OPEN FORUM

New Delhi, 13 July 2006

  Health For All

TOWARDS INCREASING PRODUCTIVITY

By T.D. Jagadesan

Social services are important component of public sector outlays on account of their role in human resource development and in raising the quality of life of the deprived sections of the society. This has necessarily to be assigned a key role in any development strategy, particularly in a country with a large population.  The most important factors which lead to human resource development are health, education, nutrition, sanitation, hygiene, social welfare, improved socio-economic opportunity with regard to under-privileged sections of the society. 

In developing countries like India where a large segment of the population is poor, there is need for multi-pronged, multi-sectoral attack on the above issues, as the bulk of the population cannot afford to buy the services at market prices. There is the added problem that such services may not be made available at all by the private sector in many areas.

In the social services, health is of paramount importance as a national asset and basis to sustain as well as stimulate optimum levels of efficiency. Health is a pre-requisite for increasing productivity.  Health has a significant impact on income levels as well. Thus, health of the people is an index of prosperity and well-being of a nation.

Majority of the people in India live on rural areas.  They are poorly-served and at best receive only rudimentary healthcare. According to the latest report of the National Sample Survey Organisation (NSSO) 2005, three out of every thousand rural household do not get enough to eat and the average annual consumer expenditure for 50 per cent of the population is less  than Rs.470.

Further, Global Monitoring Report on basic healthcare and education produced by the IMF and World Bank states that India will achieve the Millennium Development Goal of having the number of people under the poverty line within the next decade.  But several states will not be able to make the grade for making available basic health care and education.

The National Rural Health Mission (NRHM), launched by the UPA Government at the Centre on 12 April last with objectives to provide integrated comprehensive and effective primary healthcare to the unprivileged and vulnerable sections of the society, especially women and children, by improving access, availability and quality of public health services.

The key strategies of the mission include, ensuring intra and inter sectoral convergence, strengthening public health infrastructure, increasing community participation, creating a village level cadre of health workers, fostering public-private partnerships, emphasizing quality services and enhanced programme management inputs.

The plan of action of the Rural Health Mission also aims at reducing regional health imbalance in health outcomes by relating health to determinants of good health. Further the Mission aims at increasing the outreach of the health system from the sub-centre level to village level by providing a trained and Accredited Social Health Activist per thousand population as in Anganwadi set-up. The present system of health planning and management is uniform for state level.

The Government has taken timely note of India’s abysmally poor health indicators.  The NRHM objectives indicate the motivation on the part of Government to correct the rural-urban, inter-state and gender inequalities in health as a priority.  The United Nations Human Development Report (UNHDR) 2005 states that India does well on economic growth but fares poorly on human development.

High infant and maternal mortality rate, skewed sex ratio, rising rural unemployment and stagnating agricultural wages are some areas of grave concern.  Economic growth is meaningless without proportional social development.  Most of the Government operated rural health sub-centres, primary health centres and Anganwadi centres are on the verge of collapse.

The flagship schemes for social sectors would largely benefit rural development.  The provision for the National Rural Health Mission has been increased to Rs.8,207 crore from Rs.6,553 crore in the previous year.  But a close look at the schemes, however, gives the impression that most of them are repackaged version of ongoing schemes.

The success of the schemes would depend on qualitative difference in the delivery system at operational level. More funds for education, health nutrition and safe drinking water may not necessarily mean more education, more health, more nutrition and better safe drinking water.  What matters is how the money is spent prudently.

The National Rural Health Mission’s objective empowering local communities for public health by devising specific health plans for each village through village health committees of panchayats is sound.  However, transformation of village communities requires true public participation and state-community linkages because village communities are divided on traditional hierarchies of caste, creed and gender. Only a functional civil society can ensure equal rights for women and children.

The NRHM strategy integrates health with sanitation and hygiene, nutrition and safe drinking water. A holistic approach to integrate education and family planning with the Mission will yield more substantial result, according to health pundits and eggheads of Yojana Bhawan.

The National Health Mission’s strategy includes the Community Health Volunteers (CHVs), Auxiliary Nurse Midwives (ANMs), AND Anganwadi Workers (ANWs) have a focal role to play as the front line team since they are ideally positioned to create forums at the community levels and activate local resources groups to ensue community participation;. 

Further, it is most important to strengthen the capacities of these functionaries responsible for the services delivery system; delivery of an integrated package of services to vulnerable groups have been cited as the hallmark of various programme as of the ICDS programme, but unfortunately at the field level, this basic tenet has been translated into practice only to a limited extent.

The importance of community participation forms the cornerstone of the concept of primary healthcare of achieve the goal of “Health for All”. For the success of the programme it is essential to encourage and ensure full community participation by effective propagation of relevant information through which individuals, families and community can assume responsibility for their health and well being.

Regular interactive sessions with mothers, parents group, old age persons added by audio-visual demonstration along with household contact and monitoring development of local resource groups etc., as observers feel, should be incorporated. Scrutiny of various health programmes shows that partnership and network initiative alone can ensure lasting impacts with focus on communities, especially the deprived sections of society.

Given the clarity of perspectives regarding monitoring and executing with greater involvement of community participation at grassroot level, may positively alter the scenario of rural India in our life time.---INFA

 (Copyright, India News and Feature Alliance)