On a hill in Nandurbar’s Sinduri village, a lone two-room sub-centre assembled out of pre-fabricated fibre sheet has been standing since 2014. Wall scribbling by tribal kids and a poster of CM Devendra Fadnavis stuck by forest department are the only signs of human occupation. There are no beds, tables or medicines at the health sub-centre. A few hundred feet away, tribal Amshya Vasave lives with three children and wife. His youngest son Aakash has several boils, “bal-tod” as he calls them, but Vasave has to walk 35 km to Molgi rural hospital for treatment. “We never saw a nurse or doctor here. Villagers have stopped coming to this sub-centre,” he says.
A few kilometres away, another sub-centre built of fibre is idle in Manibeli village. Sarpanch Narayan Chima Tadvi says the structure has remained vacant since its construction. Of 21 such fibre sub-centres set up by the Maharashtra government in Nandurbar at a cost of about Rs 14 lakh each, 18 are non-functional. “The fibre structures get extremely hot during the day making it impossible to work inside. Even structures that were constructed were incomplete and require major repairs,” said Latika Rajput, from the Narmada Bachao Andolan. The NGO has raised the issue of non-functional sub-centres in district meetings.
Sub-centres in Nandurbar, in north of Maharashtra with over 60 per cent tribal population, are also grappling with massive vacancies – 200 out of 534 posts for auxiliary nurse midwife (ANM) and 75 of 223 posts for multi-purpose health workers (MPW) are vacant.
A sub-centre serves a population of 5,000 for basic health services such as immunisation, malaria and and fever treatment, besides ante-natal check-ups. Even as the Union health budget has a flagship programme of Rs 1,200 crore to convert 1.5 lakh sub-centres into health and wellness centres, with lack of medical staff and infrastructure, the government may have to do more than upgrading these centres. Nandurbar has 290 sub-centres, of which 270 have a building to function from. On paper, all 270 sub-centres are fully functional but analysis by Narmada Bachao Andolan shows 50 per cent of these sub-centres are shut across Nandurbar.
Forty km from Sinduri, in Khadkya village, a brick structure stands empty since its construction in 2012. Farmers now store hay on its roof and inside. Nobody calls it a sub-centre. Following its construction at a cost of Rs 8-10 lakh, the health department refused to take possession citing infrastructure problems. “Services could have started if health officials wanted, but they decided to keep the sub-centre shut,” says tribal Sitaram Valvi. Valvi walks three km to Son primary health centre (PHC) for treatment.
The empty Khadkya structure has no flooring, doors or windows. The construction of the toilet is incomplete. Six years after it was built, a budget of Rs 2 lakh has been allocated for its repairs for 2018-19. “We don’t know if it will ever function,” says another tribal Bhim Singh Valvi. He said, “At least the government should start basic facilities first. Sometimes when I don’t have money to travel, I can’t even take my child to hospital.”
In his budget speech, Finance Minister Arun Jaitley had said upgraded sub-centres will “bring healthcare closer to homes of people”. These proposed centres will provide comprehensive maternal and child facilities, neonatal care, screening and management for non-communicable disease such as cancer, hypertension and heart ailments, and basic geriatric and dental care. According to Professor T Sundaraman, dean of School of Health System Studies at Tata Institute of Social Sciences (TISS), each sub-centre will require Rs 17 lakh for upgradation, of which Rs 10 lakh will be provided in the first year. “By that logic, Rs 1,200 crore will only cater to 10,000-12,000 sub-centres in the first year,” Sundaraman says.
He adds that ANMs are easily available. In addition, ashramshalas in tribal areas can be used to train girls for the post, he says, adding, “The recruitment process is slow. There is a lack of efforts to fill posts in remote areas. It’s not an absolute problem, it is just misgovernance.” The state health budget this year has witnessed massive cuts. Analysis by Jan Arogya Abhiyan showed that public health budget has been reduced to Rs 8,705 crore in 2018-19, a cut by Rs 1,685 crore. The National Health Mission this year witnesses cuts by Rs 844 crore. An inspection by Community Based Monitoring (CBM) team in December last year found three brands of medicines kept after expiry date in Chitkhedi village sub-center. A complaint was sent to Directorate of Health Services. Locals claim this is common.
Dr Nitin Bodke, district health official in Nandurbar, said that the fibre sub-centres have been facing issues due to construction problems. “We are increasing funds in district planning committee for few sub-centres this year to upgrade them,” he said. In December 2017, in Chandsaili village, the district collector and district chief executive officer visited a two-room sub-centre. They found hay inside, but no doctor or ANM. The collector issued an order to paint the structure hoping it will encourage medical staff to attend the sub-centre. It has been painted white, but is still waiting for staff.