Times of India
01 July 2010
By Avanindra Mishra
Jaipur, India

Rural women denied basic care
Rural women in the state are being denied basic maternal and childcare facilities as nearly two thirds of the first referral units (FRU) are not functioning. An assessment by the health department in May showed that 94 of the 150 existing FRUs are nonfunctional.

Under the national rural health mission (NRHM), 237 such FRUs were to be established at all 33 districts in the state. Newborn care, blood storage facility and Caesarean section have been three critical determinants of functionality. However, the NRHM has so far been able to develop only 150 such units of which 56 are functional. Even among these, 13 lack blood storage unit, an essential component, while a couple lack manpower.

"In first week of July we had 328 specialists appointed at nearly 70 FRUs, nearly 272 posts of specialists were vacant," says a senior health official. According to officials there are 87 gynaecologists, 79 paediatricians, 92 surgeons and 70 anaesthetists appointed at 70 FRUs, while there should have been at least one specialist of each stream appointed at each of the 150 units.

The post for paediatrician have not been sanctioned and the functionality of some FRUs have been compromised due to mismanagement.

"As in case of Anupgarh in Sriganganagar district and Rohat in Pali district, there is an anaesthetist appointed but no surgeon of gynaecologist have yet joined the FRU, there are many such instances where the functionality of FRU is compromised," the official said.

The specialists are reluctant to take up rural duty despite a "decent" remuneration of nearly Rs 60,000 per month.The NRHM officials do not comment on the issue. However, the health minister has recently issued directives to improve conditions of these units."The issues faced by the FRUs have been brought to the notice of the authorities and recently 19 more specialists have been sanctioned for the purpose. More doctors will soon be hired," said health minister A A Khan.

The FRUs were supposed to provide emergency obstetric and newborn care at the village level; however, in the absence of manpower and infrastructure most of the units have been unable to provide services.

The working group on healthcare for women and children for the Tenth Five-Year Plan have identified establishment of fully functional and operational FRUs as a priority area. "Developing some FRUs in a district by ensuring they have the required number of specialists in position or have access to the services of specialists on call, would be a preferred option rather than having a number of FRUs which may not be providing full range of services," the working group recommended.

Even at the working centres most cases are being referred to bigger hospitals without any considerable medical assistance to the patient.