A YEAR after the ambitious health and wellness centre was launched under Prime Minister Narendra Modi’s Ayushman Bharat programme, newly appointed doctors at these centres complain of lack of infrastructure and equipment to provide essential health services.
In Nandurbar’s tribal belt, lack of accommodation, limited equipment to conduct clinical examination and poor electricity and water supply are some of the reasons that have forced doctors out.
Health and wellness centres (HWC) were announced in February 2018 with the aim of providing primary health care so that rural and tribal populations do not have to travel long distances. The Ministry of Health and Family Welfare announced 1.5 lakh HWCs by upgrading existing sub-centres that cater to a population of 5,000.
In Nandurbar, a tribal district north of Maharashtra, 269 sub-centres were shortlisted to become HWCs. But only 86 centres have doctors so far.
In Borwan village, BAMS (Bachelor of Ayurvedic Medicine and Surgery) doctor Gopal Badgujar started living at the centre soon after his appointment in April, hopeful that he will provide 24-hour health services to tribals.
In a two-room space with leaking roofs, he would sleep on an examination cot, waking up each time a patient came knocking at night, until he spotted a snake twice in the room. Five days after joining duty, he moved to the nearest town. The centre now operates from 9 am to 4 pm.
“There is no electricity or water supply. The septic tank is not working. The government wants us to be available there, but how can I live there?” he asked.
Badgujar, a Dhule native, said he wanted to serve tribals but lack of facilities made it hard to live at these centres.
In another case, 20 km down from Borwan, Dr Manish Patil uses his mobile phone’s torch to clinically examine throat and ears of patients at Patonda health and wellness centre.
“We were supposed to get head-torch and pulse oscillator for clinical examination. But nothing has come,” he said. The centre only got a new stool and a chair wrapped in plastic since it was upgraded into an HWC, he added.
Since March, when Patil was appointed, the patient load has increased by 30 per cent. “But we don’t have enough antibiotics. The purpose is to provide basic treatment here, but we have to keep referring patients to the civil hospital,” he said.
The government has sanctioned Rs 7 lakh for each HWC, but infrastructure still needs to be upgraded along with purchase of equipment.
“The state government has called for tenders to improve infrastructure. We have the funds, we will buy the equipment soon,” said Dr Nitin Bodke, District Health Officer, Nandurbar.
Each centre must have a doctor, auxiliary nurse midwife and multipurpose health worker, who will provide 12 essential services such as ENT (ears, nose and throat), maternal and childcare, screening of non-communicable diseases, yoga and basic health check-up.
But when The Indian Express visited the centres, yoga was yet to start patients were only being treated for cough, cold and fever.
Newly appointed Dr Vijay Karamkar left his hometown Nashik to join Nandurbar’s HWC. “I met several tribals in Nashik who said they need medical facilities. When I came here, I realised why doctors don’t want to work here,” he said.
His centre is in Vadfalya, on the hills of Dhadgaon taluka. The blood pressure meter and glucometer are not functional, and there is no haemoglobin meter. Of the 12 services Karamkar is supposed to provide, a lack of equipment has forced him to cater to basic cough, cold and fever cases apart from ante-natal care.
Lack of accommodation drives most doctors out of Nandurbar within months of joining. Bodke said advertisements to fill 285 posts for HWCs were published, but several refused to go for training when they were posted to Nandurbar. “We could only fill 86 posts. We are in the process of appointing new doctors again,” he said.