INDIA: Odisha villagers denied access to basic health facilities

Dear Friends,

The Asian Human Rights Commission has received information about the lack of access to medical facilities by the women of Sunabeda Plateau in Nuapada District of Odisha. The women belonging to the remote villages located in the Sunabeda Plateau have not been able to avail the service of institutional delivery because of lack of transport. There is not even a government ambulance that can help the women reach the nearest Community Health Centre (CHC) or Public Health Centre (PHC). Immense agony is suffered in times of complications during pregnancy and childbirth. To add to their woes, these underprivileged women do not receive financial support supposed to be given by the government to pregnant women under the “Janani Suraksha Yojana” and “Mamata” schemes because the deliveries end up taking place outside hospitals and centres.

CASE NARRATIVE:

Netri Chhatria of Junapani Village could not avail the service of institutional delivery because she was unable to pay for the transport to visit the nearest Community Health Centre at Komna, the block headquarters, located at a distance of 57 kilometers from her village and 54 kilometers from Sunabeda village. Junapani is one of several remote villages located in the Sunabeda Plateau of Nuapada District.

Although the government has made provision for an ambulance to be placed at Sunabeda, to help villagers reach the Nuapada District Hospital, considering the distance and remoteness of the area. However, the ambulance is stationed in the CHC at Komna. Therefore, Netri’s husband Hareram contacted the driver of the ambulance repeatedly to bring the vehicle to Junapani, but the driver answered that the ambulance needed repair. Hareram waited for a day with the hope that the ambulance would arrive after repair, but he got the same answer even after a day. Looking to the deteriorating condition of his wife, he requested the Accredited Social Health Activist (ASHA) workers, who are community health workers employed by the Ministry of Health and Family Welfare, to assist with the delivery. Having no alternative, ASHA workers, who are not equipped to conduct such deliveries, took the responsibility, and luckily the child was born safely, without complications.

Janaki Chhatria of the same village was not so fortunate. Her child died in her womb. According to her husband, Jagatram, the ambulance did not arrive on time and he could not pay for private transportation. One of the ASHA workers, Jamuna Bai, helped Janaki Chhatria bring the dead child out of the womb. While a local quack gave Janaki two injections and a saline drip, which helped her feel better and stopped the excessive bleeding.

For most of the pregnant women in the villages of Sunabeda Plateau, life goes on like this. The Primary Health Centre (PHC) at Sunabeda remains closed all year round. The only hope is the ASHA workers, but in critical cases the ASHA workers are helpless. The ASHA of Junapani Village has conducted five deliveries in the last three months at Sanbaheli and Junapani villages, out of which the case of Janaki Chhatria happened to be critical.

On May 2015, villagers of Sunabeda requested the District Collector and the Chief District Medical Officer in Nuapada to provide the ambulance. They were assured that the ambulance service would be resumed after the vehicle is repaired. But, it has been more than two months and the vehicle is still not in service.

It is also important to mention that the Women and Child Development Department under the Odisha state government has also provided schemes for women’s welfare, especially in rural areas. One such provision is the Mamata scheme for pregnant women, where financial support is given to women in different phases of pregnancy to ensure safety and welfare of their health and that of the child. To avail such schemes, the women have registered themselves in the Anganwadi Centres and open bank accounts under the Jan Dhan Yojana. Despite following all the directives of the scheme, none of those women from Sunabeda were successfully registered for the Mamata scheme.

ADDITIONAL INFORMATION:

Nuapada District is one of the poorest districts of Odisha state. As many as 70 percent of the District residents are living Below Poverty Line (BPL). Seasonal agriculture and collection of mahua flowers is their only source of livelihood. As the lands are not irrigated, the crops are dependent on rainfall. This year, due to less rain, the people have not yet begun their agricultural operation. The collection of mahua flowers helps the villagers earn around Rs.10,000 per year on an average. However, the villagers of Sunabeda are now deprived of such collection returns due to fear of the Naxals/Maoists. They are not going to the forest for collection due to threat. The Naxals/Maoists are now targeting the villagers, because the people are now supporting the police and the Central Reserve Police Force (CRPF), who are camping in the village for the last 4 years.

The service of ambulance was actually withdrawn by an Ex-Chief District Medical Officer, who feared that Maoists would use the ambulance. The villagers had approached the present Chief District Medical Officer, Dr. Jagdish Chandra Mahanand, and the District Collector, Md. Sidiq Alam, for resumption of ambulance services in May 2015. The officials had assured that the service would be resumed. But no action has been taken so far.

The Primary Health Centre in Sunabeda Village, Panchayat headquarters, remains shut throughout the year. According to the district administration, the staff appointed in the Primary Health Centre is not in the hospital due to fear of Naxals/Maoists. However, Central Reserve Police Force (CRPF) and police personnel are stationed in Sunabeda and therefore the Maoist excuse does not stick as one preventing the staff from resuming their duties in the hospital.

The only Community Health Centre with availability of doctors and other facilities is in Komna Village, which is 42 kilometers from Nuapada District and 54 kilometers from Sunabeda. And in critical cases, the villagers prefer the District Headquarter Hospital at Nuapada. It should be noted, that the villages in Sunabeda are located at far flung distances from each other, as well as from Nuapada District. Furthermore, there are only 12 ASHA workers in the entire Sunabeda Village catering to a population of 9,000 people.

SUGGESTED ACTION:

Please write to the authorities listed below, asking them to functionalise all the necessary health care facilities at every Primary / Community Health Centre, with staff resuming their duties, and ensure that the women of every village from the Nuapada District is registered and receiving the benefits of the women welfare scheme in a fair and just manner. Furthermore, the ambulances should be put to service at the earliest in every far flung village in the district and more ASHA workers should be appointed in the Nuapada District especially in Sunabeda Plateau/village.

The AHRC is writing a separate letter to the UN Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health and the Special Rapporteur on the right to health.

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