Your SlideShare is downloading. ×
0
Health care- Bihar & UP 2012-Dr Shyam Ashtekar
Health care- Bihar & UP 2012-Dr Shyam Ashtekar
Health care- Bihar & UP 2012-Dr Shyam Ashtekar
Health care- Bihar & UP 2012-Dr Shyam Ashtekar
Health care- Bihar & UP 2012-Dr Shyam Ashtekar
Health care- Bihar & UP 2012-Dr Shyam Ashtekar
Health care- Bihar & UP 2012-Dr Shyam Ashtekar
Health care- Bihar & UP 2012-Dr Shyam Ashtekar
Health care- Bihar & UP 2012-Dr Shyam Ashtekar
Health care- Bihar & UP 2012-Dr Shyam Ashtekar
Health care- Bihar & UP 2012-Dr Shyam Ashtekar
Health care- Bihar & UP 2012-Dr Shyam Ashtekar
Health care- Bihar & UP 2012-Dr Shyam Ashtekar
Health care- Bihar & UP 2012-Dr Shyam Ashtekar
Health care- Bihar & UP 2012-Dr Shyam Ashtekar
Health care- Bihar & UP 2012-Dr Shyam Ashtekar
Health care- Bihar & UP 2012-Dr Shyam Ashtekar
Health care- Bihar & UP 2012-Dr Shyam Ashtekar
Health care- Bihar & UP 2012-Dr Shyam Ashtekar
Health care- Bihar & UP 2012-Dr Shyam Ashtekar
Health care- Bihar & UP 2012-Dr Shyam Ashtekar
Health care- Bihar & UP 2012-Dr Shyam Ashtekar
Health care- Bihar & UP 2012-Dr Shyam Ashtekar
Health care- Bihar & UP 2012-Dr Shyam Ashtekar
Health care- Bihar & UP 2012-Dr Shyam Ashtekar
Health care- Bihar & UP 2012-Dr Shyam Ashtekar
Health care- Bihar & UP 2012-Dr Shyam Ashtekar
Health care- Bihar & UP 2012-Dr Shyam Ashtekar
Health care- Bihar & UP 2012-Dr Shyam Ashtekar
Health care- Bihar & UP 2012-Dr Shyam Ashtekar
Health care- Bihar & UP 2012-Dr Shyam Ashtekar
Health care- Bihar & UP 2012-Dr Shyam Ashtekar
Health care- Bihar & UP 2012-Dr Shyam Ashtekar
Health care- Bihar & UP 2012-Dr Shyam Ashtekar
Health care- Bihar & UP 2012-Dr Shyam Ashtekar
Health care- Bihar & UP 2012-Dr Shyam Ashtekar
Health care- Bihar & UP 2012-Dr Shyam Ashtekar
Health care- Bihar & UP 2012-Dr Shyam Ashtekar
Health care- Bihar & UP 2012-Dr Shyam Ashtekar
Health care- Bihar & UP 2012-Dr Shyam Ashtekar
Health care- Bihar & UP 2012-Dr Shyam Ashtekar
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×
Saving this for later? Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime – even offline.
Text the download link to your phone
Standard text messaging rates apply

Health care- Bihar & UP 2012-Dr Shyam Ashtekar

1,097

Published on

This is my brief pictorial personal account on rural health care in Bihar (5 districts) & UP (one district) done in Oct 2012-the ground situation and challenges.

This is my brief pictorial personal account on rural health care in Bihar (5 districts) & UP (one district) done in Oct 2012-the ground situation and challenges.

