Primary Health Care in Maharashtra: Implementation issues, funding crunch hold back Manav Vikas scheme

The state-funded Manav Vikas Mission, launched in 2006 to push the Human Development Index (HDI) higher in rural and tribal regions, such as Nandurbar, is suffering from prolonged delay in payments to women beneficiaries.

Written by Tabassum Barnagarwala | Nandurbar | Published: March 13, 2018 2:59 am
Maharashtra budget, Maharashtra healthcare budget, Nandurbar, Health Care, Maharashtra Health Care schemes, Devendra Fadnavis, Manav Vikas scheme Sanga Vasave, who delivered her fifth child in September last year, in Nandurbar district, Maharashtra. She is still waiting for `4,000 benefit under the Manav Vikas Mission. (Express Photo: Prashant Nadkar)

It was in September last year when Sanga Vasave, 24, delivered her fifth child, a boy, in Chimalkhedi village of Nandurbar district in Maharashtra. Despite weakness, the anaemic woman returned to work in a farm 15 days after the delivery. Six months on, squatting in her dark hut with toddler Anil in her arms, she says: “Our ration was over. I could no longer sit at home.”

The state-funded Manav Vikas Mission, launched in 2006 to push the Human Development Index (HDI) higher in rural and tribal regions, such as Nandurbar, is suffering from prolonged delay in payments to women beneficiaries awaiting Rs 4,000 as loss of wages during pregnancy. Under the scheme, apart from educational benefits for the girl child, a pregnant woman from a scheduled caste (SC) or a scheduled tribe (ST) of the below poverty line (BPL) category receives Rs 2,000 in ninth month of pregnancy and Rs 2,000 within 30 days of the delivery.

Vasave’s husband earns between Rs 100 and 200 per day. With her labour, their income doubles. This is the story of each pregnant and lactating tribal woman in Chimalkhedi that holds a population of 700 in one of the most remote parts of Maharashtra.

“If the money had come, I would have rested longer,” Sanga says. In her bamboo and mud hut, few basic utensils, half a dozen clothes and a charpoy are the only belongings the family of six owns. “No woman in our village waits for the government to pay Rs 4,000, they just go to farms immediately after the delivery,” says Noorji Vasave, another local.

The scheme is functional in 125 talukas across 23 districts. Though well-intentioned, it suffers from low awareness, bureaucratic delays in funding and lack of coordination in implementation. For 2017-18, Nandurbar district estimated 30,914 tribal beneficiaries to receive Rs 4,000. Till January, only 9,733 women (31.4 per cent) got the entire amount, while 3,145 other women got only Rs 2,000. District data accessed by The Indian Express show in 2016-17, 4,200 women and in 2015-16, 2,332 women did not receive the benefits under the scheme. Of the Rs 11.89 crore sanctioned for this year, the district has received only Rs 4.91 crore from the state government.

Bhaskar Munde, Manav Vikas commissioner for Maharashtra, said that each taluka is allotted Rs 2 crore under the scheme, assuming 20 women would be registered with each primary health centre (PHC) every month. “It has been brought to our notice that certain talukas have higher birth rate. This year, we will increase the funding for such regions,” he says. An analysis by the state government shows that Igatpuri, Trimbakeshwar, Nashik Rural, Nandurbar and Gadchiroli record a higher birth rate and more beneficiaries.

But the issue, local health workers claim, is not only limited to poor funding. In Chimlakhedi, an auxiliary nurse midwife (ANM) has not visited the village for a year. Usually, an ANM reports to the district office about beneficiaries under the scheme following which the amount is deposited in the respective accounts. “I have repeatedly complained to doctors in the primary health centre that ANM is not visiting our village. No action has been taken,” says Accredited Social Health Activist (ASHA) Savita Vasave. Chimalkhedi has no road access — a boat or a trek through hills are the only modes to reach the hilly village. And so, it stoops lows on the priority list of health workers for routine visits.

Nandurbar has the lowest HDI in the state at 0.604, followed by Gadchiroli at 0.608 and Washim at 0.646 against the state’s average of 0.752. The idea to support a tribal or rural woman in difficult areas, during her delivery, is lost in the absence of financial aid.

In another hamlet in Akkalkuwa, Soni Vasave delivered her fourth child in August last year. She opened a bank account and linked it with Aadhar to avail of the scheme as per norms. Twenty days after the delivery, when ration started dwindling and money was still not deposited by the government, she joined her husband in labour work.

In her village, 20 such women have not received benefits under the scheme since 2017. Several women have also not been registered due to poor awareness creation by government officials about the scheme. Of the 30,914 estimated beneficiaries in Nandurbar, only 16,625 were registered for the scheme by ANMs and ASHAs in 2017-18 till January-end. The issue, local activists claim, has been repeatedly raised at district and state levels. According to National Health Mission Director Sanjeev Kumar, the health department only provides an estimation of pregnant women in PHCs, while the Manav Vikas commission monitors its payment.

Nandurbar District Collector Mallinath Kalshetti said, “I released Rs 4 crore in 2016 for Manav Vikas for beneficiaries. For those who are left, process of payments is underway.” With newly launched Pradhan Mantri Matru Vandana Yojana, which pays Rs 5,000 in first pregnancy, the Manav Vikas commission has issued a circular to stop benefits under its scheme for first pregnancy and allow it for subsequent pregnancies. Social activists claim allowing monetary benefit for multiple pregnancy will affect family planning, especially in areas like Gadchiroli and Nandurbar that witness higher birth rate.

Meanwhile, Somi Arvind Vasawe, 20, delivered a girl on January 18 this year. She tried opening a bank account to avail of the benefits under the Manav Vikas scheme. “I walked 8 km to the nearest bank thrice but they haven’t opened my account,” she says. She adds after a moment’s consideration, “But as it is, money won’t come. Look at all these women.”