As per a new survey by WaterAid India at a time when nearly eight in 10 Indian babies are delivered in hospitals, there are around 343 healthcare institutions across six states that often lack basic hygiene, toilets, clean water and waste disposal.
As per the report 60% larger community health centres in Madhya Pradesh lacked toilets just as 50% post-natal wards of primary healthcare centres. Madhya Pradesh no wonders has maternal mortality rate higher than war-torn Syria.
Odhisa's Ganjam district fares worse that African country Gabon with regards to maternal mortality rate as open defecation was allowed within 38% and open urination in 60% of health facilities (PHCs, CHCs, area and district hospitals) in Odisha's Ganjam district.
Competing MP and Odisha is Karnataka's Raichur district which has maternal mortality rate worse than Zambia. The district reported having adequate cleaning chemicals and equipment but since 76% of cleaning staff posts were vacant, seven in 10 toilets were dirty.
How do these worse facilities affect India:
So, despite the fact that 79% of babies were born in hospitals in 2011-12, up from 41% in 2005-06, according to government data, India continues to have the highest rate of maternal and infant mortality among emerging nations.
As a result of such worse facilities, India has the highest rate of maternal and infant mortality among emerging nations. These figures are there though India registered 79% institutional deliveries in 2011-12 which is an increase from 41% in 2005-06.
Some more disturbing figures:
There were largely no data or national planning for Water and sanitation hygiene (WASH) facilities - as they are collectively called - were often absent in PHCS, CHCs, area and district hospitals surveyed by WaterAid during the years 2014 and 2016.
WaterAid had surveyed 12 districts of Uttar Pradesh, Madhya Pradesh, Andhra Pradesh, Telangana, Odisha and Karnataka. The survey revealed that if pipes were laid, water was often unavailable at such healthcare centres.
As many as 167 Indian mothers die during every 100,000 live births, a rate higher than Cambodia with 161, and 22 infants die after every 1,000 live births, according to the Ministry of Health and Family Welfare data.
The WaterAid study indicates that unhygienic hospitals could be a reason why India's maternal and infant mortality rates are almost similar to Cambodia, Bangladesh and Nicaragua, all poorer nations in terms of per capita income. This is despite government programmes like Janani Suraksha Yojana which aims to reduce maternal and child mortality rate.
Which states lag behind:
As per the WaterAid survey Andhra Pradesh had the lowest percentage (28%) of toilets in health facilities, while Telangana had 47.6% as per the health ministry's data. Four other states which were surveyed showed that more than 50% healthcare facilities had toilets but that necessarily didn't mean they were well maintained or had water.
A look at the findings in each state (the survey parameters differed in many states):
Madhya Pradesh: Few toilets, medical waste dumped
The survey was conducted in Bhopal, Sehore, Panna and Tikamgarh districts across 76 public health facilities on WASH infrastructure.
Up to 27% of sampled CHCs in the four districts did not have a toilet in the labour room; 50% did not have a toilet in the post-natal ward, while 38% PHCs did not have a toilet in the labour room and 60% did not have toilets in the post-natal ward.
Waste, including medical waste, was thrown near 40% of 48 borewells across the four districts. Stagnant water present around them raised the possibility of contaminated water.
Up to 75% of PHCs and CHCs in Bhopal, 87% in Sehore and 95% in Pannahad dumped waste in or near the compound walls. Less than four of 10 PHCs and CHCs in Bhopal and Sehore had soap in the labour room.
Only 43% of 76 medical officers (one per facility) interviewed reported having training on preventing infections.
Odisha: Dodgy toilets, waste water released in the open
The Odisha survey was limited to 34 public health facilities and one district hospital in Ganjam district. More than 60% of toilet facilities were found to be unclean and non-functional.
Nearly half the facilities had never chlorinated water tanks, making them vulnerable to waterborne diseases; 73% of health facilities did follow a safe-filtering technique (reverse osmosis/ chemical process/ biological process) for their drinking water. Waste water was drained into open areas in almost 85% of health centres.
Up to 96% of the facilities had wash basins inside the labour room.
Karnataka: Enough cleaning equipment but dirty toilets because staff posts vacant
Up to 30 healthcare facilities were surveyed in the district of Raichur. With a maternal mortality rate of 255 per 100,000 live births, it was only slightly better than Nepal with 258; with 71 infant deaths per 1,000 per live births, the infant mortality rate was the same as Nigeria (69), according to the zilla parishad, a local government institution, website.
Seven in 10 facilities had unhygienic toilets because there was no one to clean them: 76%of cleaning staff posts were vacant. Of 30 facilities, 12 did not have a urinal and open defecation was evident in 63%.
Of 17 facilities with borewells, the area around the wells was clean in 11 facilities; in the other six, the area was filled with garbage.
As many as 27 facilities (90%) reported adequate cleaning agents, such as detergent and disinfectant; 23 facilities (77%) reported cleaning equipment, such as brooms, mops, and buckets.
Telangana and Andhra Pradesh: Water and wash-basin shortages and poor water quality
Both the states were clubbed together, with one districts from each state surveyed: 81 healthcare facilities from Vizianagaram in AP and 59 facilities from Nizamabad in Telangana.
Nearly 22% of toilets were either not working or were broken, 25% were inaccessible, 24% were dirty, 24% did not have enough water and 24% had no wash basins within 5 m of the toilet.
In Vizianagaram, 36% of sampled PHCs reported inadequate water, as did 47% PHCs in Nizamabad. Despite reports of poor water quality, less than half the PHCs and CHCs in both districts regularly chlorinated their water.
Up to 19% of facilities did not have wash basins near toilets and patient-care areas and 25% did not have soap.
Uttar Pradesh: Dirty first- and second-tier healthcare, poor hand hygiene in hospitals
Conducted across 63 healthcare facilities in Varanasi, Agra, Lucknow and Banda district, the UP survey was conducted on behalf of the Ministry of Health and Family Welfare. Health facilities were scored on a scale of one to 10, with 10 being the best quality.
PHCs and CHCs scored 0.83 and 3.75, respectively; most were unclean. District hospitals scored 3.75. The average hand-hygiene score in district hospitals was 4.35, and was 3.01 and 1.42 for CHCs and PHCs respectively.