Ground report: With doctors missing, health centres used for playing cards and tying cattle

Barely 15 kilometres from Muzaffarpur, which hit the headlines this month for Encephalitis deaths, lies the village of Akbarpur. At least five children from Akbarpur and its adjoining villages died of Acute Encephalitis Syndrome (AES) in the past few weeks.

But the Primary Health Centre (PHC) a kilometre from Akbarpur and the Health sub-centre within the next one kilometre are both locked.

Says Rampukar Sah of Akbarpur, “The PHC shut down at least 10 years ago. There is a quack in the village but what can he do? Children of the poor are destined to die.”

Health centres were certainly constructed all over Bihar by Nitish Kumar. But most of the centres tell a similar tale and remain locked. Some are used to tie cattle while at other centres idle men can be seen playing cards.

At Muksudpur Health Sub Centre in Meenapur subdivision, one can see an impressive board with detail of timings and schedules when doctors will be available. But there is no doctor when we visit the place and residents say doctors are seldom available.

Dr Arun Saha is a well-known child specialist in Muzaffarpur. He was also part of the team that did research on AES with Dr Jacob John of CMC, Vellore. Dr Saha reiterates what others have already pointed out. That if children suffering from AES receive treatment within the first four hours after high fever and convulsions start, the chances of recovery are the brightest.

“But unfortunately, the PHCs are not working on the ground. Therefore, by the time the children are brought to the Medical College, it is too late,” says the paediatrician.

His words are echoed by Dr Kafeel Khan, who had hit headlines in Gorakhpur in Uttar Pradesh by arranging oxygen cylinders for dying children. He has set up AES screening camps in Muzaffarpur on his own initiative. “PHCs in both Uttar Pradesh and Bihar are not trusted by the people, it seems,” he added.

The irony is that both doctors and administrators know what needs to be done. Union Health Minister Dr Harsh Vardhan, when he visited Muzaffarpur, also declared that PHCs and Health Sub Centres needed to be strengthened. He stressed on community health and making glucometers and oxygen cylinders available.

The Standard Operating Procedure (SOP) to deal with AES, prepared in 2014, also laid down that every PHC should have glucometers. But clearly the SOP has not been followed.

Bihar does have an acute shortage of doctors. While WHO lays down the norm of one doctor for one thousand people, official figures maintain that there is in Bihar one doctor for 17,685 people. The national availability figure is one doctor for 11,097 people. A report prepared by the NITI Aayog also depicted a dismal picture of public health services in Bihar.

Yet another report brought out by an NGO, Jan Swasthya Abhiyan, claimed that the per capita expenditure on health per annum in Bihar was Rs 2047 in the year 2018. But the Government spent merely Rs 338. In other words, 82% of the expenditure on healthcare in Bihar is incurred by the citizens out of their own pocket.

Public Health expenditure in Bihar, it said, was the lowest in Bihar among 20 states studied. Dr Shakeel, who helped compile the report, says that the Bihar government actually spends just Rs 14 per person per annum on medicine. As a result, Dalits and Muslims, the poorest section of the population, are in a debt trap because they keep purchasing medicine by securing loans.

The failure of the ICDS scheme, ASHA and Midday meal schemes are also responsible for rampant malnutrition among children. Pramod Bhagat, whose three-year-old son died of AES, complained that he had taken his son to the hospital, where an injection was administered and he was asked to leave. While on the way back, the child breathed his last.

His brother also complained that Anganwadis do not provide nutritious food to the children. Most of the time the Anganwadi workers were on strike, he cribbed. An Anganwadi worker pleaded helplessness and blamed the government.

“We can serve the children what the government provides us. But if we don’t receive nutritious food, what can we do?”

She is also dissatisfied with the multiplicity of tasks given to Anganwadi workers while their honorarium remains a measly Rs₹5,500, that too fixed recently.

Cooks serving midday meal also get paid just Rs 1200 a month and that too is paid to them 10 months in a year. ASHA workers, after prolonged agitation, are now being paid Rs₹1000 a month plus incentives.

“When the government is not interested in taking care of the workers and ensuring their nourishment, how can we guarantee the nourishment of children,” quips Shashi Yadav.

No wonder the figures are dismal. 48% of the children in Bihar are stunted and 43.9% are underweight.

Md Yunus of the Federation of Anganwadi Workers points out that from January this year, the workers had been deployed on election duty. This is being cited as the reason why public awareness at the grassroots could not be developed before the outbreak of the epidemic this year.