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Study of Factors Affecting Rural and Urban Healthcare System Using Probit Model
Study of Factors Affecting Rural and Urban Healthcare System Using Probit Model
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Abstract
India has done lesser than expected to improve the healthcare sector despite phenomenal economic
growth over the last two decades. The improvement has been quite uneven across regions, with
large scale ruralurban variations and adverse accessibility to healthcare services in rural areas.To
foster an inclusive growth path and provide to bulk of its population basic amenities of health
services there exist great inequality at rural and urban level in terms of the key components
associated for human development health services, technology and education. The present work
attempts to measure the extent of the factors affecting health status and health care services in
rural and urban district of Uttar Pradesh. The primary data of 270 households have been collected
from different blocks and villages. The samples have been collected on the basis of stratified
random sampling method. Probit model has been used to analyze secondary data for the socio
economic factors affecting health status of households in both rural and urban areas. Probit model
analysis and coefficient of variations have been used to measure the relevant factors affecting
health status and health care services in rural and urban district of Uttar Pradesh and explain the
reason thereof. According to results, rural households with lower education and income levels tend
to have adverse health compared to urban areas. Also, health facilities, awareness of health
program, balance diet, safe drinking water and hygenine are effective factors for good health
among the respondents. The health status of rural households is affected by availability of health
facilities, awareness about health programs, availability of balance diet, safe drinking water and
hygenine.Lower education and income levels, also has severe impact on health status of rural
households.Outcome of the analysis suggests that there is a huge gap of knowledge and awareness
about healthcare services and programs. Hence, science and technology have potential to fill this
gap and increase the better health status of rural and urban households.
Keywords: Health, RuralUrban, Probit Model, Socioeconomic factors, Technology
268 Bridging the SciencePolicy Gap for Inclusive Growth in India
1. Introduction
The Twelfth Five Year Plan for the health sector envisages transformation of the National
Rural Health Mission into a National Health Mission program covering both rural and
urban areas. The NHM envisages providing public sector primary healthcare facilities in
selected low income urban areas, expansion of teaching and training awareness programmes
for healthcare professionals particularly in the government sector institutions, providing
greater attention to public health, strengthening both drug and food regulatory mechanism,
regulation and improvement of medical practices, advancement of human resource
development, monitoring &promoting information technology in health and building an
appropriate innovative architecture for Universal Health Care (MoHFW, 2015). NHM
further expands the reach of healthcare resources with focus on vulnerable and marginalized
sections of household population and therefore envisages substantial expansion and
strengthening of the public health systems and provision of robust primary healthcare. The
Ministry has recognized Information, Education and Communication (IEC) as an integral
component of all health initiatives. The IEC strategy has on the one hand focused on
creating awareness about various health issues including communicable and non
communicable diseases, and on the other made efforts to bring about a health seeking
behavior in the masses (MoHFW, 2015). Various channels of communication have been
used for creating awareness about various health issues. Health meals with free check
up camps have emerged as potent venues for creating awareness and inducing behavioral
changes.
The healthcare in rural areas is developed on a threetier system based on population
norms (MHFW, 2005 and NSSO, 2004). According to UMHFW report, the number of
functioning subcenters is around 146,026 which though sounds high is a 12 percent
shortfall as per Government norms. According to the Ministry of Health the number of
PHC’s increased from 23,109 to 23,236 this year; yet this increasing number is a shortfall
of 16 percent when compared with the normal norms of PHC’s (Dey Baishakhi and Mitra
Anindya, 2013). Around 75 percent of health infrastructure, medical manpower and other
health resources are concentrated in urban areas where 27 percent of the population is
residing. Contagious, sever infectious and waterborne diseases such as diarrhea, amoebiasis,
typhoid, infectious hepatitis, worm infestations, measles, malaria, tuberculosis, whooping
cough, respiratory infections, pneumonia and reproductive tract infections dominate the
morbidity pattern, especially in rural & semi urban areas. However, noncommunicable
diseases such as cancer, blindness, mental illness, hypertension, diabetes, HIV/AIDS,
accidents and injuries are also on the rise (Patil A.V., Somasundaram K. V. and Goyal
R. C, 2002).
The health status is a cause for grave concern, especially that of the rural household
population where the condition of medical facilities and health resources are deplorable.
