested leaving no private space for doctors and patients. Pregnant women are accommodated with other in-patients, which increases chances of the women contracting infections.
A Health Department says the hospital should be prioritised in the list for a new building. But the government has instructed the doctor to find a land on his own for a building.
Essential equipment like Blood Pressure (BP) apparatus and Glucometer that were provided to the health centres are of inferior quality, requiring replacement every two months, says a staff nurse. “These defective equipment let us down just when go for field visits. We spend from our pockets to either replace or repair it. When we ask for reimbursement, the doctors blame us for not handling it properly,” the nurse says.
With shortage of funds and workers, the doctors play safe by referring pregnancy cases to nearby GHs. Proving their claim, a RTI report states that from January 1 to October 30, 2020 alone 14,291 pregnancy cases from 30 UPHCs were referred to Government Rajaji Hospital in Madurai.
Wnen contacted, Minister for Health and Family Welfare Ma. Subramanian says renovation works are being carried out based on a priority list and around 500 buildings for PHCs and Health Sub-Centres were constructed in the last two years. The Kanjarampettai PHC will be included in the priority list for this year, the Minister says.
Published - February 05, 2024 07:49 am IST
