MoU not renewed, govt grants pending: Chhota Udepur’s only obstetric and neonatal care centre to shut March-end

THE TRIBAL district of Chhota Udepur is set to lose its only Comprehensive Emergency Obstetric and Neonatal Care (CEmONC) centre at Jabugam (now in Bodeli taluka), which caters to a population of close to 12 lakhs, sees more than 4,000 out-patient department (OPD) consultations and nearly 300 free-of-charge natural and assisted deliveries, including high-risk pregnancies, every month.

A three-year memorandum of understanding (MoU) between the Gujarat Health and Family Welfare Department (GH&FW) and the Deepak Foundation, for the operating of the Jabugam centre under a public-private partnership (PPP) model expired in March last year and has not been renewed yet.

According to the district administration, the foundation, a CSR arm of the Vadodara-based Deepak Nitrite Ltd, was “asked to continue” operating the unit. However, with the government grants due for the financial years 2017-18 and 2018-19, apart from the non-renewal of the MoU, the foundation found it unsustainable to continue and has relieved 23 of its staff. The MoU was due for renewal on April 1, 2020.

Earlier this month, District Collector Sujal Mayatra wrote to the GH&FW department in the matter, while BJP MLA Abesinh Tadvi wrote to Deputy Chief Minister Nitin Patel, who holds the health portfolio, urging that the MoU be renewed soon. More recently, Congress legislator Sukhram Rathwa had raised the issue in the ongoing Assembly session.

The foundation, which has been running the centre since 2016, told The Indian Express that in October last year the health department officials had assured the issue would be looked into, but with nothing moving it has decided to shut down from March 31.

Chief District Health Officer (CDHO), Chhota Udepur, Dr MR Chaudhari said, “The MoU is directly between the state health department and the Deepak Foundation, so the district administration has no role in resolving the issue. We can only send reminders and requests and the District Collector has already written to the government seeking urgent attention in the matter. The centre is the only one in the district for the entire tribal population and patients from even Madhya Pradesh visit here to benefit from the service. It will be an extreme setback to the healthcare system of the district.”

The unit, Chaudhari said, had helped in reducing MMR and creating awareness among the tribal population about pregnancies and deliveries. “For years, they (the tribals) relied on home births, which was the main factor behind high MMR here,” he added.

According to the CDHO, the district neither has staff nor funds to run the centre as it was “dealing with the Covid-19 situation and vaccinations simultaneously”. After the Deepak Foundation leaves on March 31, the state health department will have to make a call to decide what would be the next step, he added.

Sunita Rathwa, the in-charge of the Jabugam CEmONC administration, said as many as 100 deliveries are scheduled for the first week of April itself. With no word from the government, however, the centre had to relieve 23 staff members and ask patients to look for other doctors to continue their follow-ups.

Dr Mukesh Dobaria, a gynaecologist at the CEmONC centre, told The Indian Express, “Because of the lower socio-economic status of tribal population, we advise them to go SSG hospital in Vadodara (about 80 kilometres from the centre), which is the only other closest facility for free deliveries. But most of the patients refuse to travel that far.”

In his letter to the Deputy CM on March 8, Sankheda BJP MLA Tadvi said, the CEmONC “has been instrumental in ensuring a decline in the rate of infant and maternal mortality ratios (MMR). But for the last three years, CEmONC has not received the stipulated grant from the government. The centre has not received Rs 78.24 lakh in the financial year 2018-19 and Rs 77.71 lakh in FY 2019-20. In the ongoing FY 2020-21, it has not received any grant at all although the year is coming to an end.”

Urging that the grants are released and the issue resolved at the earliest, Tadvi also pointed out that the foundation had been serving at the CEmNOC centre without the official renewal of the MoU. “The state government has not yet signed the MoU and all these things have caused a financial burden on the foundation, which is finding it difficult to sustain such an important healthcare facility for the tribal district”, the letter stated.

Congress MLA from Pavi Jetpur, Ratwa also raised the matter in the Assembly. “Chhota Udepur district has a severe shortage of doctors and paramedic staff. It is my request that for tribal areas, the government must spend and fill these vacancies. The CEmONC centre being run by Deepak Foundation has done excellent work in the area. But for the last two years, they have not received any of the stipulated government grants and are relieving 23 staff members. Imagine the condition of the patients, who are seeking the healthcare facility,” the legislator said.

Mayatra’s March 19 letter requested that the MoU be renewed at the earliest so that “the emergency services for maternal and newborn care can continue uninterrupted”.

In a statement to The Indian Express, the Deepak Foundation said the GH&FW department requested them to submit a proposal for the renewal of the MoU with an estimated budget for the PPP project on November 6, 2019 — five months before it was set to expire in March 2020.

“The Foundation submitted the proposal on November 19, 2020. Usually, the renewal is for three years. In April 2020, the National Health Mission approved the Program Implementation Plan (PIP) submitted by the state government of Gujarat, which also reflects on the record of proceedings (ROP) on the website of the NHM. Thereafter, we communicated with Dr Nilam Patel, the Additional Director of GH&FW department, as well as with the former director of NHM and state Principal Secretary GH&FW Dr Jayanti Ravi to seek a signed copy of the MoU as well as the official response regarding the pending dues and the release of the first instalment of the pending payment to meet the expenses incurred during the first quarter of FY 2020-21. In October 2020, Dr Ravi assured us through a telephonic conversation about looking into the pending file,” the foundation’s Dr Mukesh Giri Goswami, who is also the in-charge clinical service CEmONC, Jabugam.

Dr Goswami said the centre saw 4,527 normal deliveries and 1,357 high-risk deliveries between April 1, 2019, and March 31, 2020. It saw 3,402 normal deliveries and 1,127 high-risk deliveries from April 1, 2020, to February 28 this year.

According to CDHO Chaudhari, anaemia and malnutrition are common problems among pregnant women in the district leading to children born with deformities. “The birth weight becomes a cause of concern as many newborns weigh between 1 kg and 1.5 kg. The centre has been crucial in ensuring the survival of babies with poor birth weight apart from maternal care, as the age of the mother and the family income also plays a very important role,” Chaudhari said.

When contacted, Additional Director of Health and Family Welfare Dr Nilam Patel said, “The file is pending with the government.” Dr Jayanti Ravi did not respond to calls or text messages.