Report on Access to Health and Nutrition theme

A Report Submitted to

Dr. Abhijeet

In partial fulfilment of the requirements of the course

ISPE

By

Soumyajyoti Mitra - 1911255

Section C

On

28-02-2020
Rural Health Care is one of the major challenges faced by the Health Ministry of India. A
major chunk of the population is inhabited in the rural areas and the fatality rate is also very
high in this particular segment. A plethora of policies and programs are being run by the
Central and the State government to uplift the rural people but generally turns out to be
ineffective due to failures in the implementation process. Health is an intrinsic part of
livelihood of every human being. It adds to the well-being and increases the life expectancy
of the population. It also adds to the economic prosperity of the region by increasing the
productivity of the people.

Our group had been assigned to the village ‘Kiyawaton Ka Phala’. The nearest CHC
(Community Health Centre) for the village is located at Kurabad which is at a distance of 2.5
km from the village. People usually travel by foot to the Health Centre if it is not an
emergency. In case of an emergency, the hospital has two ambulances to cater to the needs of
the villages that come under the particular CHC. There is an absence of any nearby PHC
(Primary Health Centre), as a result all the issues are addressed by the CHC at Kurabad.

The CHC had three doctors and the patient inflow was 150-200 people per day. This averages
to around 50-60 patients per doctor day. Usually it took some 3-5 days to get a drug available
to the patient in case it is not available. There were no special departments available in the
hospital and all the three doctors were general physicians. The quality of treatment as could
be deciphered from by talking with the village people is not satisfactory and the people were
not entirely content with their consultation with the doctors. There were two numbers
available for emergency purposes to the villager’s .i.e. 104 and 108. As per the villagers, the
ambulance service was up to the mark and were available when needed. There were 5 nurses
in the hospital of which 2 were female and 3 male. Four of them were permanent recruits
while the one remaining was hired on a temporary basis. The hospital is understaffed and
there is a proposition for at least 6 more doctors and 8-10 more wards. There are a total 30
beds in the hospital of which 20 are available. The diagnostic instruments in the hospital
comprised of X Ray, USG and sonography. The number of deliveries carried out in the
hospital is around 400 per year and the common diseases that the people suffer from are
seasonal ones like malaria, diarrhea, common cold etc. The hospital is not adequately staffed
and there have been many instances of rude behavior by the staffs with the patients. Apart
from the limitation in the number of staffs there are also instances of stagnancy and refusal to
work which reduces the efficiency further. For any major illness like tuberculosis, cataract
surgery etc. there were no facilities available at the CHC and the village people had to travel
to the nearby city .i.e. Udaipur to receive proper treatment.

Now coming to Health Card system as provided by the state and central government. The
majority of the people in the village is enrolled under state health care system .i.e.
Bhamashah Swasthya Bima Yojana (BSBY) and also avail the benefits under the particular
scheme. However, there were instances where certain people in the villages were exempted
of the benefits due to political reasons and could not avail the benefits in spite of being
eligible for the same. The coverage includes health benefits up to INR 30000 for general
illness and INR 300000 for critical illness. However, almost the entire population is still not
enrolled under the Ayushman Bharat Yojana, a scheme under the central government.

There was an Anganwadi Kendra in the village. The center was a rented ‘kutcha house’ and
had 17 children enrolled up to 3 years of age. The center was run by three women holding
different positions. The positions held were that of Asha, Karyakarta and Sahayika and they
used to earn a monthly remuneration of INR 3500-4500 depending upon the position held.
The Anganwadi center used to receive the necessities at proper time and there were usually
no delays. Vedanta and Seva Mandir provides support for the proper functioning of the center
and the Kendra also distributes ‘Daliya’ as part of ‘poshahar’ to pregnant women and women
who have given birth to their child up to a period of four years. ‘Daliya’ is distributed every
Thursday and the quantity was fixed at 900 grams. When asked about the same from village
people, they were quite content with the Anganwadi center and its functioning.

To conclude; in the context of healthcare, the village had a CHC within arm’s reach, but it is
not a well-equipped one. The center could cater to the primary health care needs of the
population but when the ailments became specific, it could not address the issue and the
patients were unwillingly forced to look out for better services at the nearby city of Udaipur
for which they had to bear the cost on their own and to say the least it is not affordable for the
people living in the village. With respect to the nutrition, the Anganwadi center functioned
smoothly but there was a need to increase the ‘poshahar’ and provide enhanced nourishment
for the mother and the child. Overall, both the health and nourishment were a sorry state of
affairs and needed significant improvement in order to bring the people out of extreme
poverty.