Laying bare the poor condition of the healthcare system in Gujarat, the Comptroller and Auditor General of India (CAG) in a report, tabled in the Assembly Friday, stated that the maternal mortality rate (MMR) is on the rise in the state in the past three years. It also pointed out instances where women were found being transported in a “chakhra rickshaw (a vehicle for carrying goods)” after a cesarean section.
In its report on “General and Social Sector”, the country’s top audit watchdog stated that among 15 big states, Gujarat stood at a lowly 11th position “in terms of percentage of reduction of maternal death” between 2004-13. While MMR in neighbouring Maharashtra (which ranked 1) reduced by 49 per cent, in Gujarat it came down by 30 per cent.
Between 2013-16, however, MMR in Gujarat rose. “The state had achieved success in reducing infant mortality rate (IMR) and neonatal mortality rate (NMR). However, the MMR changed unfavourably from 72 in the year 2013-14 to 80 in 2014-15 and finally to 85 in 2015-16. Considering the pace and direction of achievement of the goals, it would be difficult for the state to achieve the target of 67 by March 2017,” stated the CAG in its report.
“In the three test-checked districts, the MMR was higher than the state average i.e Valsad (94), Dahod (93) and Surat (89),” it added, while auditing the Government of India’s Janani Shishu Suraksha Karyakram (JSSK) scheme that was focussed on reducing MMR, NMR and NMR in the states.
The CAG stated that the implementation of the scheme in Gujarat was “fraught with many deficiencies and gaps”. The auditor stated that despite Gujarat having 1,763 ambulances and 256 khilkhilat vans (used for free drop-back facility for post natal care of mother and infants since 2012), only 33 per cent of the beneficiaries were provided with free transportation.
In Latipur, the CAG observed transportation being provided to pregnant women through chakhra — a special rickshaw designed for carriage of goods in rural areas — upon a payment of Rs 250 per woman. “Transportation of women after delivery especially after caesarean section in Chakhra rickshaw was highly risky for the fresh stitches of operation due to constant vibrations,” it said.
The report also pointed out that against a target of converting 50 per cent of the Primary Health Centres (PHCs) into round-the-clock centres by 2010, the Gujarat government could operationalise only 323 out of the 1,334 PHCs in the state as round-the-clock PHCs (as on August 2016). “Resultantly, audit could not ensure healthcare facilities for pregnant women at door step as intended in the scheme,” the report stated.
Even in the operational round-the-clock PHCs, the CAG found inadequate facilities like lack of labour room, new born care centres, ambulances, ultra sonography tests, operation theatres and drop-back facilities. The auditor also found that the in 60 per cent of the cases the mother and the new born baby were discharged before 48 hours of delivery and were thus “deprived of post delivery treatment which could cause complications for both.”
The CAG also found shortcomings in storage of drugs, availability of blood, supply of free diet and diagnostic facilities being provided under the JSSK scheme.