| RURAL HEALTHCARE
SYSTEM IN INDIA: THE CHALLENGES AND REMEDIES |
| Revant R Gupta |
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B.Com. Student,
Narsee Monjee College of Commerce, Mumbai
University, Mumbai 400049 India |
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| In India healthcare has been a neglected
area by the government. That is evident from the
fact that in 2002 investment in healthcare was only
0.9% of the total GDP. India is a country was people
are treated for the most basic diseases. In 2003
the patients treated for malaria were 1.65 million,
for leprosy there were 2.4 million people and there
were 214 cases of polio. The cases for each disease
have reduced significantly over a number of years
but still even after so much technological development
the diseases continue to exists. Also the number
of cases for AIDS and cancer has emerged as a major
concern for health authorities. |
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| To cope up with both the old and the
new challenges the need is to get a sound infrastructure
and making sure that it has been implemented to
perfection. Infrastructure has been described as
the economic arteries and veins. Roads, ports, railways,
airports, power lines, pipes and wires that enable
people, goods, commodities, water, energy and information
to move about efficiently. Increasing, infrastructure
is regarded as a crucial source of economic competitiveness.
One cans easily differentiate the infrastructure
used at urban level and rural level. Fig (1) gives
a detailed diagrammatic display of the health structure
defined in India. As it is visible from the figure
the infrastructure developed in India is very complex
and very well made but the problem has been the
implementation of the same. |
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| The government has achieved success
in implementation of the infrastructure in the urban
areas but it failed in the rural areas where the
65% of India's population live. The major reason
for success of the model in urban areas has been
its simplicity and industrial development. On the
other hand the rural area faces with a complex 4
level health model which includes tained dias to
community health centers and the major drawback
for the implementation has been the diversity of
rural sector. To cope up with the difficulty the
government started the system of the Village Health
Guides that were responsible to train one person
for safer health care of the village but with a
small salary and corruption in the Indian administrative
system it wasn't a very attractive job. The other
health care system has worked but still all of them
have their drawbacks. |
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| Figure 1: The Health System Infrastructure in India |
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NATIONAL
LEVEL
Ministry of Health and Family Welfare |
|
STATE
& U.T.S.
Department of Health Family Welfare |
| Apex
Hospital |
DISTRICTS
District Hospital |
| RURAL
AREAS |
URBAN
AREAS |
| Community
Health Centre |
Hospital |
| Primary
Health Centre |
Dispensary |
| Sub-centre |
|
| Village
Health Guides and trained Dias |
|
|
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| Based on Karkal 1991, 25 and
information provided by the Directorate of Health
and Medical Services, Rajasthan |
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| The neglecting
of rural healthcare system is largely due to lack
of specialist doctors in the rural sector. Even
the local villagers who study medicine prefer to
work in the city rather than going back and working
in their own village. The need is to establish much
more achievable and a simple health system which
can ensure good healthcare of the villagers. The
need is to breakdown the current rural health system
in place of having tainted dias and primary health
care system which calls for training of the rural
people for the treatment the focus should shift
to the young graduates from the medical school.
The whole system should be cracked down to 2-step
system and it should be divided according to the
population of the villages. The villages where population
is between 5,000 to 10,000. The establishment of
small clinics is a must, which can take care of
small diseases and help the women during their pregnancy
months. The focus should also be diseases like malaria,
leprosy etc. These clinics can organize camps in
different small villages. The next type of organizations
should be small hospitals, which includes population
above 10,000 people. These are specialist hospitals
where more complex diseases can be cured and where
villagers can be admitted. There should be a specialist
visiting from the city to take care of the more
complicated cases and performing complicated operations.
But the need is also to get the doctors and paying
them good salary. To make young medical school graduates
is also a difficult task in itself. The need is
also to improve the participation of the private
sector in the rural areas, which can attract new
blood. One of the biggest challenges of these small
hospitals would be to take off the load of the district
and the apex hospitals, which usually run out off
beds for the patients. The small hospitals should
be able to load off the work of the district hospitals
by 30%. |
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| Since there were no data available
expenditure in urban and rural areas separately
it becomes very difficult to do a comparative study.
For the funding for healthcare programs should also
increase in the rural sector. In 2001 India received
$1,705 million as aid for the healthcare programs
which were only 2% of the total healthcare expenditure
by the government. But most of this money go into
urban areas and only a small amount is used by the
rural areas. Apart from implementation the distribution
also plays a major factor in development of a healthcare
system and especially in a country like India where
the difference between rural and urban sector is
too much. The current doctor population ratio is
1:1800. |
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| Public spending on health in India
has itself declined after liberalization from 1.3%
of GDP in 1990 to 0.9% in 1999. Consider the contrast
with the Bhore Committee recommendation of 15% committed
to health from the revenue expenditure budget, against
the WHO, which recommended 5% of GDP for health.
The current annual per capita public health expenditure
is no more than Rs. 160 and a recent World Bank
review showed that over all primary health services
account for 58% of public expenditure mostly but
on salaries, and the secondary/tertiary sector for
about 38%, perhaps the greater part going to tertiary
sector, including government funded medical education.
Public health spending accounts for 25% of aggregate
expenditure, the balance being out of pocket expenditure
incurred by patients to private practitioners of
various hues. |
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| In the mid-1990s, health spending
amounts to 6 percent of GDP, one of the highest
levels among developing nations. The established
per capita spending is around Rs320 per year with
the major input from private households (75 percent).
State governments contribute 15.2 percent, the central
government 5.2 percent, third-party insurance and
employers 3.3 percent, and municipal government
and foreign donors about 1.3, according to a 1995
World Bank study. Of these proportions, 58.7 percent
goes toward primary health care (curative, preventive,
and promotive) and 38.8 percent is spent on secondary
and tertiary inpatient care. The rest goes for non-service
costs. |
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| But the
current situation has somewhat changed 17 per cent
of all health expenditure in India is borne by the
government, the rest being borne privately by the
people, making it one of the most highly privatized
healthcare system of the world. Expenditure budgets
show that capital expenditure in the health budgets
of the Central government actually declined from
Rs 45.09 crore in 1996-97 to only Rs 7.3 crore in
2001-02. |
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 CONCLUSIONS |
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| The above data calls for greater participation
of the government in the health infrastructure.
One cannot hope to depend on the private expenditure
by the people to contribute 75% of the healthcare
system. The need is to call for greater participation
by the central government and the third-party insurance
to close the balance. |
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