Review of urban health centers under NRHM: Bommanahalli and Arekere UHC’s

Abstract

While it is one thing to come up with new initiatives at the policy level and setting objectives /goals to achieve them, it is indeed appalling when these objectives are not achieved. We do recognise the Health Department in its attempt to focus on the urban poor as well through setting up of these Urban Health Centres. We also understand the constraints it works under in terms of securing the buy-in and support from various bodies and sometimes resource constraints such as getting experienced and well-trained doctors. However starting a centre for the sake of records also does not do justice to the organisation’s mission. While from a learning perspective this project has been fulfilling in terms of understanding the NRHM and these centres in light of the Governance Framework, we were more distressed by the state of affairs of especially the Bommanahalli UHC. The UHC seems to be functioning in an atmosphere of complete vacuum. It seems more of an abandoned child. This is when serious questions can be raised against the efficacy of such programmes. While it is easy to brush issues under the carpet, our attempt in this project has not been to do so. We can only consider some change to take place, some amelioration in the existing conditions if someone brings them to light. Most often nowadays, even this is not enough. As learnt from our UHC visits, the staff have conveyed their concerns to higher authorities, but to no avail. Who suffers at the end of all this, is no guess. It is the poor person who comes to the centre to get treated. The reason being- poor morale of the employees and the lack of facilities at the centre translate into poor service quality. The conditions at the Bommanahalli UHC were deplorable. While the enthusiasm among the employees seems a palpable high, their incentive to work could touch a low anytime. The infrastructure at the UHC needs serious attention. Medical facilities, in terms of basic equipment too are seriously lacking. The Arekere UHC on the other hand, seems to be in better shape. However we still believe much more can be done to strengthen its operations- generating awareness being a critical one. We have made a humble attempt at reviewing these two UHC and recommending some OUTCOME INDICATORS and a SERV QUAL measure. What we strongly think is lacking in these initiatives is a Checks and balance institution- a neutral body that can critically examine the performance of these centres-something like an audit committee that reviews these centres in an unbiased and impartial manner. All this in place, we believe the quality of human life can be impacted positively.