GENERAL APPEAL (India): Dalit women refused medical care and asked to pay bribe at the Primary Health Centre

Dear friends,

The Asian Human Rights Commission (AHRC) has received information from Gramya Sansthan, a human rights organisation based in Varanasi, Uttar Pradesh regarding the case of two women who were refused medical assistance at the Government Primary Health Centre, in Naugarh, Chandauli district, Uttar Pradesh. It is reported that since the women were from the Dalit community they were denied medical help at the centre and the staff at the centre demanded bribes if they were to receive any treatment at the centre.

CASE DETAILS:

Ms. Rambha Devi (18 years old) is a resident of Rithiya village of Naugarh, Chandauli district.  On September 3, 2007, Rambha was in advanced labour and was taken to the Naugarh Primary Health Centre (PHC) by her family. This government centre is the nearest PHC from the village.

When the family arrived at the centre, four staffs at the centre, namely Ms. Savitri, Ms. Lalti Maurya, Ms. Shanti Pandey and Ms. Daai were present at the centre. All the four are Auxiliary Nursing Mothers (ANM) employed at the centre. Rambha’s family asked the ANMs to admit Rambha for delivery which the ANMs refused. The staff refused to admit Rambha claiming that she would have a stillbirth and that Rambha must be admitted at a private hospital or else she would die. Rambha’s family being poor insisted that Rambha must be admitted at the centre. But the staff named above refused.

Rambha’s family had no other choice but to go to the private hospital in Barahua, where Rambha gave birth to a normal baby. To meet the expenses at the private hospital Rambha had to avail a loan of INR 7000 (USD 178 USD), which the family now find difficult to pay back.

It is reported that the reason why the staff at the PHC refused to admit Rambha was because they wanted Rambha to go to the private hospital so that the staff at the PHC could get their commission for referring patients to the private hospital. The fact that Rambha beloged to the Dalit community added further complication to Rambha’s case since the Dalits in the villages has less authority. The staffs at the PHC adopt the strategy of scaring the patients with wrong opinions without resorting to proper diagnosis so that they rush the patients to private clinics, which the local villagers allege is a very common practice by the staff at the PHC.

Ms. Kiran Devi (18 years old) is a resident of Thathwa village of Naugarh, Chandauli district. On September 12, 2007 Kiran also went to the Naugarh PHC for her delivery. The ANMs Ms. Daai and Ms. Kaushilya were at the health centre and Kiran’s family requested Kaushilya to do a check-up upon Kiran.

After the ANM finished the check-up, the ANM shouted at Kiran that she should rush to a big hospital for a Caesarean section. The ANM, Kaushilya, also told Kiran that she had some other urgent private business to attend to and that centre did not have any facilities for operation anyway. During all this time the ANM had not consulted a doctor about Kiran’s case.

Kiran’s family took her to another ANM, Ms. Shanti Pandey, seeking assistance. Shanti told the family that Kiran would give a birth the following day normally and asked to bring Kiran back to the Naugarh PHC the next day morning. By then it was already 11pm. Kiran and her family requested whether Kiran could be admitted at the PHC. But Kiran was refused admission.

Kiran was brought back home and her family decided to take her to a private hospital. But Kiran’s labour advanced during the night and her family asked the ANM Ms. Daai to come home to help Kiran with her labour. Kiran gave birth to her baby the next day morning at home.

The PHC is expected to provide referral service free of cost especially for the poor, women, and children under the National Rural Health Mission (NRHM). The two cases above, demonstrate the neglect and corruption at the primary health centres and by the staff like the ANMs. The centres are also expected to have qualified doctors, nurses and paramedics like the ANMs, and equipped with enough medical supply and other paraphernalia to provide immediate medical assistance to the ordinary people. However, the functioning of several of these centres is deplorable due to government neglect and corruption. This results in the failure of the public health system, which affects the poor, particularly the Dalits in remote villages of India.

It is reported that many poor and lower-caste women of Thathwa village have been asked to pay INR 400 to 500 each as bribe for certificates to claim maternity benefits from the government and an additional INR 5 for issuing a medical card for pre-delivery medical care. The bribes are demanded by the ANMs. The malfunction of the PHC caused by neglect and corruption of the health centre officers is referred in a previous Hunger Alert issued by the AHRC as HA-012-2007.

In addition, Ms. Viranji Devi, the Accredited Social Health Activist (ASHA) of Thanthwa village does not discharge her duty properly. Ms. Devi does not even stay near Thanthwa village but in Tiwarepur village.

BACKGROUND INFORMATION:

The PHC in India is a referral and basic health care unit to deliver the government health service at village level. According to Indian Public Health Standards for PHC and the National Rural Health Mission (2005-2012), the function and the infrastructure including manpower and facilities for the PHCs have been strengthened. One of the main purposes of the public health service is to support those who are poor in rural areas and to reduce infant mortality rate and maternal mortality ratio in India.

Under the National Rural Health Mission, on the basis of the Indian Public Health Standards for PHCs, a female ASHA is chosen by and is accountable to the panchayat (local administrative body). ASHA is supposed to act as an interface between the community and the public health system and as a bridge between the ANM and the village. In the PHC, ANM, the doctor and the nurse play a direct role in delivering health services to the people. Outside the PHC, ASHA is an important link for the success of the public health service. In practice, as shown in the above two cases, the officers at the PHC are responsible for the failure of the quality in the services provided to the poor at the PHC.

In paper the PHC provides 24 hour service, but it does not in practice. In theory the people can get primary medical treatment at the PHC free of cost, and thus the name PHC. Furthermore pregnant women can receive INR 1400 [USD 35] each as financial assistance for each delivery and INR 250 each [USD 6] to cover their transportation costs. The doctor at the PHC is accountable for disbursing this fund from the government to the patients. The pregnant women, on the contrary, are asked to pay bribes to the staff at the PHC for registering their case at the centre. Most of the people who depend upon the services of the PHC are the poor women and children from the lower caste. Due to poor financial conditions they cannot afford for treatment at private hospitals; several of them when refused treatment at the PHC does not go anywhere else, which is reflected in the health condition of these communities. To make things worse due to the absence of any monitoring process and accountability of the staff the quality of the services rendered through the public health service system in India remain alarmingly bad.

SUGGESTED ACTION:
Please write a letter to the Chief Minister of Uttar Pradesh and the Minister of Health to express your concern in this case. The AHRC is also writing a separate letter to the UN Special Rapporteur on violence against women and Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.

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