COVID-19: Defunct Rural Health Centres Highlight Desperate Situation in Bihar

The deadlier second wave of the COVID-19 pandemic has exposed the failing and non-functional healthcare system in rural Bihar. The ailing rural masses have been left at the mercy of inactive rural health centres, with reports of several deaths in a single day pouring in from small rural hamlets, which more often than not go unregistered in the government records.

Mathar in Khagaria district’s Rahimpur panchayat is a prime example of neglect where the village-level health centre stands defunct. Since 2005, a rusted board with Bihar government’s name inscribed is hanging on its wall. As per Shivanand Prasad Yadav, former panchayat head, the minimum distance to be covered by the rural population to get access to medical facilities is 13 km.

This is not an exception, Several health centres including sub-health centres, primary and community health centres in rural areas of Bihar have turned into ruined structures accommodating hay and cattle, even as COVID-19 cases spread like wildfire.

In Khagaria district alone, there are 70 health centres lying defunct in different blocks. Meanwhile.21 panchayats in Parbatta block of the district have reported more than 250 deaths in the last one month, however, the lack of testing has led to doubts being raised about the reason behind these deaths.

Talking about the defunct health centres, Khagaria Civil Surgeon Dr. Ajay Singh said that the health centres have remained out of order due to the deficiency of medical workforce including doctors, nurses and compounders). He added that the state government will be notified soon about the requirements.

Notably, under the National Health Mission (NHM), a Primary Health Centre (PHC) is established to cover a population of 30,000 in rural areas and 20,000 in hilly, tribal and desert areas. However, the latest report of Rural Health Statistics 2019-20 released by the Ministry of Health and Family Welfare (MOHFW), reveals a completely different picture.

The report indicates the worsening of public health infrastructure over the years. Compared to 10,337 functioning sub-centres in rural Bihar in 2005, only 9,112 sub-centres were functioning in 2020. The number of community health centres declined during the same period from 101 in 2005 to 57 in 2020.

Mokama, which falls in Patna district, has also been ravaged by rising COVID-19 cases and incompetent healthcare infrastructure despite its proximity to the state capital. Ram Tola, Chandrabhan Tola and Raghuram Tola in Aunta panchayat of Mokama block have reported at least 25 deaths in 20 days, revealing the rapid spread of the virus in the region. An estimated population of 12,000 is struggling with minimum life saving facilities at the government healthcare centre in the region.

Pic: Nazareth Hospital, Mokama

Amid this, the demands to revive the near defunct Nazareth hospital in Mokama have been increasing to deal with the rising COVID-19 cases.

As per the residents of the block, they are required to travel more than 30-40 kms to access proper healthcare facilities in the absence of fully functional health centres in the region. According to Kumar Shanu, resident of Mokama and a lawyer at the Patna High Court, unavailability of services at public health centres has endangered the life of a large rural population with no other hospital except the dysfunctional Nazareth Hospital in the vicinity.

He added, “Even basic facilities like RT-PCR testing is inaccessible in the area. The situation is such that it’s like being between the devil and the deep sea. The re-opening of Nazareth can be a game changer for an overloaded, deficient medical system.”

Afzalnagar village in Tarapur block of Munger district has reported nine deaths in seven days. Afzalnagar panchayat head Shashi Kumar Suman told NewsClick that almost every rural household has people with symptoms like fever, shortening of breath cold and cough. Most of them who returned home during the festive season of Holi have had to bear the brunt of the economic impact of COVID-19.

Launa panchayat head Madhukar Kumar conceded that at least 20 deaths have reported in the last one month, and over 100 people are displaying cold and cough symptoms. The increasing fear of death and unavailability of credible healthcare facilities has led to an increased dependency on quacks among the villagers, he said, adding that there is also a hesitation to get vaccinated due to post vaccine cases of weakness and fever.

Despite the first death due to COVID-19 in Bihar being reported in March 2020, neither the people nor those seated in power have not learned any lesson, said Ram Bihari Yadav, former head of the Primary Agricultural Credit Society (PACS), Launa panchayat.

