The NRHM Scenario in Bihar

In a survey conducted in Bihar among 2 lakh rural households, it was found that only 8.39 % people had some kind of toilet in their homes. A large number of families did not have access to pure drinking water. There were potholes all over, where dirty water accumulated, and caused spread of disease.

Defecation in the open, excessive use of asbestos for construction, along with contamination due to the use of pesticides and insecticides (arsenic contamination) is causing health hazards. AIDS is spreading fast in North East Bihar, as migrating labourers going to Bombay, Gujarat and other Metro cities come back to their home towns during the agricultural season. On the other hand, lack of sanitation and unhealthy conditions have led to the spread of Dengue. However, the NRHM can only try to develop health infrastructure and services to the extent that the budget allocation permits. But considering the enormity of the task and its ever-growing character, it is the ASHA worker who hears the brunt of any laxity in developing health infrastructure and conducting health awareness campaigns. For example, in
the State the rate of population growth has been above the national average-it is 25.07 against the national average of 17.64. The Child Mortality Rate in Bihar is 42 (National average 40) and Maternal Mortality Rate is 219 (National Average 178) are also higher than the national average. Women’s Literacy stands at a dismal 53.33% as against the National Average of 65.46%. The Crude Birth Rate is 27.6 as against the National Average of 21.4.h These conditions have increased the pressure of work on the ASHA workers of Bihar. The health infrastructure has improved in the past few years in terms of the expansion of Primary Health Centres and Sub-Centres; yet there is a shortfall of 1220 PHCs and 8837 Sub-Centres and many remain unmanned or poorly manned by competent doctors and health workers. For example, 8822 posts for health workers lie vacant and there is a dearth of female doctors and child specialists. ASHA workers in the state number more than 71,350 and most of them come from families with low income and are from socially unprivileged communities. Their formal education is also only up to class 8 and most of them have joined the NRHM to earn some extra money, since their families were not in a position to educate them further. Several may be married and divorced or widowed; since unmarried girls are not given preference. The overworked ASHA worker in Bihar has to do multi-tasking. It is for this reason that in Bihar only 26% pregnant women are able to avail the 3 standard check-ups needed. Only about 50% deliveries are institutional deliveries. The immunization rate also stands at 40-45% in the entire Hindi-speaking belt.

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