Published in: Health & Medicine
3 Comments
0 Likes
Statistics
Notes
  • Malaria Microscopes in India
    Only @2799$
    Contact:- malariamicroscope@gmail.com
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • The question is not why we start such and such programmes ... but ... why after so many repeated studies after 66 years of independence we end up faulting in implementation simply by choosing not suitable personnel selectively either intentional or unintentional
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • eye opener account indeed. In bihar, drugs are not being purchased at the state level, most doctors also do private practice and there is no public health person at district level. Civil Surgeon is also DHO and there are hardly any Deputy Health officers. I wish you should have made observations on IEC and trainings/procurements as well.
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • Be the first to like this

No Downloads
Views
Total Views
1,097
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
16
Comments
3
Likes
0
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide

Transcript

  • 1. Bihar & UP Bihar & UP Some Glimpses the Rural Public  Some Glimpses the Rural Public Health System  And Some Hard Core Issues d d by Shyam Ashtekar by Shyam Ashtekar (An unplanned personal visit in Oct 2012)Tuesday, October 30, 2012 1
  • 2. District HospitalBihar‐the typical District Hospital. Shortage of  DH in Koshambi (80 km fro m Allahabad) UP‐This  ( )doctors and nurses is writ large on each hospital!d d i i l h h i l! district hospital has no gynecologist for last 6 months!Tuesday, October 30, 2012 2
  • 3. Hospital Wards Typically, Bihar hospital wards are barely livable!  Empty wards in Koshambi’s CHC in UP: where are all Tattered mattresses, rickety cots, torn bedsheets,  y the JSY admissions? (But I am sure other CHCs will have  (cleanliness are all there to see! wards full of JSY cases)Tuesday, October 30, 2012 3
  • 4. A delivery room A delivery roomPathetic scene of a delivery room in PHC, with broken del table‐ Bih P i ith b k d l t bl Bihar‐Purniya In Karari In Karari UP • I did not photgraph a labour room  here, since a mother was there  with her baby! • May be she had delivered here  just an hr before! • All the equipment was out of  work. The Pvt Dai conducted the  work The Pvt Dai conducted the birth , in presence of a nurse &  ASHA! Birthing is treated as dirty  work and the safai –after is called  naraksafai! • ASHAs from ‘good’ families have  already left their work! But Dai is  still there! (why did we start the  ASHA program at all?) ASHA t ll?)Tuesday, October 30, 2012 4
  • 5. Efforts to improve the system! p yOne of the better DH‐‐ in Purniya dt, Bihar  (they have a color code for bedsheets from Mon to Sunday! And it  ywas followed!)  In Purnea district city In Purnea district city • There is 2 km road from Purnea station which is full of Pvt hospitals, clinics, medicine shops,  hospitals clinics medicine shops labs and may be touts! • The district Hospital marks the  end of this Pvt Health bazaar!  Patients from surrounding blocks  and districts plus from Nepal  come here for treatment! • It is said daily wage in this district  It i id d il i thi di t i t is around Rs 25/ but there are  also people who can pay.Tuesday, October 30, 2012 5
  • 6. Medicines in public hospitals p pA generic shop with 50% price in Katihar DH Bihar and below a List of available generics in Bihar Medicine shortage • However, in Koshambi district, medicines were in  short supply, in Karari block  mini PHC only paracetamol was available as the MO  was available as the MO told me! The CHC  pharmacist also repeated  the same!  th !Tuesday, October 30, 2012 6
  • 7. OPDs & doctors OPDs & doctors UP‐At 12 o’ clock a homeopath came  to ‘dispose’ an OPD in a Bihar PHC OPD..a crowd of 15 patients in the room..this is  p common• I did not photograph an  OPD in Bihar, but a doc in  PHC told me he attends 400  patients everyday with 1‐2  AYUSH docs to help! So he  AYUSH docs to help! So he must also be seeing a  crowd! Plus has 10 JSY  deliveries to attend daily!  d li i t tt d d il ! (this must be verified)Tuesday, October 30, 2012 7
