Health of the nation decides mindset, attitude and wealth of the nation. So, healthcare delivery system to both the urban and rural masses has to be looked upon as a major deciding tool. The availability and accessibility of health resources should be of primary concern to our country. The solution needs to be a collaborative effort between NGO's, government health practitioners and corporates to develop a holistic, preventative and curative health models that are accessible by all strata of population. It will require a great coordination, commitment and efforts at the national, state and local levels. If India will not be able to work with this commitment the gap between rural development and urban development will widen.
Also, it cannot be overlooked that since the liberalization of economy there have been improvement in the lives of the rural population as well. In rural India, the number of people living below the poverty line fell to 42 per cent from 63 per cent between 1991 and 2001 (Bardhan). Life expectancy rates have also risen steadily. However, these changes went hand in hand with policies and movement such as the Green Revolution that focused on alleviating poverty in rural regions. In contrast, there have not been any health polices which can change status of health care delivery system in India and in actual practice increased cost of medicines is making two classes amongst masses clearly defining the economic boundaries of urban and rural masses.
Health scenario in rural India
Since around 75 per cent of health infrastructure and health care providers are concentrated in urban areas, the health care scenario in rural area has a different story to tell.
When measuring health, three most important factors that should be considered are mortality, morbidity and life expectancy. These are governed by other factors like family background, education, income, per capita expenditure, health awareness education and availability and accessibility of health care systems.
To provide easy accessibility of health care system to deprived masses, the authorities concerned must evolve a unique model, which can be implemented successfully.
For instance, imagine a situation where one core pharmacy centre is attached to one primary health centre. Depending on the location of that community pharmacy centre select five to ten villages in the vicinity of around 30 to 35 kilometers. This system will enable the physician or pharmacist to reach the spot with in half an hour, in case any emergency arises.
To manage health care
" Out of selected villages, keep individual family record and patient record.
" Educate them about 'hygiene and sanitation ' by showing some demonstrations.
" Educate them about family budget preparation and how they can manage/afford good food habits.
" Educate them by showing first aid demonstrations.
" Train a literate person in the family as health care provider for around five families around.
" Create awareness regarding diseases like diabetes, hypertension, heart diseases, cancer and HIV by preparing charts in local languages. Provide information about disease remedies, cost of therapy and direct them to embrace basic hygiene and sanitation by following good food habits, consulting physician or pharmacist at proper time to prevent diseases.
" Exhibit bad effects of alcohol, smoking and related things.
" Train them about communication devices so that medical help can be given in instantaneously. Also, if literacy level is high then facility of e-health can be provided.
" Conduct weekly camps in villages for health check up, maintain patient records and keep a track of patient compliance.
" Teach them about responsible self medication.
" Make them aware about medical insurance, various NGOs and other funding agencies, which can provide for financial support for treatment of diseases like cancer and HIV.
" Explain them the importance of medical check up of pregnant women at appropriate intervals and the necessity to avail home nurses or trained nurses, who can take care of prenatal as well neonatal problems if any, during delivery.
If health care system is made affordable, easily available and accessible to every strata of society, the country can fulfill the dream vision of providing health care to all by 2020. As of now, a major chunk of the heath care is provided by private sector players. While private sector offer 75 per cent of health care services, the government accounts only for 25 per cent of health care services. The government should think about setting up primary health care centres along with community pharmacy, covering 30 to 35 kilometers. Government has already undertaken National Rural Health Mission (NRHM) and started establishing Accredited Sound Health Activist (ASHA) groups to take care of all health education activities as well as healthcare management.
Even private institutions or corporates can contribute by sponsoring one such health care centre and community pharmacy, which can provide a mobile health check up service along with medicines as a part of corporate social responsibility.
People like Dr Baba Amte, Dr Abhay Bang and Dr Rani Bang have already demonstrated that radical changes can be brought about in lives of people who are staying in remote areas where medical facilities are not available. Specific television and radio campaigns for pulse polio, HIV awareness, leprosy, tuberculosis and family planning by the government have created a great impact on masses. On same lines, primary health care centers and community pharmacies can conduct weekly medical campaigns, exhibitions and other related programmes to better the heath care prospects of our population. Pharmacists should involve themselves in conducting such activities.
(The author is Vice Principal, Indira College of Pharmacy Niramaya, Pune)