“Jaise maire patloon dheeli hai, vaise sarkar dheeli hai (Just like my pants are loose, like that the government is loose)” – Me, irritated.
The days are getting slightly warmer here. I had just made the walk (road by road) to the panchayat ghar in the village of Baret. A leucorrhoea health camp had been organized in conjunction with the local government hospital, the Primary Health Centre in Malla Ramgarh. At the last minute when the folks at the PHC flaked out, I gotta say I was pretty damn annoyed, and I had no choice but to speak on it.
As soon as I reached Baret the words that were slamming against the inside of my head went through the lacking translation factory of my tongue and exited as my utter frustration manifest. “What is the deal?! We’ve been trying to do one camp here with the PHC for like six months. Pradhanji has gone multiple times to the PHC, I’ve gone multiple times to the PHC, and received a confirmation from the doctor and his supervisor that the camp would happen today, and a written proposal has been sent there. And it’s not even about today. The PHC can’t give one day in six months when a Gram Panchayat, the local village government, is asking them to come provide some health services? The government is saying do this, do that. The health committees have been formed, they’ve written out yearlong action plans, they’ve written out formal proposals, now what?” (Yeah… it’s sounds so much better in Hindi).
Throughout my rant as I stumbled over my Hindi grammar, the Gram Pradhan and CHIRAG field workers nodded a long, some serious, others with the amusement beaming from their faces. But I was heated. It’s not just the fact that one camp didn’t happen. It’s a larger issue that has become quite clear, that there is an unwillingness or lack of interest from the local health infrastructure to work directly with Gram Panchayats on preventive health. Last month a proposal was submitted to the Chief Medical Officer of the entire Nainital District, directly, in his hand, on behalf of eight Gram Panchayat health committeees, and CHIRAG, about the need to hold leucorrhoea camps in the vicinity of their villages. Leucorrhoea has been identified as major health problem, cited as affecting anywhere between 50-80% of women in these given villages. While simply treatment won’t solve the problem completely, it will provide much needed relief in the short term. The CMO said he would take this up with the PHC and help ensure these camps happen. Despite attempts at following this up, no word or confirmation has come from the PHC.
“And I don’t buy the argument that this is India. This is how things work here. What is that even supposed to mean? I am not sure I know. What I do know is that the people at the hospital are competent, the facilities exist, and that over the span of five months there is a time to conduct a camp, when the Gram Pradhan, the Gram Panchayat, and the neighboring NGO have all expressed an active desire to organize such activities. Why can’t they come?”
A few days before I was in Bageshwar, another district that CHIRAG works in on a number of issues, including recently with Panchayats on preventive health. After a two-day workshop with health committee members, we had gone to meet the Chief Medical Officer regarding the supply of chlorine tablets, the absence of ASHAs (Accredited Social Health Activist) in many villages, and to discuss further coordination. The CMO in Bageshwar was quite straightforward. He didn’t know of any other Gram Panchayats organizing on health, though he knew that under the NRHM they are given a central role. He asked who the members of the health committee were supposed to be, how ASHAs were to be selected, and was all in all fairly clueless about a lot of the process. He called me a Gandhi-wallah, which, given the entire situation I guess was slightly amusing.
“What is the deal?! Sometimes I just don’t get how this is a nationally-devised scheme from the central government, that Uttarakhand is supposedly a high-focus state, and that the program is supposed to be on-going for the last four years now.” And it’s not even to say that nothing is happening, because things are, but sometimes it can be slightly unnerving to see such gaping holes in the system.
But just as my pants tend to dangle a bit, so it goes. And yeah, a letter to the District Magistrate, and the CMO, has been drafted, and hopefully further attempts at coordination will prove to be more fruitful. But, if this is supposed to be something that exists not simply on paper, there needs to be some accountability. The Panchayats are doing their part, as is the NGO, but where is local government?
It is of course sad to hear the situation prevailing in the area, but what is the deal? Working there, one realizes that the priorities of government and people are mismatched. What do people want, who is hearing them and what kind of policies they get - these are the question one is troubled with. The problem is not they are getting a bad deal or not, but on the other hand it is that that do they know that they are getting a bad deal or not. The second part of the above problem has more cynical approach and can not be solved in complex/developed societies, forget Indian villages.
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