The Gist of Kurukshetra : Adarsh Gram, Swasth Gram Health in Rural India - July - 2017

Optimum 'health' lays the ground work for experiencing all the goodness this world has to offer. For long, health is often considered as the absence of illness, and hence, a 'health system' is quantified in terms of numbers of hospitals, doctors, nurses, and ambulances. In contrast, optimum health status is attained not by curing illnesses, but by adopting promotive and preventive habits. Citizens can only adopt healthy habits when they are aware' of such habits, and such an environment exists which encourages the adoption of such habits, which can be created by the political leadership of any given country by setting their priorities right and allocating resources sensibly. Three years is a minuscule time to perceive any noticeable impact on the health status of the population, yet three years are long enough for any government to make their intention clear, lay down policy framework and roll out desired programs.

Within a span of just three years, present government has formulated new Health Policy for India. A unique feature of National Health Policy-2017 is that it has balanced 'national priorities related to health' and 'health-related targets of Sustainable Development Goals (SDG), in its objectives: But it remains to be seen that how and in what time span, the objectives specified in National Health Policy-2017 will be achieved. This is because the earlier health policy-2002 laid down many similar objective(s) but failed to achieve them in the designated time frame and therefore, had to be included in the new health policy. Similar to new health policy, previous health policy promised to increase the government's spending on health to 2.5 per cent of GDP but failed to do so. In reality, Indian government's spending on health in the last one and half decade has stuck to around 1.0 per cent of GDP. In the year 2011, the government's spending on health as a proportion of total health spending in India, Thailand, Sri Lanka, China, Russia, and Brazil was 30.5 per cent, 77.7 per cent, 42.1 per cent, 55.9 per cent, 59.8 per cent, and 45.7 per cent respectively.

The government looks determined to provide all types of healthcare to every citizen of India. In this year's budget, the Finance Minister announced to transform every single of the 1,55,069 existing health sub-centers into health and wellness centers by strengthening promotive and preventive services provided at these centers. But given the dismal condition of most community and primary health center of the country, it remains to be seen how the government will implement this initiative. It would have been more appropriate if the government would have taken similar initiative to strengthen primary health centers of the country to provide services round the clock so that patients would not have to travel to distant facilities for availing the basic health care. To increase the availability of specialised tertiary level care to citizens, the government has started fulfilling its poll promise of establishing an AIIMS like institute in all states of India.

The largest chunk of medical out of pocket expenditure is made for buying medicines. To reduce this, the Government of India had launched 'Pradhan Montri Jon Aushodi Yojono'. This scheme had two major objectives: (i) to ensure quality generic medicines are available to patients (ii) to reduce out of pocket medical expenditure associated with buying medicines. This scheme intends to open dedicated outlets of Jon Aushodhi Kendras (JAK) where high-quality generic medicines are sold at low prices. Although, launched nearly a decade ago in the year 2008, this scheme was popularised by this government as evidenced by rapid increase in the number of JAKs outlets near community health centers across rural India. To reduce the burden of medical expenditure further, the government has capped the maximum price of coronary stents used in cardiac aliments.

As per NFHS-4,only 44.8 per cent of women from rural areas made the recommended four antenatal care visits during pregnancy. The situation becomes further dim by the fact that only 16.7 per cent of women in rural areas received 'full' antenatal care. Providing antenatal care to the pregnant mother is crucial to reduce both maternal  and infant mortality rates by detecting high-risk cases at early stages of pregnancy. Pradhan Montri Surakshit Matritvo Abhiyon (PMSMA) intends to mobilise community health worker to ensure quality antenatal care is provided to every pregnant woman. PMSMA is a fixed day antenatal care service program conducted on the 9thday of every month. This scheme intends to cover over 3 crore pregnant women in the country. To increase the coverage, doctors (gynecologist, radiologist and other physicians) from the private sector have been asked to volunteer on 9th of every month. Till now, about 3,335 physicians have agreed to volunteer and 11,189 centres are currently providing quality antenatal care under this Scheme.'

In India, children are vaccinated against seven vaccines preventable diseases under Universal Immunization Program (UPI) which was launched in the year 1985. But as per NFHS-4, only 61.3 per cent of rural children aged 12-23 months in India were 'fully' immunised. To increase the immunisation coverage, the government launched {Mission lndradhanush', The ultimate goal of Mission Indradhanush (Ml)is to ensure complete immunisation for every child and pregnant women. MI intends to achieve this by conducting special immunisation sessions in the 201 high focus districts that have the highest number of partially immunised and unimmunized children. In the first phase of MI, more than 9 lakh sessions were held and more than 20 lakh children were fully immunized. As per NFHS-4,the prevalence of Diarrhoea among children in rural area was about 9.6 per cent and only half of the children with Diarrhoea had received oral rehydration solution. MI also contributed to this aspect of child care by enhancing the distribution of ORS and zinc tablets. In the first phase of MI, about 17 lakhs packets of ORS and about 57 lakh zinc tablets were distributed to children with Diarrhoea. It is the most common cause of death among children and Rotavirus is the most common organism responsible for Diarrhoea. To reduce the incidence of RotaVirus caused Diarrhoea, the Government of India has started the inclusion of indigenously developed anti-rotavirus vaccine in national immunisation schedule. The national level implementation of this vaccine will help in reducing the child mortality rate.

The maojor thing that hurts the India's image as a true global superpower is the unacceptable standard of hygiene and insanitary conditions under which, many of its citizens are forced to live. Many households which have mobile phones, electricity and cable TV do not have toilets. These unsanitary living conditions are source of numerous diseases many of which are linked to malnutrition among children. To improve this unacceptable situation, our Prime Minister launched Swachh Bharat Mission (SBM). Since its inception, about 1,86,571 villages and 129 districts have become free from open defecation. SBM intends to make whole India open defecation free by the year 2019. Complementing the SBM is the Kayakalp scheme. For long ,government hospitals had the image of being dirty and untidy. Kayakalp scheme intends to change this perception by promoting cleanliness, hygiene, and infection control practices in public hospitals premises. This scheme incentivizes, recognizes, and awards those public hospitals which adhere to standard protocols of cleanliness and infection control. Ministry of Health & Family Welfare and Ministry of Drinking Water &Sanitation launched a convergence program "Swachh Swastno Sarvatra" to increase awareness about cleanliness, sanitation and hygiene among population under the catchment area of the health facility. Specifically, it intends to increase awareness about Water, Sanitation, and Hygiene (WASH) practices which are linked to childhood morbidity and malnutrition.

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Courtesy : Kurukshetra