Considering the picture of grim facts there is anessential need of new healthcare practices
and procedures to ensure that quality and timely healthcare reaches the deprived corners
of the rural household population. Though a lot of health policies and programs are made
Study of Factors Affecting Rural and Urban Healthcare System using Probit Model 269
available by the government but the success and effectiveness of these programs is
questionable due to gaps in the implementation. In rural areas, where the number of
Primary health care centers (PHCs) is limited, 8 percent of the centers do not have
doctors or medical staff, 39 percent do not have lab technicians and 18 percent PHCs
do not even have a pharmacist. Majority of people die due to preventable and curable
diseases like diarrhea, measles and typhoid 66 percent of rural areas do not have the
access to the critical medicines. Similarly, 31 percent of the population travels more than
30kms to seek healthcare in rural India (Gramvaani, 2013).For instance, there are 369,351
population lack access to critical government beds in urban areas and a medicine to mere
143,069 beds in rural areas (National Health Profile, 2009). Rural doctors to population
ratio is lower by six times; Rural beds to population ratio is lower by 15 times; Most of
the medicines in rural areas are substandard and counterfeit;Sixty six percent of the rural
households lack access to critical medicine (PanIIT Conclave, 2010); necessity of generic
medicine is also essential need for the rural households.
In many rural areas the disease burden is rising and facilities available to test patients
for these conditions must be provided with cheaper medication to control diseases (Das
D & Pathak M, 2012). Food security, ill sanitation systems, undeveloped drainage systems
affecting drinking water quality, excessive arsenic in drinking waters of some areas, poor
transportation systems in rural regions and other geographic barriers directly affect the
health services in rural areas as well as urban areas (Bhandari and Dutta, 2007). However,
rates of leprosy, Kalaazar and Japanese Encephalitis are increasing in both rural and
urban areas. Currently, rural areas are facing a double burden crisis of malnutrition, under
nutrition as well as, overweight and obesity compounded with food insecurity in areas of
Uttar Pradesh. Obesity is a concurrently growing problem in all segments of the urban
population, linked to changing diets and activity patterns, which also increase the risk of
serious health problems, notably noncommunicable diseases.
This shows the grim picture in the rural areas despite the success of the National
Rural Health Mission (NRHM) & even the Planning Commission has conceded that
availability of healthcare services is quantitatively inadequate. In spite of ran availability
of doctors and hospital, the 108 emergency ambulance service takes nearly 75 minutes
to reach the village, allege villagers. In the absence of basic healthcare facilities, people
travel at least 20 km to reach the nearest PHC(Kumar A, IE 2013).Some of the key facts
relative to the current state of the rural healthcare system have been perceived as the
ratio of rural population to doctors is eight times lower than in urban areas; the ratio of
rural beds visavis the population is 20 times lower than in urban areas; 75 percent of
the rural household population in state lacks access to preventive medicines; PHCs in
rural area lack either an operation theatre or a lab or both. There is 75.2 percent shortfalls
of medical specialists in CHCs 45 percent of PHCs are currently without a lab technician;
Infectious diseases dominate the morbidity pattern in rural areas: 65% in rural areas vis
avis 25% in urban areas (Kumar A, IE 2013). Rural healthcare is characterized by a
huge gap between supply and demand (GV Ravishankar, ET 2012). The rural areas
270 Bridging the SciencePolicy Gap for Inclusive Growth in India
remain significantly underdeveloped in terms of health infrastructure about half the people
and over threefifths of those living in rural areas have to travel beyond 5 km to reach
a healthcare centre or 50 percent of the rural population in state has to travel over 30
km to get needed medical treatment.
