The Indian Council of Medical Research (ICMR) has revealed in a recent study that about 70 per cent of rural people in Andhra Pradesh rely on unqualified medical practitioners in their vicinity rather than visiting a primary health centre. The study exposed extremely low credibility of Primary Health Centers (PHCs) among the poor even for important health issues like child illnesses, malaria/febrile illnesses, TB and other ailments. It said the PHCs are largely limited to immunization programmes by the government.
Although the government run PHCs are intended for providing cheaper medical facilities for the poor people in the rural areas, the study revealed that the PHCs are not perceived as poor-friendly by poor patients in the villages.
The study was conducted by international researchers from Erasmus University Rotterdam, Netherlands, Tel Aviv University, Israel, and Micro Insurance Academy, New Delhi. The survey team covered hundreds of households for a first-hand assessment of people’s choice of health care providers across the state and found that 69.5 per cent of respondents accessed unqualified medical practitioners or non-degree allopathic practitioners (NDAPs) practising in or near their village.
“NDAPs fill a huge demand for primary curative care, which the public system does not satisfy, and are the de facto first level access in most cases. There is low utilization of primary outpatient care in public facilities because of long distances, inconvenient opening hours, lengthy waiting, staff absenteeism, poor availability of medicines, and poor quality of care,” the researchers pointed out.
Each PHC is supposed to serve an average 30,000 persons. It should be managed by a medical doctor. Only 25 per cent of people approached qualified doctors in the first instance. As many as 77.5 per cent of respondents named proximity as the most important reason for their choice of first contact provider when asked why they were approaching unqualified practitioners.
Not only in Andhra Pradesh, the poor people in many states across the country, especially those living in rural areas, do not receive health care from qualified providers.
Although the public sector is the main provider of preventive care services, 80 per cent of outpatient visits and 60 per cent of hospital admissions are in the private sector. Consequently, 71 per cent of health spending is out of pocket, and, every year, such expenditure forces 4 per cent of the population into poverty. On the whole, the absence of adequately trained health-care providers in public and private sectors is a major cause for concern. The migration of qualified allopathic doctors and nurses to urban areas is growing substantially day by day and is further straining the system.