Fact-Finding on NRHM Facilities in Sikkim

Post Date: Wednesday, May 25, 2016

From May 20^th to 21^st 2014 two health activists from Delhi and Gangtok travelled to a District Hospital (DH), a Primary Health Centre (PHC), Pakyong PHC and Sir Thodup Namgyal Memorial(S.T.N.M.) Hospital Gangtok to investigate the standards of care of National Rural Health Mission (NRHM) facilities in Sikkim. At the various institutions the activists were able to speak to a wide range of people, including doctors, nurses, administrators and patients.

While they were inspired to meet many dedicated medical professionals working hard for their communities, they found that every institution they visited failed to comply with basic NRHM service guarantees as set by the Indian Public Health Standards (IPHS). Allowing NRHM institutions to suffer from frequent electricity shortages, a lack of necessary equipment or severe understaffing that does not meet IPHS stipulations is a failure on the part of the state to protect the fundamental rights to life, health, and dignity enshrined in Article 21 of the Constitution.

Below is a report of the outcomes of this two-day fact-finding, and the major issues of concern that the health activists would recommend to the NRHM as critical to be improved upon as soon as possible.

Major Issues of Concern

Based on visits to four facilities and interviews with medical professionals, patients, and families, the fact-finding team identified the following major issues of concern:

Roads and Transport. Almost every medical professional we spoke to said the biggest challenge they face is that of transportation given the dispersed population, difficult terrain and poor roads of the state. Although the Janani Shishu Suraksha Karyakram (JSSK) guarantees free transport from patients’ homes to the facilities, there are still no services in all of Sikkim to help patients reach the first level of care from their villages. A delay in reaching care, especially emergency obstetric care, is one of the primary causes of maternal mortality. According to the International Covenanton Economic, Social and Cultural Rights, which India is a state party to, thestate has an obligation to create accessible health facilities. Sikkim should look to provide something similar to the 108 ambulances that exist in other states. In the meantime, it is vital that careful attention is made to ensure all those who are entitled to JSSK payments to help them cover the costs of private transportation receive them.

The team also found that limited transportation results in substandard post-natal care and adequate discharge procedures as patients often rush to get back to their villages before the last shared taxi of the day; around 2pm. Doctors cannot keep patients for monitoring or provide adequate follow-up care. Under JSSK, the government has an obligation to provide adequate transport to pregnant and lactating women. Moreover, to ensure the right to health as enshrined in the Constitution, all patients should have easy access to health facilities.  Therefore it is necessary that the District Hospitals provide transportation services to help patients get back to their villages.