While the country has been fighting the second wave of the COVID-19, it seems some of the core health issues have been overshadowed and the focus has been distracted. One of the major health issues is the increased Infant Mortality Rate (IMR) in rural areas of Assam.
In a period of over 12 months, from April 2020 to March this year around 60 infants (age group – 0 to 12 months) died out of nearly 1800 births under Gogamukh Community Health Centre (CHC) in Dhemaji district.
The Gogamukh CHC, which had been upgraded to First Referral Unit (FRU), has a total of 18 sub-centers, out of which 13 falls under Gogamukh area, 5 in Bordoloni area; and 2 more health care centres are also available established under Ayushman Bharat Health and Welfare Centre.
The report of pregnancy is first reported in the nearest Sub-centre and the registration is done here and pre-natal care is also taken by the ASHA and the nurse appointed in the sub-centre.
PrasantaSaikia, the Block Programme Manager (BPM) of National Health Mission (NHM) said that there were several causes on the growing trend of the current IMR. He mentioned low-birth weight, preterm delivery, lack of Anaesthesiologist and Paediatrician in the CHC, prenatal food habits of the mother, lack of radiant warmer, lack of awareness on neonatal care, frequent power cut and low voltage (of grid-connected electricity), etc were the basic causes of the high IMR.
From some of the sub-centres, they got pregnancy-related complications too. After registration on three months pregnancy, the woman undergoes certain medical checkups like blood pressure, blood test, weight and also TT vaccination.
Out of these 1800 deliveries, four mothers also died which too cannot be ignored as trivial.
The average rate of IMR dropped from 47.3 in 2009 to 28.3 in 2019 (out of 1000 infants). The drop was gradual but the data reluctantly revealed by the authority of Gogamukh PHC in March this year was appalling and the mortality rate is much higher than the national average which stands at 33.3. Unofficial sources claims the number of infant mortality was relatively higher. The UN Sustainable Development Goals (SDGs) targets to end the IMR by 2030 in its member countries.
Saikia further said that grid-connected power is not dependable to operate radiant warmers for infants and to maintain the cold chain for certain medicines in the sub-centres with existing infrastructure. Frequent disruptions, long power cuts and voltage fluctuations often affect the cold chain of some medicines.
Reiterating on dismal power situation he said that during load shedding the hospital uses a 35 KV Diesel Generator (DG) provided to the hospital by the National Hydroelectric Power Corporation Ltd (NHPC) under the company’s Corporate Social Responsibility (CSR) fund, but it’s too costly to operate because of high fuel cost.
Maintenance of the DG was another issue. During the warranty period it was looked after by the manufacturer but beyond that time period it was very hard to operate and maintain, the funds provided by the government were not adequate for it, he added.
The remaining available option is the installation of Solar Photo Voltaic (PV). At Borola and Adut sub-centres solar PVs had been installed much earlier but now are defunct. Assam Power Distribution Company Ltd (APDCL) installed a set of Solar PV at Jayrampur sub-centre which is still functioning but NHM provided the solar installation is not working at Nalbari. The cause for dysfunction of the solar power PV system can be attributed to lack of maintenance and skilled person(s) to maintain the installations.
Fatalities in the cases of non-communicable diseases like cancer, diabetics and others became much higher over the period. Sources told that Covid-19 protocols restricted in accessing early detection of such diseases.
World Resources Institute India, has been working with partners for improved healthcare services in rural and disaster-prone areas of Assam by providing off-grid solar to health care centres.
Masfick Hazarika, Senior Project Associate of WRI, India shared their experience of installing solar PV in remote areas of the Karimganj district.
In order to ensure proper operation and maintenance a training and capacity building program was organized when the installation was completed.
The program was for local electricians, NHM staff and local NGOs working in the area. The project involved solar PV vendors with an extensive presence in the area and they are available to troubleshoot under their AMC contract as and when the need arises.
The spiraling new variants of Covid cases in the country exposed the dismal health care system. Many people from the remote villages of Assam and also from flood-prone areas realize that the rural health care system could be upgraded by improving its power situation by installing solar PV.
To improve the health care system the government must focus on the uninterrupted power supply and infrastructure development in urban as well as in rural areas.
SDG 7 which pertains to ensuring access to affordable, reliable, sustainable and modern energy can play a role in achieving other SDG goals, specifically SDG 3 which aspires to ensure health and well-being for all.
Monoj Gogoi is an environmental activist and he is associated with People’s Action for Development (PAD).