The centres of Central Government Health Scheme (CGHS) are in the cities and towns only. The insurance products like mediclaim, accident insurance, etc. are primarily targeted towards the middle class living in the cities who can afford the high premium these products carry.It is a disturbing fact that the health care facilities are woefully inadequate in the villages. It won’t be an exaggeration to say that these facilities are non-existent in the villages. There is no hospital in a radius of ten kilometers in most of the rural belts. In many, villages there are no private qualified doctor. For minor ailments, the villagers do not normally go to a doctor, but for major problems like heart ailments, appendicitis, kidney infection, they have to shift the patient to a hospital in a nearby city which may be miles away.
The condition of government hospitals in cities is not unknown to anybody. Beds are not available for patients who can be seen lying outside the wards which are crowded with admitted patients. Poor villagers cannot afford to go for treatment in a private hospital or clinic. They are just beyond their reach. At times it may be difficult to take the patient to the city because of old age or critical condition. In some cases valuable time may be lost in taking the patient to the city. The sufferer as well as his/her family members has no alternative but to try to reach the city by whatever mode of transportation.
Apart from patients, pregnant ladies and would be mothers also need regular medical supervision. The village women often are at the mercy of untrained and uneducated ladies who look after them on the basis of their experience and guess work. If there is a complication before or during childbirth these midwives as they are called, are helpless. The village women find it difficult to go frequently to the nearby city or town for medical check up and ensure that they are in a healthy condition. It is primarily because of these reasons that the infant mortality rate (IMR) is much higher in the villages than in the cities.
Immunisation of infants and small children against the deadly diseases like tuberculosis, diptheria, MMR, typhoid and polio is an integral part of health care. But unfortunately, immunisation programmes are confined to cities. In towns and cities the private clinics and nursing homes not only ensure normal uncomplicated deliveries but also immediately start immunisation schedule for the new born baby. There are child specialists in all nursing homes and private clinics of child specialists which take care of the immunisation of children.
They prepare a card for each child who is taken there. A complete schedule of immunisation vaccines and medicines is written on the card. The parents of the child are informed when to bring the child again to the clinic for next dose or vaccine. The record and progress of the child in terms of weight and height is kept in the computer at these clinics. In villages no such facilities are available. Most of the children do not get these immunisation vaccines and medicines. In the remote villages and tribal areas such programmes have not made any penetration. A few years ago polio was said to have been eradicated but in 2006 and 2007 some cases were again detected in some states.
This bears testimony to the fact that polio drops were not given to many of the children some of whom contracted the disease. After middle age, i.e. 40 to 50 some people become chronic patients of diabetes, high blood pressure and asthma. They have to take prescribed medicines daily. But if they are living in rural areas they experience difficulty in getting the medicines. Most of the villages have no chemist shops. The villagers have to go again and again to the nearby city to get the medicine. Being poor, they cannot buy medicines in bulk as the cost may run into over thousand rupees. The chemists also do not keep the medicines in large quantities because if they are not sold within a certain time period they reach the expiry date.
India is a vast country with a large population of about 108 crore. Nearly 65 per cent of the people still live in villages. It is matter of great concern that these people have nothing in the name of health care facilities. It is however, some relief to note that the respective state governments and the central government have taken certain measures to improve the health care of the villagers. In April 2005 the National Rural Health Mission (NRHM) was launched. Its main aim is to provide accessible, affordable, accountable, effective and reliable public health care facilities, especially to poor and vulnerable sections of society. Health care has been declared as one of the seven thrust areas. It has been proposed that the current spending in this sector shall be increased from 0.9 per cent to 2.3 per cent of the GDP in the next five years.
A network of Community Health Centres (CHCs) and Primary Health Centres (PHCs) and sub-centres has been created to provide primary health care in the rural areas. However, the number of these centres and sub-centres needs to be increased. These centres are now being manned by multipurpose co¬workers. Not only the number of these workers needs to be increased but also qualified doctors and experts should be posted at these centres. Only one Lady Health Visitor (LHV) visits six sub-centres. More LHVs need to be employed so that more visits are made to the sub-centres.
The frequency of visits should be increased. There should be a provision to provide relief and medical help in each village under the aegis of state government concerned. More hospitals should be opened in rural areas. There should be at least one medium size hospital with 50 beds within a radius of 5 kilometres. The insurance companies should be asked to launch new health related insurance schemes exclusively for the villagers at a low premium. Nursing homes should be opened in the rural areas to look after the needs of pregnant women and infants. Immunisation programmes should be launched through these nursing homes. With the increase in literacy rate, the rural people are becoming health conscious. The government must supplement it with more rural health care schemes. Private Doctors and businessmen should be given incentives if they want to work and invest in rural areas for creating health care infrastructure.