Editor's Note: A network of 60 reporters set off across India to test the idea of development as it is experienced on the ground. Their brief: Use your mobile phone to record the impact of 120 key policy decisions on everyday life; what works, what doesn't and why; what can be done better and what should be done differently. Their findings — straight and raw from the ground — will be combined in this series, Elections on the Go, over a course of 100 days.
Dehradun: A pregnant lady delivers her baby in the toilet. Doctors perform surgeries under light from torches and candles. There are no oxygen points for two dozen patients suffering from chlorine inhalation. This is the condition at Doon Hospital, Uttarakhand’s biggest government healthcare centre in the state capital of Dehradun. One can imagine, then, the state of healthcare centres in the remote hilly areas.
Hill states like Uttarakhand get a special status under the National Health Mission. This Centre-state funding pattern was revised to 90:10 from the 60:40 norm applicable to other states. In addition, these states benefit from higher per capita funding and relaxed norms for ambulances and mobile medical units, with the objective of reducing time-to-care to under 30 minutes.
The electorate massively supported the BJP in the last Assembly polls largely on the promise of “double engine government for development”, meaning a BJP government at the Centre and state. But the reality on the ground is a crumbling rural health infrastructure, one of the primary causes of Uttarakhand’s migration crisis with about eight percent of the hill population having moved to towns in the plains. The Opposition Congress has been demanding that the state needs a full-time health minister, the portfolio managed by Chief Minister Trivendra Singh Rawat. But that by itself is unlikely to improve matters.
“What kind of double engine government you are talking about?” asked PC Tiwari, chief of Uttarakhand Parivartan Party. “There is no proper deployment of doctors in Almora district and base hospital. I am not referring to specialists, but general practitioners. My wife died due to negligence in Almora government hospital. The hospital admitted in response to an RTI application that the person who saw my wife was not a doctor. Regardless of the double engine, health services have not changed much.”
The problem of an acute shortage of doctors is a very real one, largely because of an unwillingness to serve in rural areas. Ravindra Thapliyal, director general of Health and Medical Services, said of the 2,727 sanctioned posts, only 1,589 doctors are permanent appointees in various government hospitals. “Another 456 doctors have been appointed on contract with 681 posts lying vacant,” said Thapliyal. Most posts of super-specialist doctors are vacant in almost every hospital in the hills for a long time.
To address this issue, the BJP government last year decided to move a few government-run district and rural health centres to the public-private partnership (PPP) model. Thapliyal justified this move saying it would provide better healthcare to the people. “Any problems will be sorted out soon,” he assured.
So far, five hospitals, including the district hospital, Tehri and Coronation Hospital, and Combined Health Centres (CHC) in Dehradun, Devprayag and Baleshwar in Tehri and Doiwala, have been handed over to private parties to be run on the PPP model. The complete cluster of CHCs in Tehri, in particular, have been handed over to the Swami Ram Himalayan Trust Hospital (SRHTH) in Jollygrant in Dehradun district, with the process to convert district hospital, Pauri and CHCs in Ramnagar, Nainital and Bhikiyasain, Almora, in the pipeline.
A district hospital in Tehri that the government runs in a PPP mode. Image Courtesy: Rahul Singh Shekhawat
But hopes that the PPP model will deliver better healthcare services have been dashed. “After conversion to PPP model, the district hospital has become a referral centre to send patients to their main SRHTH hospital,” said JP Pandey, an advocate residing in Tehri. “There are serious questions about the state government’s intentions. Ever since the district hospital started running on the PPP model, health services have worsened. The SRHTH has not replaced the government doctors who were redeployed. In fact, the situation when the hospital was run by the government was not as bad as it is now”.
Reena, a Tehri resident, was given this kind of runaround last month when complications arose in her pregnancy. “My husband took me to the district hospital in Tehri,” said Reena. “After seeing my condition I was referred to a bigger hospital in Dehradun. Eventually, I was admitted to a missionary hospital at Chamba where I received treatment. This is the situation in the Tehri district hospital, where neither a proper doctor nor an ultrasound machine was available.” Reena eventually miscarried.
“When the government doctors left, the Jollygrant trust was to bring in its own doctors as replacement,” said Ramesh Dangwal. “But the trust did not do so. Patients are either being referred to their main hospital or are just wandering around Tehri and not getting proper treatment. The 108 emergency number ambulance services, a critical service needed in the hill areas, is also not available due to lack of funds.”
Many other residents who visit these hospitals complain that they now function as a referral centre, directing patients to fully private hospitals. Jahid Anjum, an activist based in Doiwala, the chief minister's constituency, said earlier Doiwala’s CHC hospital had physicians and experienced surgeons. “The people were told that PPP model would lead to modernising the hospital and specialist doctors being brought in. But since the change was made, intern post graduate doctors are running it and the out patient department sends patients to the Himalayan Hospital in Jollygrant. Rawat has given the worst gift to the people of his Assembly constituency.”
Jahid organised a protest and staged a dharna for 45 days during the process of converting this hospital to the PPP model. “The government has mortgaged our CHC to the Swami Ram Trust Himalayan Hospital Jollygrant,” said Jahid. “The government’s intention is to promote private hospitals. In such a situation treatment will cost more, which not everyone can afford.”
BJP spokesperson Dr Devendra Bhasin denied these allegations, insisting that healthcare had improved under the new government. Dr JD Rana, retired additional director of the health and medical department charged the government with giving away priceless infrastructure to private organisations and paying them a huge amount of money. “I don’t think these private organisations are ensuring doctors and other facilities in the manner specified in the memorandum of understanding,” said Dr Rana. “There will be no worthwhile results until the government ensures accountability and transparency. Our district hospitals are not mere healthcare centres, but they are the face of our government system. Having served in the health and medical department, I can say there is a need to reconsider the PPP model and look at other options to upgrade and improve healthcare facilities.”
The earlier Congress government too tried the PPP model, but it kept the district hospitals out of it. “Government hospitals are the only hope for weaker sections who cannot afford private treatment,” said Karan Mehra, MLA from Ranikhet and deputy leader of the Opposition. “It is unfortunate that this government is determined to promote private organisations. We will put this sensitive issue before voters in the upcoming polls,” he added.
The author is a Dehradun-based freelance writer and a member of 101Reporters