Echoing similar sentiments, Rasiyari village based Nandu Kumar, a social activist engaged with the Mithila Gram Vikas Parishad, Darbhanga, said, “The casual attitude since the break out of the pandemic has exacerbated the situation during the deadlier second wave. The absence of any makeshift wooden barriers on the tarred single-lane road leading to the village indicate that the government has abandoned even the minimum testing, tracing and isolation followed during the first wave last year.”

According to the villagers of Rasiyari, Kiratpur PHC is the only active and credible health centre often preferred for check up after DMCH.

Pic: Adma Gaon Health Centre, Darbhanga

Meanwhile in Bahadurpur block of Darbhanga, the PHC building in Adma Gaon and the Sinuar sub-health centre stand in shambles, symbolising the pain of hundreds of villages. With over 1,000 reported cases of COVID-19 in the block, majority of the patients are in home isolation due to dearth of functional health centres. Keoti block in the same district has also reported several cases of patients being in home isolation. Further, a scarcity of oxymetres and thermometres in the medical stores has increased the panic among villagers.

In neighbouring district of Madhubani, the situation is no different. Sixteen deaths, all with symptoms of fever, cough and cold in Jaynagar block, have not even been registered by the officials. On being asked for a comment on the situation, Jaynagar BDO Chandrakanta denied to confirm the numbers of deaths in the region.

Khajauli village in Madhubani, with a population more than 7,000, has just one health centre, which is also lying dysfunctional in the midst of the pandemic.

Bangaon sub-health centre, Saharsa

The sub-health centre in Bangaon village in Saharsa district has been waiting to become functional ever since it was inaugurated by the Chief Minister in 2007. Established at an estimated cost of Rs 6.5 lakh, instead being a well equipped centre of treatment with doctors and nurses, the building has ended up as a hub of anti-social elements and storage of hay for cattle.

In Saharsa’s Banma Itahari block, the PHC is without an ambulance and other basic services reportedly for decades. Similarly, those in need of getting treated at Madhepura’s Jan Nayak Karpoori Thakur Medical College and Hospital (JNKTMCH) hire a private vehicle in dearth of ambulances.

The Malhipur panchayat in Rohtas district also faces the same challenges. An estimated population of 14,500 does not have a COVID-19 testing facility in the nearby health centre and the nearest testing centre is at a distance of 7 km in Chenari. “Twenty deaths in a week have instilled fear among the rural folks, said Ashok Kumar Singh, Sasaram-based renowned social activist.

Incomplete hospital building, Begusarai

Begusarai’s Majhaul sub-divisional hospital building has been lying incomplete since 14 years. Cheriya Bariyarpur MLA Raj Vanshi Mahato told NewsClick that his prolonged interventions and requests to the state government to start the hospital that could have been a relief for villagers have been ignored repeatedly. He added, “Not only that, he Majhaul referral centre’s tattered infrastructure has failed to come to people’s rescue during the pandemic-induced health emergency.”

A district health official from Begusarai said on condition of anonymity, “Between May 1 and May 14, the district saw a surge in cases. Out of 6,400 cases, 4,800 were reported from rural areas, with most patients displaying symptoms of cold, cough and fever. However, the closed sub-health centres in Bakhari and Teghra blocks are making it difficult to handle the surging cases. Majority of the rural populace, in the backdrop of dysfunctional health centres, are relying solely on local medicine shops, jhola chhap doctors (quacks), they are the first refuge against the infection.”

In Muzaffarpur district, several community and additional primary health centres in various blocks are either lying defunct or have been turned in to cattle shed by the local residents. The Mahant Darshan Das hospital in Musahari block is out of use since decades, eluding villagers from health service delivery. The double storied building that was established 1932, used to be equipped with seven doctors but is now reduced to a symbol of people’s despair amid the pandemic.

“In Sakra block of Muzaffarpur, the last 27 days have seen 36 deaths after the patients reported symptoms of cold, cough and breathlessness,” said Pramod Kumar Gupta, head of the Sarmastpur panchayat, Sakra. “Despite several requests to medical officer for COVID-19 testing, kits were no made available in the local health centre, leading to reason of death remaining unknown, he added.