Currently, rural healthcare needs are met either by adequate government facilities and
private nursing homes, which have not been able to keep pace with increasing demand
of health resources in rural households. The quality of healthcare infrastructure is usually
adverse and people end up having to go to nearby large cities if they need better quality
of healthcare. Many times the talk of rural healthcare centers on “affordability”. Rural
areas is in fact not looking for “affordable” healthcare while it is looking for “high quality”
healthcare provided in a cost efficient manner (GV Ravishankar, ET 2012) for rural
households. The real challenge of rural healthcare is in being able to provide high quality
care at a price point that provides maximum access to the rural population. Taking the
urban model and cutting it down to suit rural areas is not the right approach. Therefore,
it is critical for the model to be financially self sustaining.
A concerted effort are made to overcome reduce demand and supply gap of skilled
workforce in healthcare system. Healthcare should entail substantial infrastructure
investments, innovative setups to provide better healthcare for rural and urban households,
hospital monitoring informative system settings to provide more viable options for improved
healthcare and virtual access for both patients and doctors. Healthcare has immense
scope discovered in diagnostics and imaging as all patients are keen to be well informed
about their health reports and prefer it see their reports online (ET Healthworld, 2015).
Such advancementshelp in treatment of diseases on time and also enabling patients to
receive short time healthcare services. More diagnostic centers mean better awareness
and requirement of more administrative staff to bear responsibility for this change.
Bridging the skill gap would help to foster newer healthcare possibilities for all those
engaged in changing the face of healthcare system.
To improve the current situation, the problem of rural health is to be addressed both
at macro (national and state) and micro (district and regional) levels. This could be done
in a holistic way, with a genuine effort to bring the adverse health of the rural household
population to the centre of the fiscal health policies (Goyal R. C, 2002). A paradigm shift
from the current healthcare ‘biomedical model’ to a ‘socio cultural model’ which in result
will bridge the gaps and improve health quality of rural household life. A revised National
Health Policy addressing the prevailing healthcare inequalities, and working towards
promoting a longterm perspective plan, mainly for rural health, is imperative.
1.1 Bottleneck of Healthcare Systems
According to annual report of MoHFW 2015, the Census of India reveals that despite a
host of schemes and programmes, only 65.38 per cent of the Indian people are literate
Study of Factors Affecting Rural and Urban Healthcare System using Probit Model 271
(75.85 per cent men and 54.16 per cent women). Interestingly, literacy rate improved
sharply among females by 10.96 percent points from 53.67 to 64.63 percent as compared
to a rise of 5.62 percent points in case of males from 75.26 to 80.88 percent (MHRD,
2015). Based on national cutoff points, in Uttar Pradesh only 11percent households are
in the highest wealth quintile and more than half of the (58 percent) households are below
middle wealth quintile. More than one third of the households (40.3 percent) in urban
areas are in the highest wealth quintile whereas in rural areas it is only 4.3 percent
(DLHS3, 2008).As on 31st March, 2015, there are 153655 Sub Centres, 25308 Primary
Health Centres (PHCs) and 5396 Community Health Centres (CHCs) functioning in the
country. Strengthening existing PHCs and CHCs, and provision of 3050 bedded CHC per
lakh population for improved curative care to a normative standard (Indian Public Health
Standards defining personnel, equipment and management standards). For doctors at
PHC, there was a shortfall of 11.9 percent of the total requirement. This is again mainly
due to significant shortfall of doctors at PHCs in the States of Chhattisgarh, Gujarat,
Karnataka, Madhya Pradesh, Odisha, Uttarakhand, Uttar Pradesh and West Bengal
(NRHM, 2015). The Specialist doctors at CHCs have increased from 3550 in 2005 to
4078 in 2015. However, as compared to requirement for existing infrastructure, there was
a shortfall of 83.4 percent of Surgeons, 76.3 percent of Obstetricians &Gynecologists,
83.0 percent of Physicians and 82.1 percent of Pediatricians. Overall, there was a shortfall
of 81.2 percent specialists at the CHCs as compared to the requirement for existing
CHCs (NRHM, 2015). Similarly, the allopathic doctors at PHCs have increased from
20,308 in 2005 to 27,421 in 2015, which is about 35.0 percent increase. Moreover, the
specialist doctors at CHCs have increased from 3550 in 2005 to 4078 in 2015, which is
an appreciable 14.9 percent increase (NRHM, 2015).
