Despite the change of guards in Bihar, twice, health sector and development issues in Bihar are deplorable. Here’s a report by Ashok.
Bihar lacks and is a one of the most deplorable states, when it comes to health sector and development issues in Bihar. Much needs to be done, if the state government really wants to mitigate the woes of the poor and needy, especially Dalits. It’s time for action rather than inept lip service.
Blood is one of the important requirements in complex medical conditions such as trauma, maternal complications, head injury, major heart surgeries, etc. In addition to this, 7-8 districts of Bihar lie in earthquake zone-4. In case of earthquake, blood is the most important requirement. The ailment such as dengue, which is very frequent in Bihar, requires blood components as well. One of the major causes of maternal mortality is Post-Partum Haemorrhage (PPH), which requires ready availability of blood.
There is no substitute to blood. Blood needs to be made available to the patient at the health facility. There are no blood banks in five districts of Bihar. The voluntary blood donation in the existing blood banks has only been 75%.As per the population of Bihar, around 15 lakh units of blood is required for the state on an annual basis. The total blood collected last year was 1.5 lakh units only. Hence, there is a huge deficit of close to 90% against total requirement of blood units. Therefore, it is required to strengthen the situation of blood banks in Bihar.
Requirement of Specialists at District Hospital/Sub Divisional Hospital DH/SDH is the secondary level care centres in the state. They are expected to provide specialised services such as C-section, trauma care, diagnostics, etc. and treatment of complex conditions such as appendicitis, hernia, clubfoot, cleft lip, etc. In order to provide these specialised services, specialist doctors are required at the district hospitals/sub divisional hospitals. However, more than 70% of the sanctioned positions for specialist doctors are vacant in the state. Some of the specialist doctors in positions are not placed at the primary level care centres rather than secondary level care centres. The estimated number of deliveries in Bihar is 30 lakh. Considering the all India averages, 1.5-3 lakh C-sections should be conducted in the state. But the number of C-section is around 30,000, which are much lower than the expected numbers. This has led to poor maternal mortality ratio in Bihar. According to available data, Bihar ranked 23rd in the maternal mortality ratio in India: 208 in Bihar against 167 in India.
Strengthening of Ambulance Service
Ambulance service plays a major role in providing critical care to the patients. During the times of distress, it is very important to reach the facility in the shortest possible time. Considering the geography of Bihar, accessibility has always been an issue in some of the hard to reach areas. The state has close to 900 ambulances whose total cost is more than Rs. 150 crore. As per World Health Organization (WHO) norms, one ambulance should be present for every one lakh population. Considering this, Bihar requires close to 1100 ambulances to cater to the needs of the entire population. Considering the deficit in the number of ambulances, it is even more important to run the existing ambulances properly.
Ambulance is not only a transport vehicle but a lifesaving unit. In addition to the vehicle, it requires trained technicians, trained driver and fully functional lifesaving equipment and medicines. There is deficiency of trained personnel for ambulances. Non-functional equipment and poor condition of existing fleet is adding to the already existing woes of this system. The centralised call centre is not in place which is creating a lot of operational problems. The efforts of the state to run this system in outsourcing mode have failed due to irregularities in payment and stringent terms and conditions.
Due to the improper functioning of ambulances, the institutional deliveries have dropped by around one lakh as compared to the previous years. This can eventually lead to increase in maternal and neonatal mortality rates in the state.
The Janani Bal Suraksha Yojana (JBSY) was launched on April 12, 2005, to increase the number of deliveries at the public health facilities. As a part of JBSY, the mother should receive Rs. 1400. As the cash assistance to the mother is mainly to meet the cost of delivery, it should be disbursed effectively at the institution itself. However, the JBSY payments have suffered huge backlogs in the state. Upon the emphasis of Hon’ble Chief Minister of Bihar in 2010, JBSY backlogs were cleared but it has again started to pile up. JBSY payments to over 75,000 beneficiaries were pending till November, 2015.
ASHAs have been recognised as one of the most integral part of the health system. There are more than 85,000 ASHAs in the state that interact directly with the beneficiaries. They do not get any monthly salary. They only receive activity wise payment for around 25 activities. It has been observed that in most of the areas, there is a lag of more than 3 months. Lack of timely payment has led to de-motivation and hence poor performance of these workers.
There have been delays in the payment of salaries to the contractual staff under National Health Mission. There is more than 25,000 contractual staff working under National Health Mission and the payments not being done on time has been an issue across the state. Considering the fact that a huge chunk of the workforce comes under National Hospital Mission, this may lead to de-motivation leading to lack of interest amongst these staff.
There are various projects such as radiology services, pathology services, bio-medical waste management, ambulance services, dialysis units etc. being run in Public Private Partnership mode/outsourcing in the state. To ensure the quality of service, it is very important to ensure timely payment to the service providers. It has been observed that even the payment conditions agreed in the contract document are not being followed in time. This is leading to legal disputes and unnecessary disruption in services.
Establishing canteens at District Hospitals through Jeevika & setting up Sulabh Sauchalaya
It is very important to provide healthy, nutritious and hygienic food to people visiting District Hospitals. Although there are provisions at some health facilities to provide free diet to the patients, it has not been implemented properly. Hence it is required to provide food at very nominal rate, easing burden on the patient and their relatives. This will also lead to increased convenience to outpatients and their attendants by providing food in the premises of district hospital. The setting up of these canteens can be decentralised to respective district hospitals, where the district hospitals might employ local workforce (with preference given to Jeevikas Self-Help Groups where applicable) and will set their own prices for food items. However, this will be conditional to these canteens providing a subsidised Thali of specified quality and quantity at least to patients and relatives. States such as Tamil Nadu have taken up a similar thing in the name of ‘Amma Canteen’.
Additionally, as a part of the Nischay scheme, the government envisages having a toilet at every house. Considering that, it is required to setup hygienic sanitation facilities to visitors of facilities – through setting up of Community toilets and Public toilets through tie-ups with organisations such as Sulabh International.
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Ashok Kumar Sinha is an experienced social activist working for empowerment of socially excluded groups through collectivisation processes, convergence and advocacy at micro and macro level. For 18 years, he worked on various social and environmental issues like food & livelihood security, health & nutrition, skill development, water & sanitation, renewal energy, child and Dalit rights. His expertise is in programme conceptualisation, development and planning, rights based and participatory approaches in development, capacity building, etc.