In Bichhiya CHC Sangeeta W/O Deepkumar was brought at 7.00 AM as she delivered a baby at home at 5-5.30 AM and placenta didn’t come out. Hospital staff tried to call Nurse but after waiting for about half an hour Nurse would not come then Dai accompanying Sangeeta tried to take out placenta and she succeeded. CHC is the place of 24X7 with 30 bed facility and it is also a FRU (First Referral Unit) but if this is the situation who wants to take services from the facility. In January 2010 a woman died after half an hour of normal delivery without any complaint. That time also there was no expert available to look her.
When we visited CHC of Bichhiya on 15th May 2010 around 9.00 AM, a person examining OPD persons in chamber of Medical Officer. We want to talk him thinking that he is Doctor but we are reported that he is not the Doctor he was a retired Compounder Mr. Khan and the Doctor (Block medical Officer) Dr. Taksande was on leave due to death of his mother. Is it acceptable that we should leave villagers on mercy of god? Thus population of more than one and half lac (154815) of 196 villages is left without any authorized Doctor. In this block there are 7 PHC in 9 sectors and 44 SHC operational. The CHC is an old institute and has been working as Block PHC since 1935 and upgraded as CHC in 1980. Building of CHC
As per Govt. of India norms a CHC should have 15/16 doctors i.e., 2 specialists namely Anaesthetist and Public Health programme Manager will be provided on contractual basis in addition to the available specialists namely Surgery, Medicine, Obstetrics and Gynaecology and Paediatrics. The support manpower will include a Public health Nurse and ANM in addition to the existing staff. An Ophthalmic Assistant will also need to be provided in centres where currently there is none. One Ophthalmologist (MS-Ophthalmology) for every 5 CHCs is recommended in addition to existing provisions. One Dental Surgeon, 6 GDMOs, One AYUSH specialist and One AYUSH general doctor are also recommended in IPHS[1].
But MP Govt. sanctioned 5 posts of Doctors (1 BMO, 1 Specialist Gyanecologist, 1 Specialist Pediatrician, 1 PGMO Surgery and 1 PGMO Anaesthesia) for Bichhiya CHC[2]. But other than BMO all other 4 positions are vacant. Although one Dr. is transferred to CHC only one day prior this visit and he may join CHC in few days. But in absence of Gynecologist and Anesthetics, in case of emergency, a pregnant woman or case of obstructed labour will remain un operated and she has to go 40 km. to District Hospital Mandla. In such circumstances how can we think to reduce maternal and child mortality.
Although cleanliness in labour room of CHC was satisfactory but relatives accompanying pregnant women will have to maintain this cleanliness as they have to clean surface before and after delivery as well as to wash clothes and sheets used during delivery even when Sweeper and Aya are available at CHC.
In CHC there were more than one ward but male and female, both patients are kept in the same ward. Although there is an OT but in absence of gynecologist and anesthetics no cesarean section can be performed and OT is only used for LTT camps. There is one OT table available but it was found that that it is not an advanced operational table but a simple iron table. Focus lamps are also not available. In absence of incubator a local made baby warmer was kept in a corner of OT. Bulb of baby warmer is loosely fitted and cause damage to baby any time.
One PHC, Sijhoura, was also visited and the condition of that PHC was also not satisfactory. Position of doctor is vacant and there is only one ANM who has to conduct delivery. Although one LHV was also posted in the PHC but she was not providing services in PHC as she is a field duty LHV. According to other staff members of PHC she is always on tour and never works in PHC. LHV keep cheques of JSY at her own house and ask people to come her house to collect cheque of incentive of JSY, where people get cheques after several rounds.
Condition of delivery table in this PHC was also not satisfactory. Thus ANM conducts deliveries on floor. In this PHC position of Sweeper and Ward Boy was vacant and in their absence relatives of pregnant women have to clean labour room before delivery and other items used during delivery. In such conditions when community members contacted they reported that why we should opt institutional delivery when we have to maintain cleanliness in the institution and there is no expert. Thus they do not prefer institutional deliveries.
Sub Health Centre Rajo has 2 ANMs. In past, ANMs take services of Dai when she was getting remuneration of Rs. 100/- per delivery. But after stopping this honorarium Dai are not a helping hand in conducting deliveries. Cleanliness could also be not maintained without their participation. However Village Health and Sanitation Committee arrange Rs. 500/- per month for a worker who clean labour room but now a days this arrangement is also not working.
Above mentioned status of health institutions clearly indicates that how much it is difficult to achieve Millennium Development Goal 4 and Goal 5 i.e.,
Reduce by two‐thirds, between 1990 and 2015, the under‐five mortality rate
Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio
Reduce by two‐thirds, between 1990 and 2015, the under‐five mortality rate
Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio
Only 5 years are remaining to achieve these goals and in such circumstances it is quite impossible to attain these goals.
[1] http://mohfw.nic.in/NRHM/Documents/IPHS for CHC.pdf
[2] http://www.mp.gov.in/health/institution/sanctioned post-chc.htm
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