The diets and nutritional status of urban slum children is far away from being
satisfactory. The nutritional status of slum children is worst amongst all urban groups and
is even poorer than the rural average (Ghosh S, 2004). In the NFHS2 report, under
nutrition was higher in rural areas than in urban areas. The figures for underweight,
stunting and wasting in urban areas were 38 percent, 36 percent and 13 percent (NFHS,
2002). Malnutrition, Obesity and related health disorders are commonly prevailing childhood
diseases in the rural and urban community and can effectively are addressed by appropriate
public health program (Patel N, Gunjana G, 2015).Growing evidence suggests a link
between child linear growth and household water, sanitation and hygiene (WASH) practices.
It has previously been estimated that as much as 50 percent of child undernutrition may
be attributable to poor WASH practices (Ngure FM, Reid BM, 2011).Access to protected
sources of drinking water has improved from 68 percent of the population in 1990 to 88
percent in 2008 (UNICEF India, (2011). However, only 26 percent of the slum population
has access to safe drinking water (Sangam Unity in Action, 2011) and 25 percent of
the total population has drinking water on their premises (UNICEF India, (2011).This
problem is exacerbated by falling levels of groundwater caused mainly by increasing
extraction for irrigation (UNICEF India, 2011). Insufficient maintenance of the environment
272 Bridging the SciencePolicy Gap for Inclusive Growth in India
around water sources, groundwater pollution, excessive arsenic and fluoride in drinking
water pose a major threat to India’s health (UNICEF India, 2011). The majority of rural
deaths, which are preventable, are due to infections and communicable, parasitic and
respiratory diseases. Infectious diseases dominate the morbidity pattern in rural areas (40
percent rural: 23.5 percent urban). Waterborne infections, which account for about 80
percent of sickness in India and annually 1.5 million deaths and loss of 73 million workdays,
are attributed to waterborne diseases (Bhanot B, 2000).
Rural areas faces a growing need to fix its basic health concerns in the areas of HIV,
malaria, tuberculosis, and diarrhea (Jayaraman R.V., 2015).In rural areas about 67 percent
had knowledge of various national health programs but only 33 percent participated. Over
68 percent received information regarding the health programs through the media, and
only 28 percent received information through public health staff (Dasgupta , 2013). It has
been observed that there is a great deal of disparity in quality and access to healthcare
between urban and rural regions.
This can be bridged through telemedicine technology if the tool is integrated into
existing healthcare delivery system. Both government and private sector have been actively
participating in telehealth programmes (Mishra, 2012).There is no existing health system
model that can simply be applied to rural and urban areas. It is our prospective to generate
new models and to provide highquality care in vast rural areas where there are very few
doctors. In 2014, rural and urban areas developed a strategy to save the lives of infants,
to provide vaccines to the routine immunization schedule, and to create Indradhanush and
Swachh Bharat missions to promote universal immunization coverage and better sanitation
but it is not enough for these plans and missions to exist unless and until they perform
(Bill Gates, 2015). More than anything else primary health systems in every rural area
must reach every single person with highquality services and creating a society so that
every citizen has access to healthcare, education, and nutrition to maximize their potential
as productive citizens. Rural and urban areas are now extensively with mobile phone
subscribers. Telemedicine can overcome major gaps of health in respect to disease
burden, immunization, health programs and schemes through these mobile network ; a Wi
Fi connection can work through this facility.
the districts were stratified on the basis of availability/nonavailability of health infrastructure
in urban and rural areas. Further households of these villages have been randomly selected.
The data was collected through a questionnairebased survey of 150 samples of rural
households & 120 samples of urbanhouseholds, which was conducted, between May,
2015 and August, 2015.
The survey data has been extensively analyzed. To find out the major factors affecting
the health status of rural and urban household’sProbit model was applied on survey data.
