HEALTH workers in Madhya Pradesh offered money from own pockets to try and meet sterilisation targets set earlier this month. One of them, in tribal-dominated Alirajpur, said he gave one person Rs 5,000, over and above the Rs 2,000 paid by the government. A health worker in Bhopal talked of desperately approaching labourers gathered at a square on the capital’s outskirts for work to convince them.
Alirajpur Chief Medical and Health Officer Dr Prakash Dhoke, who admitted that health workers resorted to such measures, is not surprised. The district saw all of six male sterilisations between 2015 and 2019. But, in the 10 days since a February 11 circular mandated that each health worker ensure at least one male sterilisation by March 31 or face loss of pay or job, it logged in 12 cases. The target the health workers in Alirajpur district were set was 693.
The Kamal Nath government has since withdrawn the controversial circular, following a report by The Indian Express, while blaming officials for it. National Health Mission’s state director Chhavi Bharadwaj has been removed.
Alirajpur has 27 multi-purpose health workers (MPHWs) to carry out its sterilisation drive. At a meeting of the District Health Society in the last week of December, they were told by officials to meet sterilisation targets or face punitive action. Officials said those 50 or older or who had completed 20 years in service were warned they might be the first to go.
Arvind Bairagi, 46, has been an MPHW with the Madhya Pradesh Health Department for 21 years, earning Rs 34,000. Alirajpur where he is based is a tough case for the Health Department as bigamy is common in the tribal district as are multiple children given the high rate of infant mortality.
Bairagi admitted that at his Malpur sub-centre in Bhabra block, he had been unable to convince even one man in six years to undergo vasectomy. After the circular came, he looked for willing men in villages around. When he couldn’t find any, he said, “I somehow convinced a government employee and offered him Rs 5,000. Jabran karvaya payment de ke (I got it done forcibly),” Bairagi told The Indian Express over the phone.
“A load lifted off my mind… Pressure was building for days,” he added, saying he had little choice.
Even after the government employee, who underwent sterilisation on February 19, accepted the money, Bairagi said, doctors had to reassure him that the operation would not affect his sex drive — a common fear believed to be behind the low rate of vasectomies in India despite it being the safest form of family planning.
Suresh Ajnar, another MPHW in Alirajpur district, said he could not get even one man to agree though he offered up to Rs 4,000. One reached the point of filling the consent form, Ajnar said. “But on the day of the camp, he fled to Gujarat, where he works as a labourer. I almost went into depression.”
Ajnar added that, but for the last few days, in his 21 years on the job he hadn’t been able to get a single man to undergo vasectomy. While he had better success with women, even getting them to agree to sterilisation in tribal areas was not easy, Ajnar said.
Said CMO Dr Dhoke, “Men think sterilisation will leave them ‘inferior’. Health workers run the risk of assault on the field.”
Dr Dhoke added that earlier too they had been set sterilisation targets, but this time formal orders were issued.
Ravi Kushwah, a 43-year-old MPHW in Bhopal, said that even in the capital city, meeting sterilisation targets was difficult. He tried his luck at the Karond square where up to 40 labourers queue daily for work.
Regional Joint Secretary, Madhya Pradesh Swasthya Karmachari Sangh, Vimlesh Khode said while the Health Department always reviews progress of the family planning programme, such a circular had never been issued.
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