Why is the government not appointing proper doctor and other medical staff in the district?
Answers
While India today is in the forefront of healthcare, and we often hear of health tourism being a great revenue generator, the vast majority of Indians, especially in the rural areas, today lack even the basic health amenities.
Even today "quacks" or "Docsaab", who are former compounders of doctors or even the compounder’s assistants, rule the roost in such areas. Those in the government setup largely ignore such "quacks" as they are regularly paid off to turn a blind eye to their activities. It is common to have a person walking into a clinic and asking for a drip because of "weakness". In a matter of 30-45 minutes, dextrose is pumped into that person alongwith injections of Avil and dexamethasone, he or she ends up paying some Rs 250 to 300 and leaves satisfied at having been treated well. Even the auxiliary nurse midwives (ANMs) and "dais" who are the "Doctorani" have well educated persons utilising their services for ante-natal services and deliveries.
Against this background of grassroots realities, the National Rural Health Mission may have been launched to remove the dichotomy in healthcare. As it stands even today, the NRHM could have revolutionised healthcare delivery in India and been a role model for all the Third World to emulate. But this is not the case.
The NRHM mission document states that "The goal of the mission is to improve the availability of and access to quality health care by people, especially for those residing in rural area, the poor, women and children." (1) It primarily aims to improve the following parameters: health, sanitation and hygiene, nutrition and safe drinking water. It seeks to provide to rural people equitable, affordable, accountable and effective primary healthcare.
Along with other national programmes like the Janani Suraksha Yojana, the NRHM can go a long way to improve the mother and child welfare parameters in the country. While the concept is utopian, given the ground realities in the country, it has become a milch cow for many to siphon off funds.
The NRHM workforce comprises accredited social health activists (ASHAs), auxiliary nurse midwives (ANMs), and multipurpose workers (MPWs) along with contract or "samvida" staff nurses, AYUSH (ayurveda, yoga, unani, siddha and homoeopathy) and allopathic doctors. There is a great emphasis on reviving the AYUSH system of medical treatment for which various measures have been incorporated into the mission.
The ASHAs form the backbone of the NRHM and are meant to be selected by and be accountable to the panchayat. There is no fixed remuneration provided for the ASHAs but it is assumed that they will be suitably compensated for their work through various schemes. They are to act as a bridge between ANMs and the village. They are to be provided with a drug kit including Ayush drugs for common ailments, worth Rs 1,000, which are to be replenished from time to time. The government has also allocated "total support of up to Rs 10,000 per ASHA for initial training, monthly orientation, drug kit, support material, travel expenses, etc. Rs 5,000 permanent advance may be made available to every gram panchayat as a permanent advance for performance based incentive for ASHAs and anganwadi workers (2).
In fact the ASHAs were selected by the government’s provincial medical service doctors for a consideration and legalised later by getting the panchayats to appoint them. Yet, even today no ASHA has a drug kit and so there is no question of these kits being replenished. Finally, funds are provided to the panchayats to transport patients to primary health centres (PHCs) but again these are siphoned off as most of the population is not aware of this and other facilities under the NRHM.