  • 8. The neat looking PHC in Vaishali district, the queue is  The neat looking PHC in Vaishali district the queue is for JSY cheques!Tuesday, October 30, 2012 8
  • 9. In PMCH patna In PMCH‐patna• I saw pathetic conditions in the PMCH (Patna Medical  College Hospital), with crowded wards and few doctors,  unmanageable conditions! Friction is common in this  PMCH where all of Bihar patients have to come if they  PMCH where all of Bihar patients have to come if they cant find help in districts! Bribes and attacks are –they  say‐common in PMCH!Tuesday, October 30, 2012 9
  • 10. Problems about Govt doctors! Problems about Govt doctors!• The regular doctors in Bihar are permitted to do Pvt practice! So it is official to stay away and work in pvt as  i ! S i i ffi i l d ki per convenience! I heard an anesthetist comes once a  week for his CHC duty. Also, a Pvt doctor told me every  Govt doctor has to pay the MOH/CS monthly as a  d h h / hl ‘retainership’ no matter what you do! Salaries are paid  irregularly, sometimes not paid even for months  together! h• The On contract doctors—difficult to get in the first  p place—are also unwilling to work because of poor terms  g p of pay etc.• The conclusion‐both are cribbing and do not work  wholeheartedly!Tuesday, October 30, 2012 10
  • 11. JSY beneficiaries JSY beneficiariesLong queues are common for JSY cheque of 1400/‐ may  gq q y UP‐JSY payment is beset with frauds, be this is all that is institutional about delivery! is it increasing quality of care? is it increasing quality of care?Tuesday, October 30, 2012 11
  • 12. RSBY scandal in Bihar! RSBY scandal in Bihar! Such minimum set ups of illegal doctors  also The apparently pro‐people  misused the RSBY harvest! 46000  hysterectomies in Bihar alone. And still counting hysterectomies in Bihar alone. And still countingscheme is in for heavy misuse!scheme is in for heavy misuse!Tuesday, October 30, 2012 12
  • 13. The JSY transport! UP bought the ambulances but they are still stranded in 102 In use in Bihar, this is quite useful in Bihar  the scandal, so mothers are mostly brought on and good roads have made it comfortable d d d h d i f bl motorbikes by ASHA husbands at a rate of Rs100 one  t bik b ASHA h b d t t f R 100 way!Tuesday, October 30, 2012 13
  • 14. In Koshambi UP, to get this 1400 Rs cheque after  delivery, she has to spend some 500‐700 as follows:  Dai  100 150, mobike transport, medicine purchase,  trip to   100‐150 mobike transport medicine purchase trip to health center with ASHA, small sum to the baboo! The  ASHA is unwilling to spend on transport.  In Bihar they  have the van!Tuesday, October 30, 2012 14
  • 15. ASHAs Pilot project for using mobile platform for The ASHA facilitator says  health education. UP is expanding such a everything is on paper!everything is on paper! scheme now! h !Tuesday, October 30, 2012 15
  • 16. ASHA as ‘agent’ ? g I heard some ASHAs have been used by ANMs to ask the JSY mother to  y cough up some money for issuing cheque or even take turns as a fake case!  Photographs are now made compulsory for JSY cheque. I saw  photographers working in the hospitals to produce photos for attachment  to the application. to the application Newspapers have printed this news in UP. One ASHA I met was apprehended by karyakartas for coercing JSY mothers. ASHAs are vulnerable to all such blackmail.Tuesday, October 30, 2012 16
  • 17. ASHAs The CTY workers say that 80% of ASHAs  are  non0literate with a farji certificate (must be less!), but Not all ASHAs earn even 1000 a month  they are only good for  JSY and teekakaran! People  will  y yg pfrom JSY, many of them cant read !f JSY f th t d! necer take medicines from them!Tuesday, October 30, 2012 17
  • 18. ASHAs talk of their woes, too much  work and little pay (what is the stat?) k dl l ( h h )ASHAs (in white sari) in a Bihar  ASHA in Karai‐Koshambi UPPHCTuesday, October 30, 2012 18
