Obscured by wild shrubbery, a land of two Kanals houses a dilapidated structure surrounded by a crumbling compound wall. This ramshackle building presents a daunting access: open gutters, thorny bushes that can tear a passer-by's clothes and an occasional encounter with a snake or scorpion in the compound.
This building is the Health sub-centre in the densely populated village of Goran, barely twenty two kilometres from Samba in Jammu and Kashmir.
Popularly known as "Bhoot Bangla" (Haunted house), this four-room sub-centre, though meant to offer health services, has become a threat to their hygiene and sanitation - foul smell constantly emanating from human and animal excreta scattered everywhere, wooden doors and racks eaten by termites and broken chairs.
According to the local residents, this sub-centre was shut eight years ago. Previously, the staff was operating from the same building but for reasons unknown to the villagers, the services stopped. For many years, a parallel sub-centre is being run on makeshift arrangements in rented accommodation on the first floor of a shop owned by a local, Rattan Chand, who said that the prime reason behind the closure was water - logging during rains that made it difficult to keep the centre functional.
As per the guidelines issued by the Government of India, Ministry of Health and Family Welfare, a Health sub-centre is the first point of contact between the primary health care system and the community. A sub-centre provides interface with the community at the grass-root level, providing all the primary health care services. It is the lowest rung of a referral pyramid of health facilities consisting of the sub-centres, Primary Health Centres, Community Health Centres, Sub-Divisional/Sub-District Hospitals and District Hospitals.
Socially active Dr Bias Dev, Lecturer in Orthopaedics, Government Medical College, Jammu, who serves the rural population by offering free health services, believes that erecting structures in the name of health centres is sheer mockery of the intent behind these centres.
On the one hand people like Dr Dev are trying their best to serve their state and on the other, there is Union Minister of Health, Ghulam Nabi Azad, who despite hailing from the State, is evidently unaware of the ground reality. In June this year, he had sanctioned over 600 new Sub Centres to the State. Even in his recent announcements, Azad declared 22 Sub Centres only for the Banihal region.
The story does not end here, for State Minister of Health, Shabir Khan, has also made similar announcements. When the condition and efficiency of the existing centres cannot be maintained, what is the point of erecting structures only?
As per population norms, there shall be one Sub-Centre established for every 5000 population in plain areas and for every 3000 population in hilly/tribal/desert areas. As the population density in the country is not uniform, application of the same norm across the country is not advisable. So in Jammu and Kashmir, which has considerably tough geographic terrain and extreme weather conditions, a Sub- Centre is required for a smaller population.
Moreover, Goran is a popular spot known for its famous religious temple of Baba Goran where every week, thousands of devotees visit from far off places. This makes it even more essential to have an active Sub- Centre in the village that would cater not only to the villagers but also to the medical needs of the devotees.
Goran, unfortunately, is not a case in isolation. The adjoining villages of Samutha and Lodath are victims of similar neglect.
The Goran Sub- Centre clearly depicts a typical example of huge losses incurred by the government exchequer. It appears that the concerned authorities are more keen on issuing contracts for raising physical structures with a focus on spending the funds and not on making the services effective.
The new guidelines of monitoring and evaluation in the health care systems in India permits no space for such practice as it involves the complete hierarchy, including the Sarpanch, MLA, Block Level and District Level Medical Officer, Health Directors, Health Secretary, District Development Commissioner and Health Minister, among others.
Despite this extensive hierarchy of monitoring and evaluation of State-run programmes, such acutely visible lacunae continue to undermine the intent of the State to provide healthcare to all citizens and their families.
The ruined structure at the Sub- Centre, Goran, loudly conveys the plight of residents of the rural belt in Jammu region. The Government's claims about achieving excellence in providing health care facilities sound hollow due to the poor execution of the health schemes on the ground.
Residents of Jammu region are seeking an answer from those at the helm of affairs as to how they intend to provide proper delivery of health care system at its most basic unit
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