Probit model is a statistical probability model with two categories in the dependent variable
(Liao, 1994). Probit analysis is based on the cumulative normal probability distribution.
The binary dependent variable y, takes on the values of zero and one (Aldrich and
Nelson 1984). Binary Probit model was employed to the survey data to see the effects
of socioeconomic and demographic variables on the individual health status. In the binary
Probit model, quality health status was taken as 1, while adverse health status as 0. It is
assumed that the individuals of urban areas obtainbetter health services rather than
individuals of rural areas. The probability pi of choosing any alternative over not choosing
it can be expressed as in equation, where x is the variable (Greene 2011).
WWW -1 / 2
[Y i = 1| X] = ò-¥ ( 2 p ) exp (t 2 /2)dt =f ( W W W )
p i = prob
In the study, the variables considered affecting choices of individuals between
preferences alternatives are: education (EDU), income (INC), availability of health facilities
(AVHF), Awareness of Health Programs (AWHP), Balanced diet (BD), safe drinking
water (SDW) and Hygenine Facilities(HF).
Table 1. Definition of Variables
Variables Definition
EDU (Education) 0= Uneducated, 1=Educated
INC (Income) Average monthly household income; (TL/Month/
Household)
AVHF (Availability of Health facilities) 0=Unavailable health facilities, 1= Available health
facilities
AW HP (Awareness of Health Programs) 0=Unawareness Health Programs, 1= Awareness HP
BD(Balanced diet) 0= Unbalanced diet, 1= balanced diet
DW (Drinking water) 0= unsafe drinking water, 1= safe drinking water
HF( Hygienic Facilities) 0= Unhygienic, 1= Hygienic
In this study, in order to determine the most appropriate model the variables described
above, it was made various model experiments and was tested whether statistically
274 Bridging the SciencePolicy Gap for Inclusive Growth in India
significant at 1% significance level or not. As a result, seven estimators as per Table1
(EDU, INC, AVHF, AWHP, BD, DWand HF) in the Probit model were found to be
statistically significant at 1% level.
3. Result
Some Economic status of the surveyed households
The survey was conducted among 270 families, consisting of 150 rural and 120 urban
households. Out of 270 surveyed households 80.6 percent males in urban areas and 40.3
percent males in rural areas were educated. The situation was almost similar for female
and children. As almost 85.9 percent female in urban and 43.8 percent in rural areas were
educated. It has been observed that in rural areas only 49.6 children were educated as
shown in figure 1.
Fig. 1. Status of Education in Rural and Urban areas
Fig. 3. Availability Health Facilites PHC, CHC, ASHA and ANM
The Health programs awareness for communicable diseases, child and women welfare
plays important role in health of individual well being. On the basis of the survey awareness
about health programs like RBSY, JSSY, ASHA , PMSSY was founded to be 31.6 %, 49.3
%, 85.8% and 20.2% in rural areas but it urban areas it was founded as 80.5 %, 83.6%,
85.8%, 90.2% respectively. National AIDS Control Program ( NACO) awareness amomg
individuals of rural areas were founded to be 25.7 percent in rural areas and 78.4 percent
in urban areas. National Pulse Polio program (NPPP) has improved in rural areas over
fast few years, therefore on the basis it was analyzed that 90.5 percent individuals are
aware about immunization program in rural area and 95.6 percent in urban area. National
Tuberculosis program( NTBP) awareness 35.8 percent in rural area and 85.7 percent in
urban area. The communicable diseases like JE, swineflu, influenza, dengue, malaria ,
typhoid , jaudience and others have adverse impact on health status of both rural and
urban areas. Similarly, of National Communicable Control Program awareness 30.3 percent
in rural areas and 89.8 percent urban area as shown in figure 4.
