State sponsored health care in rural Uttar Pradesh: grassroots encounters of a survey researcher.

This paper reports on impressions gained by the author while gathering data for a baseline survey on the delivery and quality of health and family planning (FP) services in rural Uttar Pradesh in India. Data were collected from FP staff and acceptors. The author found that the public health service staff were often derelict in their duties and failed to maintain proper records. Staff positions were secured and kept through the payment of bribes. Bribes are also used to secure or prevent transfers to other districts. Staff morale was further demoralized by harassment in the form of delaying payment of salaries or travel allowances and by the creation of factions loyal to the Medical Officer-in-Charge and the immediately subordinate Medical Officer. In order to reform this system, it must be held accountable to the people it serves and must regain their confidence. The presence of a privately-operated clinic in the area indicates that affordable services can be delivered. FP staff also require a means of transportation, such as mopeds, to allow them to increase their effectiveness. Despite this climate of derelict service provision, it must be noted that some personnel were performing an exemplary service to their districts.