Public Health Facilities in Bundelkhand
By Government of India norms, one primary health centre (PHC)
should serve a rural population 30,000 people. Roughly, that means there should
be one PHC per 30 villages.
Census 2001 data showed that in both UP and MP, and all
Bundelkhand districts, the coverage was much poorer, with roughly one PHC per 50
villages in both UP Bundelkhand and MP Bundelkhand (see first table in Amenities
in Villages and Households).
The poor coverage was also seen when one uses rural
population of a district as the criterion. Using Census 2001 population figures
(see Current Population), one can see that one PHC served a rural population of
more than 50,000 in all districts of the region except Chitrakoot and Chhatarpur.
In Banda, one PHC served over 90,000 people - thrice the norm.
At the level of primary sub health centres (PSHCs), the
situation was terrible in UP Bundelkhand. While the region should have had over
1000 such centres by norms of the National Rural Health Mission for the region
(10 PSHCs per PHC ), it had only around 250; the situation was worst in Lalitpur
and Chitrakoot districts where there was only around one PSHC per PHC.
There is a gap even between sanctioned and completed
infrastructure. A plan made in 2006 by the Chhatarpur District Collector for the
Backward Regions Grant Fund (BRGF) disclosed that while 43 PHCs were sanctioned
for the district, there were only 33; buildings for 186 PSHCs were sanctioned
but there were only 56 on the ground [ District Collector, p 31].
These gaps were expected to be filled through BRGF, but even
after that happens, there would be an increasing gap between demand and supply.
Going by population growth trends, Chhatarpur needs to have at least 50 PHCs in
2010, according to Government of India norms (one PHC per rural population unit
of 30,000). The gap would be more pronounced at the level of more easily
accessible PSHCs: Chhatarpur would require around 450 such centres by 2010 , but
would have less than 200 even if the BRGF plan projection is met by that year.
(The assumption is that rural population of Chhatarpur, which was around 11.5
lakhs in 2001, would be around 14 lakhs in 2010. The National Rural Health
Mission norm for Bundelkhand is that one PSHC should serve a rural population of
In UP Bundelkhand, the gap between required and available
primary health sub centres would be staggering. Looking at the situation in 2001
(see first table in Amenities in Villages and Households ), the progress made
since then and population growth trends, it appears that by 2010, PSHCs in the
region would be, on an average, catering to 12,000 to 15,000 persons, against
the National Rural Health Mission’s norm of 3,000 persons for the region.
Infrastructure is only aspect of health service; the more
important aspect is availability of trained staff and adequate stock of
medicines. The situation in UP is dismal, and reflected in extremely poor usage
of government health facilities. A large `poverty and social monitoring’ survey
(PSMS-II) conducted jointly by the state’s Planning Department and the World
Bank in 2002-03 found that only 10% of people in rural areas who consulted any
medical practitioner went to a government health facility; the rest went to a
private sector doctor (35%) or a quack or traditional healer (55%) . Among poor
families in rural areas, the percentage was even lower (7%) [Directorate, p
Probably the most important reason for low usage is low staff
presence. Quoting a World Bank study, a `note on the health sector in Uttar
Pradesh’, prepared by the state’s Planning Department in 2005, reported that 40
to 45% of doctors in PHCs were absent on the day of an unannounced visit [Dept.
of Planning, p 14]. As it is, PHCs are few; a poor family living at a distant
location would be very foolish to risk expenditure of time and money for a visit
to a centre where the chances of the doctor being present are 1: 2.
As regards subhealth centres closer to villages, the vast gap
between minimum need and supply has already been mentioned. In UP much of the
supply is also incapable of dealing with acute illnesses and accidents ; many
sub health centres are manned by ayurvedic or homeopathic doctors with limited
and outdated medicine stocks.
The situation seems to be better in MP. A review of health
facilities in 2006-07 in 17 states, conducted jointly by representatives of
donor agencies and state officials, gave MP the highest rating with 12 points;
UP got 6. Among the criteria used was assessment of PHCs and observation of
sample health facilities [Dept. of Public Relations].
The rating does not tell us about usage of facilities. PSMS-II
data mentioned earlier and field observations indicate that 30-50% of rural
people of Bundelkhand who require medical attention consult traditional healers,
called vaidyas or vaidoos, and 'ojhas’ who claim to have powerful mantras to
drive away evil spirits that bring illness . A survey of 152 villages in
Tikamgarh block of Tikamgarh district done in 1993 found that there were 165
well-known vaidyas in the block. The vaidyas had little or no education, but
people had great faith in them; even sick animals were taken for treatment.