276 Bridging the SciencePolicy Gap for Inclusive Growth in India
Fig. 4. Awareness about Health Programs in Rural and Urban areas
Healthcare Technology utilized in the form of blood test, ultrasound, Xray, ECG/
Doppler/TMT in rural area and urban areas are shown in the figure 5. Result showed that
rural areas household utilized more healthcare technology in the form of blood test (50.3
percent), Ultrasound (45.6 percent), Xray (39.5 percent) and ECG (21.4 percent). Similarly
urban household utilized significant level of healthcare technology during the process of
health treatments such as blood test (88.5 percent), Ultrasound (85.4 percent), Xray
(78.2 percent) and ECG (75.2 percent) respectively.
Fig. 5. HCT facilites utilized by households of rural and urban areas
The health facilities advancement is based on health technology availability in rural
and urban areas. On the basis of the survey 30.6 percent of ambulance services were
founded to be rural areas and 90.8 percent in urban areas. The mobile phone availability
in rural areas was 28.9 percent while 95.7 percent in urban areas. In concern to telemedicine
availability in rural areas was 6.5 percent while 11.3 percent in urban areas as shown in
figure 6.
Study of Factors Affecting Rural and Urban Healthcare System using Probit Model 277
Fig. 6. Availability of Health Technology in rural and urban areas (percent)
The survey results revealed that average annual income of rural was found lower
than urban areas. Health status substitutes according to educational level and income
level. Therefore, low income group in rural and urban areas would have the possibility of
adverse health.Table2 presentsresults estimated from binary Probit model. The model is
significant at 1% level of probability.
The estimated coefficients and standard errors reveal the factorsthat significantly
influence health status of respondent’s. A statistically significant coefficient suggests that
the likelihood of better and adverse health status as the response on the explanatory
variable increase/decrease (Borooah 2002). McFadden Pseudo coefficient of determination
(R2) was calculated to be about 0.0949 in rural areas and 0.0651 (R2) in urban areas.
This value represents that variables placed in the model explain increased level of probabilities
of household’s health status. Seven estimators (EDU, INC, AVHF, AWHP, BD, DW and
HF) in the Probit model were found to be statistically significant at 1% level.
Household education level (EDU) was found to be an important socioeconomic
factor for the probabilities of better health status in urban areas. In estimated model,
education level was statistically important at significant level 1% and related positively in
urban areas. As educational level increases, tendency of better health status increases and
when it decreases it manifest in the form of adverse health as in the case of rural areas.
Educational level might be a good starting point to increase the awareness of quality
health. According to the estimated results, income level is one of the factors affecting the
health status of rural and urban areas. This variable is included in the model because low
income families may have adverse health. There is a positive relationship between quality
health and income level it is statistically significant at the level of 1%. For a household
with high income level, the probability of quality health increased by 1.6%. This implicates
that when income level is raised, quality health increases. This result is significant and as
per prediction. Therefore, it is said that low income groups tend to have adverse health
because of their economic difficulties in both rural and urban areas. On the other hand
other five variables like AVHF, AWHP, BD, DW and HFwere determined as other factors
affecting health status of the individual.
Table 2. Estimates of the binary probit model in rural and urban areas
278
Number of obs= 150 LR chi2(7) = 13.98
Prob> chi2= 0.0515 Log likelihood = 66.663084 Pseudo R2=0.0949
Iteration0:log likelihood=26.807977
Iteration1: loglikelihood=25.14627
Iteration2:log likelihood=25.063693
Iteration3:loglikelihood=25.06251
Iteration4:loglikelihood=25.062509
Number of obs =88 LR chi2(2)=3.49 Prob>chi2=0.1746
Bridging the SciencePolicy Gap for Inclusive Growth in India
4. Discussion
On the basis of binary probit model; education, income, availability of health facilities,
awareness of health programs, safe drinking water, balance diet and hygenine are significant
and associated with better and adverse health. Education and income werefound to be the
primary reasons mentioned in the survey for having adverse health in rural areas.It was
perceived that health facilities are quite expensive in rural areas compared to urban areas.
