Tamil Nadu grappling with severe shortage of village health nurses

Tamil Nadu is grappling with an acute shortage of Village Health Nurses (VHNs), who play a crucial role in maternal and child healthcare. Not only is the percentage of vacancy nearing 50% in some districts, the existing VHNs — some of whom are handling over two Health Sub Centres (HSCs) each — are struggling to keep up with data entry work on multiple portals for registration of pregnant women, antenatal care and immunisation.

The State has 8,713 HSCs. Each centre has to function with one VHN. While health officials maintain that around 2,500 VHN posts are vacant, many VHNs and associations representing their demands said the number of vacancies has crossed 3,000. In the long run, this shortage could affect maternal and child health (MCH) services.

“In the plains, one VHN covers a population of 5,000, while it is 3,000 on the hills. But this is no longer the case. Many VHNs are now covering a population of at least 10,000. There are VHNs who are in-charge of two or three HSCs in some places, including hilly regions. This is because the vacant posts were not filled on time,” a VHN said.

Salem, Cheyyar, Namakkal, Dharmapuri, Kanniyakumari, Sivakasi and Krishnagiri, were among the places where there was a significant number of vacant posts, a number of VHNs pointed out.

“Our primary duty is to focus on MCH services. We [VHNs] have to cover adolescent girls, keep track of pregnant women and children. We have to prevent higher order births and ensure that high-risk pregnant women are taken care of. Field work is our forte, but we are loaded with online data entry work for various schemes,” one such nurse said. “If the quality of MCH services drops, how can the State achieve further reduction in infant and maternal mortality?” a VHN asked. “Entry on Pregnancy and Infant Cohort Monitoring and Evaluation (PICME), a State portal, that leads to Dr. Muthulakshmi Reddy Maternity Benefit Scheme and U-WIN (a Government of India portal for immunisation) is done by VHNs. They have to enter details for antenatal registration, vaccination of pregnant women, delivery and immunisation of children. They also need to make monthly entries on Health Management Information System and Integrated Health Information Platform portals. This entry on multiple portals has increased their workload,” a source said. Many of them were aged above 45, and have no periodic training in skill enhancements or computer skills.

VHNs had to make these entries on their mobile phones as the laptops that were given to them about five to six years ago were no longer working, and returned. “We have to upload details after every visit such as antenatal and postnatal visits. Often, these portals have technical glitches and are slow. Many of us start the data entry work after 10 p.m. and continue till midnight. Many are stressed, have vision problems and back and neck pain. Some are nearing retirement too,” a VHN said.

P. Nirmala, State president, Tamil Nadu Public Health Nurses Federation, demanded that the vacancies be filled immediately and more HSCs be established in proportion to the increase in population. There should be data entry operators for the online work in every Primary Health Centre.

With a court case against the recruitment of VHNs pending, officials said that measures were being taken to get the case listed at the earliest in the Supreme Court.

T.S. Selvavinayagam, Director of Public Health and Preventive Medicine, said existing VHNs who took additional responsibility for the vacant areas, and trying their best to provide services in both areas, should be appreciated. “Some of the Sector Health Nurses and Community Health Nurses have stepped in to help with the field activities, particularly during immunisation services,” he said.

In future, additional HSCs will be created based on the population in rural and urban areas, he said, adding: “We are working with NIC, ELCOT and a National Health Mission team to improve the performance of the PICME portal. It will be more user-friendly with increased speed. I have already given instructions to utilise the services of existing data entry operators for entering data in the U-WIN portal after immunisation details are given by VHNs. Now, we are increasing the immunisation coverage at the institutional-level using the existing staff, which will reduce the load for field staff.”