The survey also found there were 157 practising ojhas in the
block, who give mantras not only for illnesses, but also for realising desires
like having a male child or winning a court case; ojhas were even consulted for
recovering stolen property. Some ojhas, like one in a village called Chhipon,
claimed to get their powers on one particular day and a huge crowd gathered on
that day - in the crowd were many educated people too [Samarthan, p 41].
A few tantra-mantra practitioners have diversified and moved
with the times, in a manner of speaking. In Badhokar Khurd block of Banda, the
son of a famous mantra dispenser has a 'hospital’ exclusively for treatment of
mental illnesses, especially schizophrenia. Patients are observed in the
'hospital’ for many days or weeks and appropriate mantras are given. The
'hospital’ stay may have to be repeated or modified over the years. In 2007,
all-inclusive cost of treatment ran into several thousand rupees per week.
Demand was high and booking had to be done months in advance.
Such methods of cure, which may be called under the category
of faith healing, probably do work for a lot of people, and many vaidyas
probably have good knowledge of medicinal plants, but it is difficult to
distinguish between `genuine’ healers and rogues. Besides, the most common
illness in rural India, diarrohea, can only be tackled by adopting good hygiene
practices and simple home treatment methods; recourse to healers - or medicines
- will do no good.
In both UP and MP Bundelkhand, all systems of medicine fail
miserably at the stage of life when healthcare is most crucial: when a woman is
expecting and in the first year of an infant. This is reflected in mortality
rates (see tables in Health Indicators).
One basic problem is very low percentage of births in
hospitals (`institutional deliveries’) or at home with assistance of skilled
professionals. While 2005-06 National Family Health Survey data indicated that
72% of births in rural MP and 76% in rural UP take place at home with assistance
of relatives or traditional midwives, PSMS-II data indicated that among poor
households in rural areas of UP Bundelkhand, the percentage of institutional
deliveries was almost nil [Directorate, Table 22].
Another related problem is low presence of anganwadis, which
are supposed to provide `integrated’ care and supplementary nutrition to young
children and expectant mothers. PSMS-II mentioned earlier reported that over 60%
of rural households in UP either stated that there was no anganwadi in their
village, or they did not know of its existence. Only 10% of rural children in
the age group 0-6 years went to an anganwadi [Directorate, p 47].
The Chhatarpur BRGF plan disclosed that there were only 285
anganwadis in the district, against a sanctioned requirement of 891 [District
Collector, p 31]. The gap was proposed to be filled through BRGF funds. The plan
proposed that the anganwadi buildings would be 'multipurpose’ centres: the
buildings would function as panchayat bhavan; community centres, with play
equipment for children, and as `resource’ centres.
Public health sector performance is also very poor with
respect to prevention and control of contagious and infectious diseases. The
Chhatarpur BRGF plan noted that the district was `highly prone’ to filariasis,
elephantiasis and malaria. Malaria is also common in Panna, as mentioned in the
discussion on the Ken Betwa link plan.
The problem has to be obviously tackled at the more basic
level of sanitation and sewage disposal; the problem is extremely serious in
many urban settlements inhabited largely by poor families. Quite often, slums
are near dirty nalas or ponds choked with filth, making the inhabitants highly
vulnerable to malaria and diarrhoeal disease.
Urban poor face other severe health-related limitations.
While anganwadis are far and few in rural areas of UP, they are almost
non-existent in urban areas. According to an analysis of National Family Health
Survey (1998-99) data, across UP less than 30% of children of age 12-23 months
among the urban poor had received complete immunisation.
The analysis also showed that around 30% of children of the
urban poor reported diarrhea in the two weeks preceding the survey and around
20% of children suffered from acute respiratory condition, primarily pneumonia,
due to pollution and highly congested living conditions [Urban Health Resource
Centre, pp 39-43].
Congested living conditions also aggravate TB among adults,
and its high prevalence in urban slum areas of Bundelkhand has not received any
special attention (see Poor Widows).
Another problem that has emerged due to high seasonal and
annual migration is HIV-AIDS. High prevalence of HIV/AIDS cases has been
detected in Lalitpur, Banda, Chitrakoot by the National Aids Control
Organisation (NACO) and the Uttar Pradesh State Aids Control Society (Indian
Express, May 18, 2008). Till December 2008, there was not a single anti
retroviral treatment (ART) facility in the region.
Courtesy : bundelkhandinfo.org