Amartya Sen at the release of the health report prepared by Pratichi Trust in Calcutta. Picture by Amit Datta

Calcutta, Dec. 19: Non-functioning health centres, non-availability of basic services, reliance on private practitioners and a high proportion of quacks — the first report on health by Pratichi Trust, set up by economist Amartya Sen, highlights the deficiencies in the delivery of services in two districts.

The report assesses the condition of health services in Birbhum in Bengal and Dumka in Jharkhand. It also presents a comparative picture — by investigating the services received by people in 24 randomly selected villages from three blocks in both districts.

“The picture in Birbhum is that of considerable disquiet, but it’s worse in Dumka,” said Sen. “The scene in Birbhum presents a mixed picture. There are signs of good performance, but there are failures as well.”

According to the Nobel laureate, the primary problem is not financial, but organisational. That is why the non-functioning of the system despite budgetary allocations for the services, is a critical deficiency, says the report’s summary. The final report will be published in February and forwarded to the government.

“The government response to our education report was very positive and we expect the health report to be taken seriously,” said Sen.

According to the report, prepared after visits by the research team to block primary health centres, primary health centres in villages and sub-centres, only 11 of the 18 sub-centres in Birbhum were functioning. Only five out of 13 were working in Dumka. “The sub-centres, run by paramedical staff, have played a critical role in spreading medical awareness in southern states like Kerala and they have a big role to play in rural areas,” said Sen.

He, however, seemed satisfied with the findings from primary health centres. All the 10 were functioning in Birbhum, while out of nine in Dumka, two were shut and seven had “irregular openings”. But the “non-availability of services” like basic diagnostic facilities and “limited availability of medicines” in these centres was forcing patients to go to private clinics.

The research team found around 68 to 70 per cent of the sample population were going to private practitioners and spending around 17 per cent of the annual family income on private medical facilities. Highlighting the poor state of health service delivery, the report says around 29 per cent of the sample population was treated by quacks in Birbhum. In Dumka, the proportion was as high as 62 per cent.

“One of the peculiar features in both states is the neglect of some particularly important health services, such as immunisation and arrangements for child-birth,” says the report. Only 45 per cent of the children, in the age-group of 0 to 5, in Birbhum are fully immunised, while it’s zero in Dumka and 100 per cent in Kerala.