File picture of Daana Majhi carrying the body of his wife after being denied a hearse and relatives of a patient carry her on a cot to a hospital in Rayagada in the absence of ambulances. Picture by Ashwinee Pati
Bhubaneswar, Aug. 12: Another case of dengue death was today reported from the SCB Medical College and Hospital in Cuttack, while swine flu has already claimed nine lives in the state this year.
When the state is facing multiple health issues, a Bhubaneswar-based organisation, the Centre for Youth and Social Development (CYSD), has conducted a survey on the issue and challenges of primary heath care facilities in the two most backward districts - Kalahanadi and Balangir. The survey reveals how people are still not getting basic health services, including ambulance services.
The study was conducted in Balangir and Patnagarth constituencies of Balangir district and Narla and Junagarh constituencies of Kalahanadi district. The infamous Daana Majhi case that was reported last year, where Daana had to carry the body of his wife for nearly 12 kilometres after being unable to get the ambulance, was reported from Kalahandi district. In these four constituencies, a total of 37 primary health care centres have been selected by the organisation. The study covered primary health care centre, sub centres, villages and communities in these areas.
The expert team interviews 50 per cent of out patient department (OPD) patients visiting each PHC. The patients were selected on the basis of convenience and snowball sampling method. They were asked to share their satisfaction levels and experience at the primary health care centres. Total 370 patients (10 patients from each primary health care centres) were covered. Besides, the grassroots services providers - Accredited Social health Activists (Asha), auxiliary nurse midwives and anganwadi workers were interviewed on implementation of various government schemes.
They find unavailability of buildings as a major problem in imparting health care service to the patients. In absence of adequate and habitable staff quarters, it won't be possible to put a check on doctor absenteeism and 24X7 primary health care centres won't function smoothly. The primary health care centres need to be converted into 24X7 centres with in-patient department facilities.
Provision of safe drinking water and power back up (important in case of power failure during emergencies) are also major issues at the primary health care centres. The unavailability of diagnostic services and referral transport is causing a lot of difficulties for the people. While in some instances people are bound to pay higher prices in getting their medical condition resolved, in other cases, many are often showing lack of interest due to lack of money (thus, turning again to traditional healing methods or quacks).
The service providers also showed displeasure in many aspects. The doctors showed discontent regarding unavailability of staff quarters leading to daily commuting to the primary health care centres (few of them which are in remote areas).
Though medicines never run out of the stock and the quality of the medicine is good, the people don't trust the quality of medicines as they think that government medicines are free and therefore, might be of poor quality. In many cases, doctors allegedly prescribe expensive medicines that patient parties have to buy from outside.
Asha and auxiliary nurse midwives are the health activists in the community who create awareness on health and its social determinants and mobilise the community towards local health planning and increase utilisaton and accountability of the existing health services. But these service providers face various issues at the ground level, such as communication problem, excessive field area and too much workload.
The survey report also alleges that the Asha workers are losing interest and motivation to carry out their regular duties as they are not getting incentives at the right time. Some of them also remained absent on the MAMATA Divas which is held on the second Friday of every month. Due to this continuous absenteeism, the beneficiaries have started losing trust on Asha workers.
Another major issue is lack of ambulance facilities and the people depend on their own bikes and bicycle, to reach to hospitals. Lack of ambulance facilities often turn out to be fatal for pregnant women. The status of 102 and 108 ambulance services is in highly deteriorated condition and people have been grossly disappointed.
CYSD co-founder Jagadananad said: "The study is an attempt to understand the nuances of the primary health care services provided at the grassroots and to gather the perceptions of the community regarding the services like access to health, infrastructure, human resources."
Delivery in auto-rickshaw
A woman of Sunakhandi Tikarpada village in Kalyansighpur block of Rayagada district delivered a baby in an auto-rickshaw on her way to the hospital on Saturday. Her family members alleged that though they called the 102 ambulance service to rush her to Kalyansinghpur Community Health Centre after she complained of labour pain, the ambulance did not turn up.