June 2016 – Seva Setu

An Audit of the Health Sub Centers (Phulwari Sharif, Patna)

At Seva Setu, our efforts are two-fold in ensuring that existing government infrastructure reaches the last mile: one line of our effort involves hand-holding and providing innovative interventions to make existing infrastructure work better and the other involves strong advocacy to urge relevant stakeholders in improving the existing infrastructure.

In an attempt at our advocacy – we were curious to know how the state’s Health Sub Centers were functioning. The HSC, as envisioned by the National Rural Health Mission, is meant to be the first point of contact by the community for basic healthcare. An Auxiliary Nurse and Midwife (ANM) is supposed to man these clinics and treat and dispense non-critical cases, referring the critical ones to the Primary Health Centers (PHCs). These centers are normally located in every panchayat as against the PHCs, which usually cover one block. By the design of it, it rightly should reduce the load of footfalls happening at a PHC.

When we went around to see what’s going on, we found a different story. Of the 15 HSCs we visited in a span of 2 weeks recently, we noticed 13 of them to be closed. On speaking to the locals there, we realized this has been the case for a long while now.

HSC at Bhusola Danapur: People in the vicinity did not even know there was an HSC in the area.

HSC at Suitha: Unknown to the locals, this HSC neither has the required stock nor is visited by the locals. All of them prefer to head to the nearest PHC, which is a good 10km from this place.

HSC at Parsa: Totally unused, the locals told us that the ANM (Auxiliary Nurse and Midwife) visits once a month. During the other days, it is used as a makeshift place to store grass, fodder etc.

HSC at Pashi - 1: A very dirty and clearly unused HSC, one of the rooms here is used to store fodder.

HSC at Pashi : A very dirty and clearly unused HSC, one of the rooms here is used to store fodder.

HSC at Pashi

HSC at Chilbili: This three-roomed HSC is closed throughout. Two of these rooms did not have doors; the other was locked. There were men seated outside playing cards. Was visibly very dirty.

HSC at Chilbili

HSC at Visanpur: The HSC runs within the premises of a temple

HSC at Visanpur

Some highlights from our study –

13 out of the 15 HSCs were closed.
Of the ones open, there were expired tablets kept in stock.
One of the HSCs runs in the premises of a temple.

What’s worse was the people around did not know what an HSC was or why it is of use to them.

We are shifting gears into a concerted drive to get this awareness reach the last mile as well as sensitize a wider audience regarding this.

Do share this to as many you know with the hope that those who err and those responsible for its upkeep also catch sight of it. We are also working on some innovative interventions to aid the existing system in doing better – drop a line to know more!

At Seva Setu, we are actively pushing for these cases to be highlighted by the media as well. We have a detailed report on these findings. Do drop in a line if you’d like to read it or if you have ideas to share on how to increase readership.

We have now started off with a drive to evaluate the PHCs in some of these districts and highlight discrepancies we find there. Full steam ahead!

An Audit of the Social Audit Day Program by the Ministry of ICDS (Phulwari Sharif)

A social audit of the Anganwadi centers in every village is supposed to be an audit by the members of the society in seeing whether the Anganwadi is able to serve the people right. This is an event which takes place every six months and is widely publicized by the organizing ministry, the Integrated Child Development Services.

Designated office-bearers along with the citizens get an opportunity to walk up to the Anganwadis and audit the performance of the center over the last couple of months. A very powerful tool by the letter of the law.

However, when at Seva Setu audited the audit today, we found a different story. No audit really happens! The letter of the law is all the remains. Most Anganwadi centers were busy doing paper work related to Aadhar and ration cards. Further, we found out some centers which were not functioning at all!

Expected vs. reality – Social audit program by the department of ICDS where the society is supposed to walk up to Anganwadis and ask how the last 6 months have been. Of the ten we visited randomly today, none had the audit going on!

Further, some Anganwadi centers were dysfunctional!

Non-functioning Anganwadi center number 101 at Kurthol village, Phulwari block in Patna, Bihar.

Minutes of the audits maintained by the Anganwadi centers. This is a boilerplate message, without real information on any actionable items or discussions, being used for the last couple of years.

Attendance logs maintained by the Anganwadi centers. It shows most of the members required to be at the audits to be missing.

Jago Ganatantra, Jago! Spread the word to make those who err sit up and notice.
We also have a detailed report on our findings which we hope to publicize. If you have ideas on how to make this go viral, please drop a comment here. Further, to read our detailed report on this, drop a comment here – happy to share it with you.