The report of 16 childbirths in ambulances in many parts of the state in the last three months portrays a good state of affairs in terms of emergency transport services,but also reflects the unequipped state of grassroot-level health institutions in handling deliveries.
During a recent meeting of the governing body of National Rural Health Mission (NRHM) chaired by Chief Secretary Rajwant Sandhu,it was discussed that of the 453 primary health centres in the state,72 per cent (326) did not handle a single childbirth from April to December 2010. District hospitals in the state,most of them catering to the rural population,are overburdened and handle the highest percentage (43.22) of deliveries. The reasons were attributed to the practice adopted by grassroot-level health institutions to refer a large number of cases to districts,mainly to avoid the risks involved.
Two medical colleges in Shimla and Tanda handled 21.96 per cent of child births in the state last year and only 19.92,11.78 and 3.12 per cent cases,respectively,were dealt with in civil hospitals,community health centres and primary health centres.
To ensure even distribution of responsibilities,the Directorate of Health Services was directed to define standard service levels and classify institutions for mandatory handling of childbirths,so that every referral case is supported by an explainable reason.
Talking to The Indian Express,NRHM Director Rakesh Kanwar said: We have decided to upgrade 25 more health institutions (75 at present) for handling childbirths and these will be evenly distributed across the critical areas. Twenty health institutions in rural areas this year will be equipped with blood storage units to handle emergencies. Muti-skill training of MBBS doctors in short-term courses of obstetrics-gynaecology and anaesthesia to handle deliveries has been proposed.
Another grey area is handling ante and post-natal care. Rationalisation seems the only alternative as 178 of the health sub-centres (HSC) are still without any health worker,even as their number (2935) is higher than the HSCs (2,071).
Himachal has not fared well in the past in institutional deliveries and its score was only 50 per cent till 2009. However,the rate has gone up to 62.92 per cent this year. The backward Chamba district has the lowest rate of 36.2 per cent,followed by Mandi (46 per cent) and Sirmour (52 per cent). Hamirpur and Shimla are on the top with 86 and 88 per cent,respectively.