(The Gist of Kurukshetra) HEALTHCARE INTERVENTIONS FOR RURAL INDIA [MARCH-2019]

(The Gist of Kurukshetra) HEALTHCARE INTERVENTIONS FOR RURAL INDIA

[MARCH-2019]

Healthcare interventions for rural India

Introduction

The National Health Policy (NHP) 2017 of India aimed to provide Preventive and Promotive Healthcare and Universal access to good quality healthcare services through the mix of public and private healthcare services. The policy emphasizes reorienting and strengthening the Public Health institutions across the country, so as to provide universal access to free drugs, diagnostics and other essential healthcare. The NHP 2017 expressed its vision for Universal Health Coverage and creating affordable and quality healthcare for all.
The policy is ensuring availability of free, comprehensive primary healthcare services, for all aspects of reproductive, maternal, child and adolescent health and for the most prevalent communicable, noncommunicable and occupational diseases in the population. It also talked about reinforcing trust in public healthcare system. The Government intended to achieve various targets by involvement of all possible stakeholders.

Key Initiatives and Interventions Ayushman Bharat:

As part of Ayushman Bharat programme, two major initiatives in health sector have been taken. First is Health and Wellness Centres and second is the Notional Health Protection Scheme (NHPM). The goal of this intervention is to address health needs in a holistic manner in primary, secondary and tertiary care systems, covering both prevention and health promotion. The National Health Policy 2017 has envisioned Health and Wellness Centres as the foundation of India's health system. It is expected that under this, 1.5 lakh centres will bring healthcare system closer to the homes of people.
Also that these centres will provide comprehensive healthcare, including for non-communicable diseases and maternal and child health services, free essential drugs and diagnostic services. The Interim Budget 2019-20 has allocated Rs.1,200 crore for this flagship programme. Contribution of private sector through Corporate Social responsibility (CSR) and philanthropic institutions in adopting these centres is also envisaged.
The National Nutrition Mission: The National Nutrition Mission (NNM) has been set up with a three year budget of Rs.9046.17 crore commencing from 2017-18. The NNM is a comprehensive approach towards raising nutrition level in the country on a war footing. It is comprising mapping of various Schemes contributing towards addressing malnutrition, including a very robust convergence mechanism, ICT based Real Time Monitoring system, incentivizing States/UTs for meeting the targets, incentivizing Anganwadi Workers (AWWs) for using IT based tools, eliminating registers used by AWWs, introducing measurement of height of children at the Anganwadi Centres (AWCs), Social Audits, setting-up Nutrition Resource Centres, involving masses through Jan Andolan for their participation on nutrition through various activities, among others.
NNM targets to reduce stunting, undernutrition, Anaemia (among young children, women and adolescent girls) and reduce low birth weight by 2 per cent, 2 percent, 3 per cent and 2 per cent per
annum respectively. Although the target to reduce Stunting is at least 2 per cent p.a., All About UPSC Exams Mission would strive to achieve reduction in Stunting from 38.4 per cent (NFHS-4) to 25 per cent by 2022 (Mission 25 by 2022).
All the States and districts will be covered in a phased manner i.e, 315 districts in 2017-18, 235 districts in 2018-19 and remaining districts in 2019-20.

Poshan Abhiyan:

This is based on convergence and collaboration of all important sectors considered to be important for healthy growth of the child for first 1,000 days. Thus, it covers all schemes, Beti Bachao Beti Padhao, Swachh Bharat, Adolescent Care, Prenatal and Postnatal Care, Supplementary Nutrition, Breastfeeding Counseling, Immunization, Growth Monitoring. Under Poshan Abhiyan, the Government has fixed targets to reduce stunting, undernutrition, Anaemia (among young children, women and adolescent girls) and reduce low birth weight by 2 per cent, 2 percent, 3 per cent and 2 per cent per annum respectively.
Mission also strives to achieve reduction in Stunting from 38.4 per cent (NFHS-4) to 25 per cent by 2022, Outreach worker or frontline worker will cover all the aspects of essential healthcare for the mother and child. Accredited Social Health Activist (ASHA) and Anganwadi Worker (AWW) are supposed to work in collaboration to improve the institutional visits, nutrition outcomes, physical and mental growth of the child through home visits to create awareness for proper utilisation of all the facilities and benefits provided under this scheme.\

Pradhan Mantri Matru Vandana Yojana:

The Maternity Benefit Programme is implemented from 01.01.2017, in all the districts of the country. The programme is named as 'Pradhan Mantri Matru Vandana Yojana' (PMMVY). Under PMMVY, a cash incentive of Rs 5,000/- is provided directly to the Bank / Post Office Account of Pregnant Women and Lactating Mothers (PW&LM) for first living child of the family subject to fulfilling specific conditions relating to Maternal and Child Health.
PMMVY is implemented using the platform of Anganwadi Services scheme of Umbrella Integrated Child Development Services (ICDS) under Ministry of Women and Child Development in respect of States/UTs implementing scheme through Women and Child Development Department/ Social Welfare Department and through Health system in respect of States/ UTs where scheme is implemented by Health and Family Welfare Department. PMMVY is implemented through a centrally deployed Web Based MIS Software application and the focal point of implementation would be the Anganwadi Centre (AWC) and ASHA/ANM workers. In the Interim Budget (2019-20), the key highlights related to health sector provisioning especially for women, children and poor are as follows:
World's largest healthcare programme, Ayushman Bharat, for nearly 50 crore people.
Jan Aushadhi Kendras providing medicines at affordable prices to poor and middle class.
Allocation for Integrated Child Development Scheme (ICDS) increased by over 18 per cent to Rs. 27,584 crore in BE 2019-20.
Maternity leave extended to 26 weeks.
Financial support for pregnant women under Pradhan Mantri Matru Vandana.
6 crore free LPG gas connections provided under Ujjwala Yojana ; Ail 8 crore by next year.
India has achieved 98 per cent rural sanitation coverage and 5.45 lakh villages have been declared "Open Defecation Free".
Aspirational Districts Programme launched for development in 115 most backward districts.
Rs. 1,70,000 crore spent during 2018-19 for cheaper food grains to poor and middle class.
70 percent of MUDRA Loan availed by Women.
Rural roads' construction tripled under the PMGSY.
Targeted expenditure to bridge urban-rural divide and to improve quality of life in villages.

Way Forward

The Rural India is exposed to challenges that are having direct impact on health of women and children living in this area. Focus on primary healthcare through outreach activity household coverage, availability of quality public healthcare services and appropriate financial support for secondary and tertiary care with more accountable and transparent system is required.
The strengthening of primary healthcare system is required in order to address the factors that have direct impact on health status of rural population. The expansion of Public Health Education to create more professionals is required, as many programme and schemes required skilled personnel with sound knowledge of socio-economic and cultural aspects of health and medicine.
To assess the standards of public health services, government developed Indian Public Health Standards (IPHS) and all the healthcare facility should be monitored and regulated according to these standards.