No Muzaffarpur medical centre has a rating better than zero

While the state and Union governments are now scrambling to deal with the outbreak of acute encephalitis syndrome (AES) disease in Bihar's Muzaffarpur, official data shows the shocking state of the public health infrastructure in the district. The health ministry's health management information system (HMIS) shows that all of the 103 primary health centres (PHC) and the only community health centre in the district were not considered even fit for evaluation or were rated 0 out of 5.
The mandatory requirements for a PHC to be evaluated under HMIS were that if it is a 24x7 centre, it has to have at least one medical officer, over two nurse-midwives and a labour room. For non-24x7 centres, all that was needed was at least one medical officer and one nurse. Yet, 98 of the district's 103 PHCs could not meet even these minimum requirements and hence were not graded in the 2018-19 evaluation.
At least 98 of Muzaffarpur district's 103 primary healthcare centres (PHCs) could not meet even minimum requirements. Of the remaining five, every single one got a zero rating. The rating consists of three points for infrastructure and two for services. Thus, each of the five failed miserably on both counts.
Incidentally, according to the official norms, there is supposed to be one PHC for every 30,000 population in the plains. By that count, Muzaffarpur should have had over 170 PHCs for its population of a little over 5.1 million.
The situation of the lone community health centre (CHC) was no better. In the 2017-18 rating of CHCs, the one in Muzaffarpur was rated "not eligible". This is because it failed to meet the mandatory criteria required for being rated.
What were these mandatory criteria? In terms of staffing, there should have been two or more doctors, six or more nurses or ANMs (auxillary nurse-midwife) and at least one lab technician. As for infrastructure, there should be an operation theatre, a generator and separate "public facilities" (read toilets) for men and women.
Again, Muzaffarpur's population should have meant it should have at least 43 CHCs, given the norm of a CHC for every 1.2 lakh population in the plains. Instead, there is just one and that in a shape that does not even merit evaluation.
What makes this situation particularly shocking is that the district has been witnessing deaths of scores of little children at this time of the year every year for the last two decades or more. And yet, successive governments have not bothered to beef up the public health infrastructure to cope with even routine health needs, leave alone a medical emergency they know will hit unfailingly each year.