Looking at the idle labourers at the construction site, Dr Vaidyanath Ram, the medical officer at Rafu, says, “In the unlikely event of the building being ready in a couple of years, I hope I will be out of this place. Kab tak koi rahega yahan? (How long can anyone stay here?). Till I joined two years ago, the pharmacist was known as the doctor. I doubt anybody will come to Rafu.”

Health minister Ashok Bhatt has only words of assurance, “All the vacancies in our PHCs have been filled. Where we could not find doctors, we have appointed ayurvedic practitioners.” However, primary healthcare in Gujarat is visibly in a shambles. In its own quality assessment report of May 2007, the department of health and family welfare has categorised the output of 86 per cent of the 352 PHCs and CHCs in the state in Grade D, while the remaining 14 per cent are in Grade C.

Yet, it is planning to seek accreditation of its facilities from the United Nations Population Fund.

According to the Gujarat Human Development Report 2004, only a third of the state’s population relies on public health facilities. Savitaben Sadhu, of Kumbhariya village in Rapar block in Kutch, says, “For ten years, the PHC sub-centre in our village was abandoned. Female health workers have been recently posted here. To see a doctor, we have to go to another village, but we prefer going to a private doctor.”

“The primary health centre in Fatehgarh, in Rapar block of Kutch district, remains under lock and key for the most part of the day,” says Bijalbhai Sagan, of Khadeg village. The medical officer, Dr FB Sahay, of the Fatehgarh PHC was taking a nap in the staff quarters when we contacted him. “There are hardly any health problems here. We hardly see any malaria, dengue, tuberculosis or respiratory problems here. We do not conduct any deliveries here either. Medical camps are held whenever a minister’s visit is due,” says Sahay. “Six posts of nurse, male worker, malaria worker and pharmacist are vacant out of a total of 13 posts.”

Dr D K Dabhi, the district health officer of Kutch, says, “The medical officers in each PHC are the custodian of almost 30,000 people. He has to attend malaria, tuberculosis and other medical camps apart from going to the subcentres and attending meetings at the block and district levels. Due to these reasons, they might not always be available for OPDs in their own PHCs.”

Health Commisioner Amarkeet Singh says, “In Gujarat, there has been a 25 per cent increase in the number of patients going to PHCs and CHCs in the last one year. The medical officers at the PHCs are trained to provide services in rural areas and are doing good work.”

In Rajula taluka in Amreli district, few doctors stay in the villages. “One pharmacist and one lab technician is shared by three PHCs in Dungar, Bherai and Vavera. Despite this being a malaria endemic zone, the strength of malaria workers is not adequate here,” says Deepak Parmar, of Dungar village.

Dr Satish Paswan, a government medical officer who resigned recently says, “Government doctors are infamous for malpractices. While most of them cannot be found in their PHC during office hours, those who are present often sell government medicines to their patients. Even the nurses take a fee for conducting deliveries.”

According to an assessment of monthly OPDs and expenses in PHCs conducted by the department of health and family welfare in 2006, almost 70 per cent of the PHCs did not conduct any deliveries, leaving the rural women with no option but to go to private doctors.