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Rural Health Services in India!
Health forms an Important index of human development and in turn that of the development of any society. It is the fundamental human right. Health, defined as the state of complete physical, mental, social and spiritual well-being and not merely absence of disease and infirmity, proves to be a major contributor to the level of quality of life. Healthy population plays a key role in achieving the developmental activities as health helps to improve the productivity of mankind both directly and indirectly.
The health picture of our country is far from satisfactory. The vision of “Health for all by 2000” has not materialized. The situation in rural areas of India, where over two-thirds of our population lives is worse with only rudimentary health care services being available to the masses.
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All the recent advances in medical science and technology have not reached the majority of the disadvantaged people living in rural India. Poor socio-economic status and poor health status together make a vicious cycle wherein poverty brings inadequate nutrition, unhealthy environment, sickness causing low productivity and hence poverty.
India, with a wide range of topographic and climatic conditions has witnessed various types of natural disasters. During 2001, eleven states were affected by heavy rains and floods, one with a cyclone and three with landslides. In most of these calamities, the worst affected is the population of rural areas.
Health does not exist in isolation. It is influenced by a host of genetic, environmental, social and economical factors related to each other. Poverty is related to health. Poverty, though difficult to define, is much more than Just the lack of money. It is a state that involves the total life of a person, his/her food, clothing, housing, education, health, family life and aspirations.
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Poverty leads to sickness by depriving individuals of their needs of adequate nutrition and shelter and by exposing them to hazards of poor sanitary conditions. It is an established epidemiological fact that the prevalence and distribution of disease is strongly influenced by socio-economic factors. Poverty also predisposes one to crime, violence, drug abuse and many other forms of deviant behaviour. All these are responsible for low productivity, which in turn leads to poverty.
Health Situation in Rural India:
To know about the health standard of a society, we need to understand some of the indicators of health. The commonly used indicators are: Crude Death rate. Infant mortality rate, Birth rate, Sex ratio, Life expectancy at birth and access to health care services. In the following table, on a few of the health indicators it is clear that the rural areas have far poorer health standards in comparison to the urban areas.
History of Rural Health:
To understand the health situation of rural India, we should study the present health care services available and their evolution from the time India became independent in 1947. At that time the health status of the people was the poorest in the world. Expectation of life at birth was 26.9 years for males and 26.5 for females. 50% of the deaths were among children under the age of ten and in his group half of the mortality took place during the first year of life.
Bhore Committee:
This Is the Health Survey and Development Committee setup in 1943 and gave its report in 1946. The basic principles of the report are that no individual should be denied of adequate medical care on grounds of inability to pay, special emphasis should be given to preventive work, focus on rural population and active co-operation of people must be secured in the (development of health programmes.
The committee recommended that a living wage for all workers, improvement in agriculture and industrial production, elimination of unemployment, suitable housing and clean environment are essential for healthy living.
The First Five Year Plan:
It accepted the suggestions of health survey committee and First Primary Health Centre was established in October 1952 as a part of the community Development Programme. It was based on the objective of bringing about multi-faceted development of rural areas.
The major function of Primary Health Centre (PHC) under the integrated, creative, preventative and promotional— approach to the development of health services was:
(i) Medical care.
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(ii) Control of communicable diseases.
(iii)Maternal and child health
(iv) Collection of vital statistics.
(v) Protection of water supply and environmental sanitation,
(vi) Conduct of school health programme,
(vii) Family planning services which were added on later.
In the second Five Year Plan (1956-61), the thrust was to expand the then existing health services and to bring them within the reach of all the people.
The Mudaliar Committee:
This was the health survey and planning committee appointed to assist and review the development of health care services in independent India. Its report was submitted in 1961.
Mudaliar Committee recommended:
(i) Consolidation of the then existing services before taking up any expansion.
(ii) Strengthening of staffing in the then existing PHCs.
(iii) Each PHCs should serve a population of 40,000 instead of 60,000.
(iv) Not to open any new PHC without ensuring the full staff component.
(v) Strengthening of the district hospitals with mobile clinics to cover non-PHC populations.
Kartar Singh Committee:
In 1973, a Government of India’s Committee, known as Kartar Singh Committee recommended the provision of integrated health and family planning services through multi-purpose workers. It reviewed the functions of PHCs and observed that there was little co-ordination among the various health workers.