  • 19. ASHA which way to go? ASHA‐‐ which way to go? ASHA will educate about child health IN UPIN UP in UP; has its own version of IMNCI in UP has its own version of IMNCI• Some say most ASHAs are not  even literate!• In bothUP and Bihar, ASHAs told  In bothUP and Bihar, ASHAs told me they never got that regular  dava peti, but occasionally some  medicines!• But mobile phones can help even  But mobile phones can help even in this situation!• IMNCI program has been added  to their tasks!• In karari block, the CRY statistics  suggests IMR t be about   (Koshambi is a backward district  near Bundelkhand)Tuesday, October 30, 2012 19
  • 20. AnganwadisBihar‐Poshahar is a point of  UP‐No poshshar for last 3 conflict and corruptionconflict and corruption months (Oct 2012) months (Oct 2012)Tuesday, October 30, 2012 20
  • 21. SubcentersChrnoic Staff shortage leading closure of subcenters, subcenters Many SC in UP are closed Many SC in UP are closedThis block has27 subcenters but no ANM to staffTuesday, October 30, 2012 21
  • 22. Both in UP & Bihar, having 4‐5 children  in families is a common feature! f l fA young mother in BiharA young mother in Bihar UPTuesday, October 30, 2012 22
  • 23. Malaria is endemic, but it is for  informal doctors to treat! i f l d t t t t!Ubiquitous water bodies make malaria endemic  Malaria yes, but ASHAs don’t in Bihar‐ASHA don’t have even chloroquini ih d ’ h hl i have even chloroquin! have even chloroquin!Tuesday, October 30, 2012 23
  • 24. Development Bihar has no electricity for 20 hrs a day, and some districts do only with  a sole CFL bulb Pvt generators! A symbolic lantern at 8 pm in Purniya villages! I saw  y p y g Villages in eastern UP are still very poor! similar situation in Hazipur next to Patna! Electricity is missing 20 hrs a day! El t i it i i i 20 h d !Tuesday, October 30, 2012 24
  • 25. RoadsTuesday, October 30, 2012 25
  • 26. This 2 year boy (Akhilesh is his name) from a Koshambi village has chronic suppurative ear infection ‘since birth’  as the mother says! But no one has really told her to seek  higher care of an ENT surgeon! I gave her a chit to seek  help ENT section of the Allahabad medical College  help ENT section of the Allahabad medical College Hospital. The father has lost his hand in a fodder machine  and has no employment. The mother has to work and  take care! I asked about ASHA’s help! She says she is only  for money from pregnant mothers!Tuesday, October 30, 2012 26
  • 27. Where Does  ASHA program go from here? After 7 years of NRHM, it is now clear  te yea s o , t s o c ea that Pvt informal doctors could not be  eased out and ASHA has been reduced  to a largely non‐medical role of fetching  l l d l l ff h cases and gathering children for  teekakaran! Many ASHAs are not literate and can  hope to play any bigger role in the  p p y y gg politics of health care! A dai could have  been more effective for JSY and thru  transit support! t it t!Tuesday, October 30, 2012 27
  • 28. ‘Informal’ doctors!Medicine counters are a euphemism for untrained  Every village in this district has 1‐2 untrained doctors‐common doctors in Bihar‐doing valuable public services in Bihar  scene in UP. Villagers bank on them and will even protect them that faces shortage of trained  doctors. I counted 10  from action! In the 25 villages of the karyakartas, all but one had a suchmedical counters in one Bazaar in the Kumarkhand counters in one Bazaar in the Kumarkhand doctor or two (4 were women). All Zola Chaap docs  have  doctor or two (4 were women). All Zola Chaap docs haveblock..there are many such bazaars every 5‐7 km  mobikes.distance! All of them were busy  when I met themTuesday, October 30, 2012 28
  • 29. SKY clinics of WHP in Bihar! SKY clinics of WHP in Bihar!WHP is trying to improve the ‘informal’ doctors with teleclinic network, however the numbers and coverage  gis small! Inside the sky clinic run by WHP! Inside the sky clinic run by WHP!Tuesday, October 30, 2012 29
  • 30. Good Schools but teachers not good  enough, so bihar is  g g Schooling conditions in UP are pathetic, most full of pvt coaching classes even in villages in Purniya! teachers on contract and  dilapidated bhavans ! h d dil id d bhTuesday, October 30, 2012 30
