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Indulging in fancy hyperbole

Young Bites. Dated: 9/20/2017 11:14:40 AM

In 2005, the central government launched the National Rural Health Mission (NRHM) under which it proposed to increase public expenditure on health as a proportion of the GDP to 3% from 1%. But increased expenditure without appropriate policy reform is unlikely to suffice. Experience to-date inspires little confidence in the ability of the government to turn the expenditures into effective service. Rural India consists of approximately 638,000 villages inhabited by more than 740 million individuals. A network of government-owned and -operated sub-centres, primary health centres (PHCs) and community health centres (CHCs) is designed to deliver primary health care to rural folks.Sub-centre is the first contact point between the community and the primary health care system. It employs one male and one female health worker, with the latter being an auxiliary nurse midwife (ANM). It is responsible for tasks relating to maternal and child health, nutrition, immunisation, diarrhoea control and communicable diseases. Current norms require one sub-centre per 5,000 persons, one PHC per 30,000 people and one CHC per 120,000 people in the plains. Smaller populations qualify for each of these centres in the tribal and hilly areas. Each PHC serves as a referral unit to six sub-centres and each CHC to four PHCs. A PHC has four to six beds and performs curative, preventive and family welfare services. Introducing new schemes with ambitious targets is like indulging in fancy hyperbole because where will the money for achieving these targets come from? It’s clearly not business as usual for our health sector. There needs to be a calibrated focus to address disparities in budgetary allocations, disparities within and among states and regions, there is an inevitable need to bring health services under the umbrella of universal health coverage. Our policymakers cannot seek refuge under the veil of statistics and figures. They ought to focus on devising schemes that focus on special requirements of susceptible, hardest-to-reach populations and the marginalised sections of society. Health workers and medical professionals in rural areas ought to be adequately remunerated, lest they indulge in malpractices. They need to wake up to the reality that affordable lifesaving medicines and procedures continue to remain inaccessible to a vast majority of our population. All these challenges can only be confronted when the policymakers accept the fact that healthcare infrastructure is as essential, if not more, as physical infrastructure for the development of our economy. Hence, it is important to substantially boost the public expenditure on the health sector as in developed countries of the world. Each CHC has four specialists — one each of physician, surgeon, gynaecologist and paediatrician — supported by 21 paramedical and other staff members. It has 30 indoor beds, one operation theatre, X-ray and labour rooms and laboratory facilities. It provides emergency obstetrics care and specialist consultation. Despite this elaborate network of facilities, only 20% of those seeking outpatient services and 45% of those seeking indoor treatment avail of public services. While the dilapidated state of infrastructure and poor supply of drugs and equipment are partly to blame, the primary culprit is the rampant employee absenteeism. Nation-wide average absentee rate is 40%.The employees are paid by the state, with the local officials having no authority over them. Not surprisingly, many medical officers visit the PHCs infrequently and run parallel private practice in the nearby town. ANMs are frequently unavailable for childbirths even if the mother is willing to come to the PHC. Though PHCs are supposed to be free, most of them informally charge a fee. Under these circumstances, even many among the poor have concluded in favour of private services.