These five variables like AVHF, AWHP, BD, DW and HF found significant at 1% level
and were related negativelylikely to adverse health in rural areas. According to the results,
households of urban areas preferred better health compared to households of rural areas
having adverse health.The findings of present study showed that households of rural areas
were affected by adverse health due to education, income, availability of health facilities,
awareness of health programs, safe drinking water, balance diet and hygenine.To overcome
the essential gaps as resulted above for different variables the education and income level
has to improve in rural household to provide better health. Health awareness program and
technology can play essential role in reducing the rural and urban shortfall, which in bigger
picture can improve health conditions of rural and urban household. Gaps obtained can be
worked out through different model designs as implementing it for both households to
achieve better health conditions.
5. Conclusion
Rural households with lower education and income levels tend to have adverse health
compared to urban areas. Health facilities, awareness of health program, balance diet,
safe drinking water, hygenine and technology are affective factor for adverse heath in
rural areas. The rural household’s health facilities, awareness about health programs,
requirement of balance diet, safe drinking water, hygenine and technology is affected by
lower education and income levels, which shows a grim picture of adverse health as
compared to urban households. According to empirical results, individuals of urban areas
with higher education and income levels tend to have better health. Availability of health
facilities, awareness of health programs, safe drinking water, balance diet and hygenine
were prominent factors for better health in urban areas.
Three critical design principles that are essential ingredients to creating a scalable and
sustainable healthcare model: a) Zero based approach; b) Standardization; c) Technology
driven. a) Zero based approach through design and costing: If the common disease types
occurs across the rural and urban areas and healthcare model try to design a solution that
catered to more than 90percent of the disease occurrences in both areas (ET, 2012),
would widely improve the healthcare. Our focus is on reducing capital expenditure per
bed by focusing on a smaller subset of disease types and providing better quality of clinical
excellence for curing all disease types. b) Standardization: doctor driven model means
protocol driven model facilitated by doctors. Skilled doctors are the core of any healthcare
services protocolthat allow for ensuring better quality of health services and reduces
280 Bridging the SciencePolicy Gap for Inclusive Growth in India
errors. Technology driven model uses technology extensively to ensure operations that
could be leant across both the clinical and administrative aspects of healthcare delivery
and improves both accuracy and efficiency of healthcare services at public hospitals.
Technology is also being used to access high quality specialists who may not be physically
located at the hospitals; the ecosystem clearly needs more such sustainable and long term
models.
Healthcare as an industry is spearheaded by intensive information and manpower.
Improvements and advances in medical technology are insufficient to improve the quality
of health services because the skill set of doctors and other healthcare workers is not
being continuously enhanced and utilized (ET Healthworld, 2015). Moreover, there is an
immediate need for the government to bridge policy gaps and ensure generation of
sufficient qualified human resources for health (HRH) to provide quality care in primary,
secondary and tertiary levels of healthcare facilities in rural and urban areas. Increasing
skilled gaps in rural areas has emerged to be one of the key barriers in healthcare sector
and burden of rising healthcare costs and rapidly increasing household population has
further widened making it difficult for households to equate healthcare needs with existing
means.
In such a scenario, both rural and urban areas are struggling to supply adequate
numbers of trained, qualified health care professionals, especially physicians, medical
laboratory professionals, nurses, paramedics as well technologists. In the light of the
findings, the necessary policies needed for providing access to education, income, nutritious
food and health technology reaching to the level of rural areas and urban areas. Also, on
the basis of present study, it would be expected to prepare strategies on better health by
looking at household preferences. Rural areas were found to be more vulnerable to health
risks as a consequence of living in a suitable environment, inaccessibility to health care,
irregular employment and lack of negotiating capacity to demand better services in respect
to urban areas.It has been observed in the field survey that two major problems equity
and quality have consistently directed attention to the underbelly of the apparent health
policy gap.
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282 Bridging the SciencePolicy Gap for Inclusive Growth in India
ANNEXURE
Table 1: Allopathic Hospital / Dispensary / Primary Health Centre/Public Health Centre
Table2: Family Welfare Centre / Sub centre
Table 3: Mother Child Welfare Centre / Subcentre
Table 4: Allopathic hospitals and dispensaries in the district