Times of India
29 April 2010
By Sumitra Deb Roy
Mumbai, India

A 40–year–old farmer approaches his nearest primary health centre at Dhadgaon village in Nandurbar district, hoping to get treatment for a persistent fever. Leave alone being provided with medicine, he is told to have some pills, the names of which are written on his palm as the doctor does not provide him with a paper. The farmer goes scouting for drugs, showing his palm to every chemist, while trying to protect it from water or sweat.

In another incident, a villager is asked to purchase antibiotic Taxim injections from any nearby chemist shop even though the primary health centre (PHC) has enough stock of it. These and many such appalling stories left the policy makers of the much touted National Rural Health Mission (NRHM) red–faced as they met community health workers on Wednesday.

Raising doubts about claims that the NRHM has been reaching out to lakhs in rural areas, a survey of 41 primary health care centres catering to 225 villages across five districts in Maharashtra revealed gross irregularities in the supply of medicine. The survey found that in Amravati, Pune, Nandurbar, Osmanabad and Thane, about 14% of the PHCs had zero supply of basic medicines like paracetamol, antisnake venom and painkillers. In about 37% of the centres, the supply of medicines was limited and irregular.

But the interesting revelation was that in about 11% of these centres, drugs were available in excess. At certain centres, the supplies were about 600% more and many drugs were nearing expiry. “Some PHCs had stocks to last them for one–and–a–half years even though the law does not allow them to stock anything for more than three months,” said Abhay Shukla of SATHI–CEHAT, which along with local NGOs carried out the survey under the NRHM programme.

Mission director of Maharashtra NRHM Jayant Bantya, who attended the meeting said, “We made note of the issues but are yet to get the survey report.” The survey also found that only about 53% of the PHCs had laboratory facilities for testing urine, blood and sputum samples. “The supply and distribution of medicines need to be streamlined for NRHM to be successful,” said Anand Phadke of Jan Swasthya Abhiyan.

“The programme is facing issues like medicine supply, staff and infrastructure among others,” said Shukla. The study also revealed that the availability of treatment or curative care has not gone beyond 42% in the past five years. “Drugs are not reaching patients in villages,” said Phadke.

To weed out malpractice in procurement of medicines, centres’ officials have suggested the Tamil Nadu model wherein an independent body looks into procurement and distribution, using a fully computerised database. “Maharashtra, however, is not too keen on adopting it,” added Shukla.

Lack of Specialists
The lack of specialists has become a crisis in rural areas. This has emerged after a meeting was held between community health workers and NHRM officers. According to officials, the state has even allowed doctors from nearby states like MP or Gujarat to treat patients. Satish Pawar, joint director, Maharashtra NRHM, said that the problem will be addressed soon as a team will be travelling from medical colleges to rural areas.