Kerala - Thiruvananthapuram   

Health set-up under strain

Thiruvananthapuram: Local demands to augment services in many primary health centres (PHCs), which are expected to deliver only primary care, have been forcing the Health Department to pump in more money and valuable human resources to expand these facilities.

This in turn is playing havoc with the department’s efforts to create a network of hospitals which conform to the Indian Public Health Standards (IPHS), as envisaged under the National Rural Health Mission (NRHM).

There have always been gross disparities in the level of services offered in various categories of health care institutions as more than a need-based assessment, political and regional considerations play a key role in deciding the status of these institution. As a result of pressure exerted by local politicians, there are mini-PHCs and government dispensaries with in-patient facilities and more staff than community health centres (CHCs), which are supposed to serve a larger population and offer better health care facilities.

There are innumerable PHCs where the local bodies have constructed wards and new buildings for starting in-patient facilities. All this is done with scant regard to the fact that the Health Department is already over-stretched to provide necessary staff and infrastructural facilities to the institutions under it.

“A senior politician who visited Pozhiyoor in 2006 following the rape and murder of a child in the locality declared that in-patient facility would be started at the mini-PHC there, which had just one doctor and one nurse. A building had already been constructed by the local body. It was left to the officials to mobilise cots and mattresses from other hospitals for the new facility and to get an additional nurse on a working arrangement basis,” an official pointed out.

The IPHS was brought in under NRHM to standardise the health sector and to fix the level of minimum care that each category of health care institutions should provide. Under IPHS, in-patient facilities are only envisaged from the CHC-level upwards. There are about 104 government health care institutions in the district. Out of the 84 PHCs and (CHC), 40 institutions have in-patient facilities. The 18 CHCs in the district with in-patient facilities are slated for major upgrades in line with the IPHS.

However, the department and NRHM are now forced to pour in money to strengthen those mini-PHCs and PHCs where in-patient facilities currently exist. Public Health experts point out that this is a sheer waste of money and valuable human resource which could be better utilised to develop the nearest CHCs or taluk hospital so as to serve the same population.

Some of the PHCs and mini-PHCs in the district with in-patient facilities are Kattakkada, Tholikkode, Kollayil, Pallikkal, Perumbazhuthoor, Balaramapuram, Kadakampally, Kunnathukal, Kulathoor, Chengal, Paraniyam and Pozhiyoor, to name a few.

“The NRHM now has no option but to strengthen the IP facility in these institutions by providing additional resources and staff on contract, regardless of the category. We cannot discontinue facilities which already exist,” a senior official said.

Last week, the local people and politicians gheraoed the medical officer at Balaramapuram mini-PHC because the department had posted two out of the five nurses who were here to Poovar CHC, which has a shortage of staff.

Though 50 beds had been sanctioned for Balaramapuram recently, it has space only to accommodate 10 beds. Not more than 150 patients report at the OP daily. There are three doctors and five nurses here.

“There was only one in-patient at Balaramapuram. Hence we re-deployed two nurses from there to Poovar where the OP is heavy and where there are 25 in-patients. There was such uproar over this that we were forced to post the nurses back. We now have to find new staff for Poovar,” a department official said.

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