  • 31. RoadsGood Roads everywhere will pave way for more development! Made a big difference to girls goingto p g g g g PMGS roads connect most high schools villages  villagesTuesday, October 30, 2012 31
  • 32. Tuesday, October 30, 2012 32
  • 33. Even after CMO deaths in NRHM in UP, political  pressure is telling! How do doctors work in such  situations?Tuesday, October 30, 2012 33
  • 34. I was told that this Koshambi district has about 2000 gun licenses. I saw  two karyakartas carry their guns. A kartoos costs about 300‐500 apiece.  There are many unlicensed guns too. The people are used to terror.  Who will govern and how? The very next district has the famous  g y RajaBhaiyya as  UP’s imp  minister.Tuesday, October 30, 2012 34
  • 35. Summing up (1) g p( )Bihar! UP• Bihar has just woken up after  • UP enjoyed a better access  d b 2‐3 dark decades,  and development than  development is slow.  Bihar, but faltered on health  Corruption and power deficit  C ti d d fi it are two major problems! system development• Health care is hit with poor  • NRHM scams have  infrastructure, scant and  i f t t t d tarnished its image further t i h d it i f th unhappy staff and abysmal  • 1 PHC for 1lakh pop! conditions!• 1 PHC f 1 l kh l 1 PHC for 1 lakh plus pop • JSY has brought the crowds JSY has brought the crowds • JSY and free medicines have  to public hospitals, but is  brought back poor patients to  that all? health centers! health centers!Tuesday, October 30, 2012 35
  • 36. Summing up (2) g p( )Bihar! UP• Big Pvt sector and countless  • The RH/CHCs buildings are The RH/CHCs buildings are  ‘informal’ doctors have made  better than Bihar, but doctors  it difficult, but people bank on  arrive late. them!  them! • Pvt doctors and informal doctors and informal • RSBY is reportedly a scanda! providers have infiltrated deep  into each village.• ASHAs are merely into JSY &  teekakaran, and nasbandi , • RSBY  is a scandal too.• No one can solve the  • ASHAs are merely into JSY &  complaints! teekakaran, but some kind of  HBNC is being rolled out!• Doctors unwilling to join, poor  pays and awful working  • No one will heed to No one will heed to  conditions.  complaints• Corruption and governance  • Corruption and governance  problems! problems!Tuesday, October 30, 2012 36
  • 37. The Questions are.. The Questions are..Where do we begin health reforms?• Training more doctors and nurses?• Banning Informal doctors? Or thru their inclusion?• CBHM? RSBY?• Child survival?• Governance?  G ?• Free medicines?• Increasing fund supply? Increasing fund supply?• what  is the period of framework?• Is NRHM helping—is it the right prescription? p g g p pTuesday, October 30, 2012 37
  • 38. MANY PEOPLE ARE TRYING TO  MANY PEOPLE ARE TRYING TOIMPROVE THESE SYSTEMS, AND THERE  IS SOME CHANGE!  BUT FOR A REAL UHC IT IS INDEED A  BUT FOR A REAL UHC IT IS INDEED A LONG WAY TO GO FROM HERE!Tuesday, October 30, 2012 38
  • 39. UNFORTUNATELY MANY OF OUR STATES ARE IN THE SAME LEAGUE!  ARE WE ON THE RIGHT TRACK? ARE WE ON THE RIGHT TRACK?Tuesday, October 30, 2012 39
  • 40. Personal NoteI have been associated with the NRHM and ASHA program for some years now, and with health workers for over two decades right from the CHW  k f d d i h f h CHWscheme!  For two years I also participated in the Common Review Mission! This 2012 tour was more of out curiosity to know the ground realities after 7 years of NRHM  in Bihar and UP. I have toured UP years of NRHM in Bihar and UP I have toured UPearlier. In 2008. This is not a systematic fact finding mission, there was no sampling, no enquiries with officers  or ggetting the stats!  This is not the whole truth! I  grespect men and women who are working for  On a boat ride on the Kosi river in Purnea!change in these conditions!I toured 4 districts in the Kosi region in Bihar‐katihar, Madhepura, Purnea, Shupaul And then Vaishali near Patna! In UP I visited only one district. I took the travel funds from  our trust‐BharatVaidyaka sanatha! Friends from UP & Bihar helped, mainly AmulyaNidhi and his network!Tuesday, October 30, 2012 40
  • 41. Dr Shyam Ashtekar y 26 October 2012 shyamashtekar@yahoo.com 09422271544Tuesday, October 30, 2012 41

×