Rural Health, a sorry figure

Oct 27: A sorry figure in Rural Health has been a major concern, once Rajiv Gandhi observed that out of every rupee meant for the anti poverty programmes only 15 paisa reached the beneficiary, out of 85 paisa may be 40 paisa can be accounted for as administration overhead, the leakage of the remaining 45 paisa is definitely due to corruption.

This is real story of what the government promise and happen actually in all most all sectors and hence the health.

In a country like India, where more then 50% of the population live in rural areas, executing a program that is essential to ensure proper health care in areas which remain aloof from the health services.

Recently an announcement came from the desk of Planning Commission (PC), the Deputy Chairman of PC Montek Singh Ahluwali, to invest 2% of its GDP on health in the 11 th five year plan (2007-2012).

He stated during 35 th Convocation of All India Institute of Medical Sciences (AIIMS) “There is a serious need for the expansion of healthcare facilities in rural areas and here the role of public (government) expenditure is essential. The government has decided to roll out double the fund for the purpose”.

He pointed the loopholes in its health sector which in spite of having done well has lot to achieve in this sector. Comparing the data’s he said that in 1956 the life expectancy was 37 years which has now reached up to 66 years.

“We have eradicated diseases like smallpox but majorities of our people in rural India continue to suffer due to lack of medical facilities,” he added.

Giving a look on the data he said, “At least 60 per cent of our pregnant women and 80 per cent of kids in the 6-18 month category are anemic. Our infant mortality rate is 58 per 1,000 births. This number is 36 in Indonesia and 32 in China”.

Comparing the data he mentioned “Our maternal mortality ratio is 301 (per 100,000 pregnant women) as against 130 in Vietnam and 56 in China. Still over 50 per cent of our pregnant women deliver babies without attendance of health experts”.

He said that primary healthcare centres were in bad shape, district hospitals lacked infrastructure as well as health personnel and that the government is analysing a couple of schemes like possibility of public partnership to boost the health sector and counting on his government measure to tackle the plight of rural health he further added that Prime Minister has already mentioned a proposed health insurance scheme for people below the poverty line.

He said that all stakeholders of the country should join hands to make it a world power.

“Our GDP growth is good and in the next 25 years we are going to be the third economic power of the world, after the US and China. In achieving this feat, our health sector needs to be strengthened,” he added further.

Sharing information on his Ministry’s work on Rural Health Anbumani Ramadoss, the Union Health Minister said, “Our National Rural Health Mission is beginning to show good results and we hope that you will play an important and productive role to ensure that programmes benefit the poorest of the poor in the country”.

The scene behind

The above listing cited by the Dr, Ahluwalia is the major problem in Rural Health sector, where people suffer from inadequate medical facilities; they are affected by different disease and have least access to proper health care. The infant mortality and maternal mortality has put India in a miserable state , the high rate in both these cases are due to several reasons but can be reduced taking proper measures including generating medical literacy, improving infrastructure and basic health care.

Poor health care facilities in rural areas are a mirror of our medical profession, which are much focused towards urban society. And one of the major shift towards specialization rather than public health as the primary service is the main concern.

In India the plight of villages should be address as there is shortage of specialist and overall infrastructure. The villages in Orissa, Bihar and Bengal the condition is even much poor. While a very stark difference we can notice in cities where we can find growing jungles of clinics with all the advance equipments.

The reason are quite simple as the cost of medical education is very high and after investing the precious years no body seems to inclined towards practicing in underprivileged area where there is lack of infrastructure and basic facilities.

In this world where everybody is thriving for a better life and the wage differences between public and private sector lure them.

Earlier the government used to spend 1% of GDP to the health sector which was inadequate and no equitable distribution of resources.

Though we have scaled progress in the field of health care, new challenges and problems have emerged out of the lack of development and knowledge. Problems like anaemia, high infant and maternal mortality rate, lack of sanitation are areas that need immediate attention.

There is a need of skilled professional in the rural health programme, also the Govt. should accelerate its plan to increase its contribution to health services and look into bringing in health insurance, which should go a long way in ensure affordable health care to all.

The government can retard the drain of doctors by dealing it first by providing them the infrastructure and minimizing the differences of wages.

NRHM - First step to cover a mile …

National Rural Health Mission (NRHM) was flagged in 2005 to provide effective health care to rural population throughout the country with special focus on the states having weak public health indicators and infrastructure.

The NRHM is to cover all the villages through “Accredited Social Health Activists" (ASHA) who act as a link between the health centers and the villagers. The ASHA are trained to advise village populations about Sanitation, Hygiene, Contraception, and Immunization to provide Primary Medical Care for Diarrhea, Minor Injuries, and Fevers; and to escort patients to Medical Centers.

They also deliver direct observed short course therapy for tuberculosis and oral rehydration to give folic acid tablets and chloroquine to patients and to alert authorities to unusual outbreaks.

Goals and strategies

The goals of the NRHM includes reduction in infant Mortality and Maternal Mortality, universal access to integrated comprehensive public health services, child health, water, sanitation, hygiene. Population stabilisation, demographic and gender balance are also focused with other programme.

But the problem is that the road is bumpy ahead, basic education and infrastructure facilities should be amalgamated with concerted effort of centre and state to implement the programme and with tight vigilance if the programme is going to the right direction.

Role of civil society is a must which act as a connecting link between state and people, and can play a major role in creating awareness and providing facilities to the far flung interior places.