Health subcentres in Gujarat shift gear as launch date nears
SEPT 23 Upgraded subcentres ready to offer primary healthcare and timely referrals, and take burden off the district hospitals
GANDHINAGAR/SABARKANTHA: How prepared is India for the nationwide launch of Ayushman Bharat on September 23? In Prime Minister Narendra Modi’s home state, Gujarat, the training of community health officers began in December, two months before the Budget announcement of the initiative termed ‘Modicare” by finance minister Arun Jaitley. And 26 health and wellness centres have quietly started providing primary healthcare since August.
The health sub-centre in Raslod village in the north-east district of Sabarkantha got a fresh lick of paint in July, and opened its doors to 4,200 mystified residents as a Health and Wellness Centre (HWC) on August 2.
Raslod’s is one of the 150,000 HWCS being set up by 2022 to offer primary care and timely referrals under Ayushman Bharat, which offers up to ~5 lakh health insurance cover per year for hospitalisation to 100 million poor families, with benefits expected to reach 500 million people.
The villagers still call it “sarkari dawakhana” (government pharmacy), but they have noticed that the upgrade is more than just cosmetic. “There’s a doctor there every day, and he has medicines,” said Mamtaben, 25, who passes by there twice a day while herding her buffaloes.
The “doctor” is community health officer Abid Mansuri, 32, part of the first batch of 26 community health officers (CHO) deployed to operationalise HWCS in Gujarat after undergoing a six-month bridge course in community health. Mansuri and CHOS like him are the backbone of Ayushman Bharat because correct and timely referrals are essential for the flagship programme to deliver on its promises. “Providing financial security for hospitalisation does not mean promoting health. Healthy well-being of India’s 1.04 million registered doctors of modern medicine work in cities of the population in rural areas is dependent on the public health system
is the average population nationwide for which the country currently has one doctor available in the public (government) health sector — as against the World Health Organization’s recommended doctor-patient ratio of 1:1,000
is the average population for which there is one doctor availbale in national capital Delhi — the best ratio in the country
is dependent on people not falling sick in the first place and that is possible only when comprehensive primary care becomes the foundation on which the health system stands. In the absence of that, it is like looking east to go west,” said Sujatha Rao, former secretary, ministry of health and family welfare.
HWCS will focus on health promotion and disease prevention and management. “The health sub-centres badly needed an upgrade to ensure patients are heard, counselled and given basic medicines and treatment to take the burden off primary health centres and district hospitals. It’s a move in the right direction, provided it’s implemented as conceived,” said Dileep Mavlankar, director, Indian Institute of Public Health, Gandhingar, which is offering the certificate course in community health designed by the Indira Gandhi National Open University in Gujarat.
Mansuri is the poster child of national integration. A resident of Ramayan village in Sabarkantha district, he graduated as a staff nurse from SM College of Nursing in Bangalore, worked as a staff nurse at the Pri- mary Health Centre (PHC), Kishangarh, in Aravalli district of Gujarat before volunteering to train in community health at IIPHG. “There’s a village called Mahabharat, too. Both were named after the popular TV serials in the late 80s. People find it odd because both villages are home to a large Muslim community,” he said.
On anaverage, HWC Raslod gets between 20 and 30 patients a day, “older people mostly coming in the morning and others at the end of the day,” said Mansuri. Apart from taking blood pressure readings and doing simple pinprick tests for malaria, diabetes and haemoglobin, Mansuri’s “bridge” course allows him to dispense over-the-counter medicines for fever and pain, and continue prescription medication after a Skype consultation with the medical officer at Bilasna PHC, 6km away.
He, however, cannot prescribe medication, change prescription treatment or give injections, which he is qualified to do as a staff nurse.
The doctor-patient ratio is heavily skewed in favour of urban areas. Of the 1.04 million doctors registered with the Medical Council of India or state medical councils in 2017, around 80% work in urban region. India’s 69% rural population is heavily dependent on the public health system, where the allopathic doctor-population ratio is 1:11,082, when the World Health Organization (WHO) recommends a ratio of 1:1,000.
Delhi is the best served, with one government doctor per 2,203 people, while Bihar is the worst, with one doctor for 28,391. Gujarat has one government doctor trained in modern medicine for a population of 11,475, as per National Health Profile, 2018.
Disease prevention, diagnosis, management and referrals will also lower complications and lead to fewer hospitalisations, lowering cost of treatment for both patients and the government. “Customising training and protocols for early management and referrals, such as for encephalitis or malaria in the endemic districts, will lower disability and deaths substantially. With funding and supervision, these health and wellness centres will be gamechangers not just for Ayushman Bharat but also universal health coverage,” said Tapasvi Puwar, associate professor, IIPHG. The blackboard was blank when we came to power for the first time. There was no governance. Even a small achievement looked big. Now people don’t compare this government with Lalu Prasad’s. They compare us with our first tenure. The perception problem is because of this. The image of the government got affected because of incidents such as the shelter home scandal and the topper scam. But people know the government is not involved, and there is not a single case where an accused has been protected. Governance was affected during the four years when the BJP was out of power. Now, it is getting back on the track. The BJP and the JD(U) (Janata Dal-united) are natural allies.the Lalu-nitish alliance was unnatural, and died naturally. It was always a challenge in Bihar because of land. The state has the highest population density in India and land holdings are small. Law and order, electricity or incentives were not the problem. Land will always remain a challenge in Bihar. We are promoting agro-based industry. No, there is a huge positive impact of prohibition. No government in future can afford to roll it back. Any government that will dare to reverse the decision will have to go. There is revenue loss, but crime has The impression about jobs is about getting a government job. They are limited. No country can absorb everyone in government. If you provide jobs to 70 people, there will be 30 others who will be left out. The way this government has taken up skill development programmes and self-employment promotion has never happened before. Job opportunities have increased over the last few years. The grand alliance crumbled in Bihar after Nitish Kumar joined us. The National Democratic Alliance (NDA) has 65% votes and the Rashtriya Janata Dal (Rjd)-led alliance has just 35%. Narendra Modi and Amit Shah have weaved a perfect social equation. The Scheduled Castes (SCS) and the Other Backward Classes (OBCS) account for 70% of population. They were not our traditional supporters, but they voted for Cognisance should be taken about the concerns and confusion among the upper castes. The SC/ST act is the mask -- the real issue is reservation. The upper castes feel it is eating into their job opportunities. Can the Congress say that it is against the SC/ST act? Chandrababu Naidu left the NDA because of local compulsions. Why would Nitish join us if allies had problem with the BJP? Some join, and some leave. It is a natural phenomenon. Some people also left the NDA during Atal Bihar Vajpayee’s government. Some of them returned. The JD(U) has said the discussion is going on in an amicable environment and it will be concluded soon.