For
my project I am working on assessing the implementation of the Indian Public
Health Standards in HD Kote taluk. I have been in Saragur for the past few
weeks working at Vivekananda Memorial Hospital (VMH) alongside many amazing
doctors in order to execute a government survey consisting of health facility
requirements for services, manpower, and physical infrastructure in Primary
Health Centers (PHCs) and Subcenters. Since India is such a populous country (2nd
largest population in the world), I am curious to see how national policies are
implemented at the local level, specifically in rural villages.
Based
on preliminary analysis of the subcenters and PHCs I have been able to visit;
it is evident that all of the centers are struggling to retain enough manpower
to keep the centers running efficiently. I interviewed one ANM (Auxiliary
Midwife Nurse) who served as the sole employee of two subcenters since she had
to fill in for a center that was vacant for 15 years. The center, Ramenahalli
B, also does not have a building at the moment, so the ANM, Bharthi, travels to
Anganwadi centers to treat patients. I also talked to another ANM, Kamala, who
runs two other subcenters in the N Belthuru village, and she said the most
challenging part about her job is that it is located in such a dangerous area,
alongside Nagarhole National Park and Tiger Reserve, so there is a lot of fear
of wild animals. Subcenters cover the smallest population in the public
healthcare system (ideally 3,000-5,000 people) and therefore they are often the
most remote. Thus, it is difficult to find people to work in these areas, which
is evident in N Belthuru, where there are nine subcenters but only five ANMs to
staff them.
Data
collection for my project has definitely been frustrating at times, but this
just goes to show how challenging it is to monitor national policies in such a
large country, especially in areas that are difficult to access. Furthermore,
it is hard to know for sure if the centers actually provide the services I am
inquiring about, as I am unable to observe the centers over an extended period
of time, and instead I just have to interview the doctors and nurses. This is
another challenge of policy monitoring, as especially as an outsider, it is
difficult to understand the inner workings of centers. Although it is exasperating
to see these understaffed and sometimes underutilized centers, the strength and
dedication of the health workers is incredible, and I have really enjoyed
traveling to these more rural sites and experiencing a part of India that I
probably wouldn’t have been able to see otherwise. For the past few days we
have driven through endless fields of crops and marigolds all on the backdrop
of beautiful mountainscapes, and we have also seen many wild animals, from
lizards to elephants. I have really enjoyed my time here in Saragur at VMH and
I am so grateful for this experience and to have made so many memories and
connections here that I know I will never forget.