It recommended:
(i) One male multi-purpose worker for a population of six to seven thousand initially.
(ii) One female health worker for a population of ten to twelve thousand,
(iii) Integrated training for all workers,
(iv) Co-ordination of programmes and personnel.
In 1977, the new Government at the centre launched a Community Health Worker Scheme. The objective was to provide health services to rural population through village level community workers. This programme also collapsed because of several schemes.
The Fifth Five Year Plan (1974-79):
It acknowledged that the health care services in the rural areas had expanded at the cost of the rural services. It intended to provide integrated health services, family planning services and nutritional packages through the Minimum Needs Programme (MNP).
Primary Health Care:
In 1978, India signed the Alma-Ata Declaration on “Health for All By 2000 A.D.”. Here also primary health care was visualised as the nucleus of the health care system.
According to the declaration:
“Primary health care is the essential health care based on practical, scientifically sound and socially acceptable methods made available to one and all the members of the community with their full participation and at a cost that the community and the country can afford”.
Primary Health Care covers:
(i) promotive, preventive, curative and rehabilitative services.
(ii) Prevention and control of endemic diseases.
(iii) Adequate supply of safe water and basic sanitation,
(iv) promotion of food supply and nutritional services,
(v) maternal and child health care.
(vi) family planning services,
(vii) provision of essential drugs.
(viii) immunization against vaccine preventable diseases,
(ix) health education regarding prevailing health problems and their solutions.
The Sixth Five Year Plan (1980-85):
National Health Policy was adopted in 1983 during the sixth plan.
The policy emphasised the need to re-structure the health services with the following aims:
(i) Provision of a network of primary health care services with organised support of the volunteers, auxiliaries, paramedics and adequately trained multi-purpose workers.
(ii) Location of curative centres according to the size of the population they serve.
(iii) Large-scale transfer of knowledge, skills and techniques to health volunteers selected by community,
(iv) Efforts to build up individual self-reliance and community participation.
(v) A well-functioning referral system to provide support to family health care,
(vi) Establishing a nation-wide chain of sanitary-cum- epidemiological stations to provide integrated service to eradicate/control diseases.
(vii) Support of voluntary agencies in health services.
(viii) Establishing centres for specialised treatment whatever required.
(ix) Make special efforts in the areas of mental health and rehabilitation work.
(x) Priority to the provision of services to people living in tribal, hills, backward and disease prone areas.
Seventh Five Year Plans (1985-90):
Special emphasis was given to Rural Health Care in the seventh plan
It stipulated the establishment of the followings:
(i) One sub-centre for a population of 5,000 in planes and 3,000 in tribal and hilly areas,
(ii) One Primary Health Centre for a population of 30,000 in planes and 20,000 in tribal and hilly areas,
(iii) One Community Health Centre for a population of 1,00,000 (One Block).
It was envisaged to cover the entire population by setting up 54,883 sub-centres and 12,390 PHCs. But the targeted 1,553 Community Health Centres were not sufficient to cover even of the population. In view of the significant epidemiological and demographic changes in the country, an exercise was undertaken by the ministry of Health and Family Wildfire to revise the National Health Policy.
The revised draft of National Health Policy has since been formulated. The main objective of this policy is to achieve an acceptable standard of good health amongst the general population of the country. The Department of Health is implementing disease control programmes for controlling communicable diseases such as Malaria, TB, Leprosy and AIDS, as well non-communicable diseases like blindness, cancer, mental disorders etc.
Disease surveillance programme is also under implementation in 100 districts with a proposal to be extended to cover the entire country during tenth plan period. The plan outlay for the central health sector scheme during the year 2001-02 was Rs. 1,450 crores which is an increase of 11.5% over the outlay of the then previous year.
The Government of India decided to expand the National Surveillance Programme for Communicable Diseases (NSPCD) (started as a pilot project in 1997-98) to the entire country under Integrated Diseases Surveillance Project. All states/union territories would be covered in a phased manner during the five-year project (2004-2009).
This project will undertake surveillance of important communicable diseases which include Acute Diarrhoeal Diseases (Focus on Cholera), Typhoid, Measles, Polio, Malaria, TB, Plague and state specific diseases. Surveys of risk factors for non-communicable diseases would also be undertaken under the project. This project was launched in November 2004. The project has been Initiated in 23 states/UTs under phase—I and II of the project. Remaining States/UTs will be covered during 2006-07.