The Primary Health Centre in the small village of Chirai, Varanasi has a serious simian problem; monkeys have settled down on its roof and are terrorising the occupants and nearby residents. “Oh, they are a big problem. If you’re walking by with anything to eat or drink, they snatch it out of your hands. Really, they will grab anything that you’re holding,” says Rajkumar, a shopkeeper in the area. This monkey problem is more serious than just a few lost plates of food. “They’re very strong and smart; from shopkeepers to patients, everyone is sick of them. They even bother the newborns in the delivery wing.” he adds exasperatedly. “If we leave the door open in the ward the monkeys come inside. They’ve already come inside three, four times,” explains Laalmani, a member of the nursing staff, as she double-checks the shut door of what functions as the delivery and emergency ward of the PHC. The biggest fear is a baby getting snatched. “It will be terrible if a monkey comes in and snatches a baby,” says ASHA worker Reena, “They’ve already bitten a few people in this block, they’ve had to get injections.” But Chirai’s monkey menace seems like a slight inconvenience in front of the challenges that plague rural healthcare in India’s most populous state — Uttar Pradesh. The National Rural Health Mission has a three tier approach to rural healthcare — on gram panchayat level are sub-centres, followed by PHCs for a cluster of gram panchayats, and then Community Health Centres for referrals for every four PHCs. Health workers like ASHA and ANMs form the base of this pyramid, but the PHC is often the first point of contact for many in the rural population requiring medical care. They are supposed to be well-equipped to deal with in-and-out patient care, with an ambulance service, a functional operation theatre and labour room. The on-ground reality does not reflect these aspirations. In Uttar Pradesh, which has a decennial rural population growth rate of 28.82%, there is a requirement of 5194 PHCs, while only 3621 functioning PHCs currently exist — a shortfall of 30%. Only 170 of all of these PHCs function as per IPHS norms; 213 don’t even have electricity. The CHCs, sub-centres and sub-divisional hospitals don’t fare any better. One of the central goals of the NRHM is to reduce infant and maternal mortality rates across the country, and although they have significantly decreased in the last decade, the numbers in Uttar Pradesh are still alarming. The infant mortality rate in 2016 in rural Uttar Pradesh was 46 per thousand live births, the second highest in the country. Maternal mortality rates, as configured out of one lakh live births, was 285, according to 2011-2013 data — again, one of the highest in the country. Only 5.9% of mothers in Uttar Pradesh have received full ante-natal care, while half the population of women and children in the state suffer from anemia. For a state with 30% of its population living below the poverty line, governmental provisions of healthcare are often the only option. And yet, there is markedly lower service utilisation in Uttar Pradesh when compared to the national average — 2.5 times less in the case of out-patient department visits, and roughly half for in-patient department visits — which is an indictment of the poor quality of services. The Gorakhpur hospital tragedy is a clear reminder of the ramifications of doctor’s negligence and infrastructural failure in public hospitals. The widely discussed Ayushman Bharat Yojana launched in September this year promises two things — health protection coverage up to Rs 5 lakh per poor family per year, and upgrade of existing 1.5 lakh sub-centres into Health and Wellness Centres (HWCs) for ensuring primary care, especially against non-communicable diseases (NCDs). The allocation for this is Rs 1,200 crore. Assuming this money is spent on revamping just half the target, it amounts to Rs 1.6 lakh per centre — which seems insufficient, to say the least. Meanwhile, there has been a 2.1 percent decline in the allocation for National Health Mission – a national health programme that funds infrastructure for primary healthcare – from Rs 31,292 crore in 2017-18 (revised estimates) to Rs 30,634 crore (2018-2019 budget estimate). In a country where 3.9 crore people are pushed into poverty every year because of inadequate public health infrastructure , and rising healthcare expenses, monkeys may seem like the laughable final straw — but this too is a problem the locals are struggling to get a handle on. “I’ve recently been informed that the monkeys are a nuisance here,” says Dr. Amit Kumar Sinha at the PHC, “I’ve spoken to the District Forest Officer and have drafted a letter to the Block Forest Officer as well, which I hope will reach him tomorrow. Let’s see what happens.” The stop-gap solution for now is, as the exhausted-sounding Laalmani tells us, “They tell us to keep the door shut.” Reena adds, a bit more stoically, “Everyone is so frustrated, all we can do is shut the door and hope for the best.” Khabar Lahariya is a women-only network of rural reporters from Bundelkhand.