Friday, 9 November 2012

RURAL DEVELOPMENT


RURAL DEVELOPMENT
Eradication of Poverty in Rural India – Health

1.   SIGNIFICANCE OF THE STUDY
        India’s  rural poverty is like a multi-hooded octopus. Poverty lays proper road to health. Ill-health can lead more and more poverty. The innocence of the rural people, lack of knowledge of things, not knowing the ways of the urban people, unaware of how fast the world is changing, backwardness, etc. are some of the self-defeating-hoods of the rural people. There are some more things, about which the people are not aware of, lack of whose knowledge; the people are frequently losing the battle of life. They are medicine, exploitation, latest techniques in agriculture, facing market to sell their produce and so on. One among many is medicine, which keeps the people healthy.
        Health, defined as the state of complete physical, mental, social and spiritual well-being and not merely absence of disease and infirmity. The basic objective of human development is to improve the quality of life. Healthy population plays a key role in achieving the developmental activities as health helps to improve the productivity of mankind both directly and indirectly. The health situation of India is worse. Two thirds of our population lives in worse condition. The developments in science and technology brought drastic changes in medicine, but in the same ratio the prices are shot up. The common man is again far from medical provisions. Health does not exist not alone. For poor health condition of life there are many factors responsible. To name some,
Bhore Committee 1943
Bhore Committee felt that
1.   no individual should be denied adequate medical care on grounds of inability to pay,
2.   special emphasis should be given to preventive work.
3.   focus on rural population.
4.   active co-operation of people must be secured.
5.   a living wage for all workers,
6.   improvement in agriculture
7.   Industrial production.
8.   elimination of unemployment,
9.   suitable housing,
10.                clean environment.
The First Five Year plan. 1952
In this plan various health plans are enunciated.
1.   medical care,
2.   control of communicable diseases,
3.   maternal and child health,
4.   collection of vital statistics,
5.   protection of water supply and environmental sanitation,
6.   conduct of school health programme,
7.   family planning services which were added on later
8.   PHCs are envisaged as a nucleus for all health activities in the area.

Mudaliar Committee 1961
Mudaliar committee  recommended
1.   consolidation of the then existing services before taking up any expansion.
2.   strengthening staffing in the then existing PHCs.
3.   the each PHC should serve a population of 40,000 instead of 60,000.
4.   not to open any new PHC without ensuring the full staff component.
5.   strengthening of the district hospitals with mobile clinics to cover non-PHC populations.
Kartar Singh Committee. 1973.
This committee reviewed the functioning of the PHCs. It observed that there is little co-ordination among the various health workers.
It recommended that,
1.   one male multi-purpose worker for a population of six to seven thousand people.
2.   one female health worker [ANM] for a population of ten to twelve thousand.
3.   integrated training for all workers, and
4.   co-ordination of programmes and personnel.
National Health Policy.[1980-85]
This was adopted in the Sixth Five Year plan [1980-85]. The Policy emphasized
1.   the need to re-structure the health services.
2.   provision of network of primary health care services,
3.   curative centres according to the size of the population,
4.   large scale transfer of knowledge, skills, and techniques,
5.   to buildup individual self-reliance and community participation,
6.   referral system to support family health care,
7.   establishing a nationwide chain of sanitary-cum-epidemiological stations to provide integrated service to eradicate/control diseases,
8.   support voluntary agencies in health services,
9.   establishing centres for specialized treatment wherever required,
10.                make special efforts in the areas of mental health and rehabilitation work,
11.                priority to the provision of services to people living in tribal, hills, backward and disease prone areas.
HEALTH CARE PROGRAMMES
The Government takes concerted measures to combat communicable and non-communicable diseases at the national level. For this purpose, the Centre organizes various National Health Programmes.
1.   National TB Control Programme
2.   National Programme for the Control of blindness,
3.   National Leprosy Control Programme,
4.   National Malaria Eradication Programme,
5.   National Filaria Control Programme,
6.   National Iodine Deficiency Disorders Control Programme,
7.   Medical Care for Remote and Marginalized Tribal and Nomadic Communities,
8.   National Mental Health Programme,
        Medicine is not a word, but a universe of many branches. It itself is a system. From medical point of view rural health can be decided by many factors;
1.   Potable water,
2.   Good atmosphere,
3.   Tensionlessness,
4.   Nutritious food,
5.   Chemicals used in fields,
6.   Superstitions,
7.   Ignorance,
8.   Illiteracy    and many more.
        India is a country of villages. The largest percentage of our population resides in rural India. If the rural India is strong, then the nation will be strong. Rural India is like our mother. Mother always sees the needs of the children and gives what is needed to them. The farmer is the back bone of this nation. That farmer is not strong financially, in health, and knowledge. He has been exploited for generations. He is a very hard worker, but his lack of knowledge of other things is making him weak.
        The farmer, who was self sufficient once, has become dependent on others for everything. For seeds, fertilizers, agricultural implements, and many other things the poor people of India have to depend on the multinationals. Many plants, roots, ashes, and other Ayurvedic items which saved the rural people also have lost their prominence. For small or big items the poor have to depend on the corporate for treatment. That is why, treatment has become costly and beyond the reach of the common man.
        India is in need of many things. You choose one problem, think it, discuss it, and dedicate your life to it.” Swami Vivekananda. This inspired me to learn medicine, which is one of the common problems of rural India.  It is a skill that never goes waste. Wherever such people reside,-- Baba Amte, Norman Bethoon, Kotnis, Puchalapalli Rama Chandra Reddy, Jetty Sesha Reddy, -- their ideas can help an ordinary man.
                Secondly, in China, Mao implemented bare-foot doctors. Generally what are the health problems of common people in rural side? Fever, motions, headache, cuts, and many types of first-aid treatments are the common ailments. For ladies delivery problems, menses problems, and other general ailments.  To give minimum treatment to such diseases, one need not study M.B.B.S. It is time consuming and lots of money consuming.  If the knowledge to cure such small diseases is imparted to those volunteers who have interest in medicine, a major problem can be solved. This idea was used and lakhs of volunteers were given training in common diseases and sent to the rural China to serve the people. Mao was successful. This thought of Mao inspired me to learn medicine, a valuable skill, needed by the people.
        In 1978, in Alma Ata city a world conference was conducted on “Health’. Keeping in view of the suggestions, our government formulated a National Health Plan. In 2002 the then NDA government modified and reformulated the same plan.
        Health for all is the basic objective of Primary Health Care and proper planning was initiated to achieve it.
        The amount that is expended on ‘health’ in USA is 15% of GDP, in England it is 8% and in India it is 8%.
        As per government’s Macro Economic Commission on Health, the per capita expenditure required is 34 dollars, but we get Rs.215 out of which only Rs. 120 are allotted.
        As WHO commission the per capita expenditure in America 4,900 dollars, England 4500 dollars, but in India it is only 250 dollars.
        The life expectancy in USA and England 75 years, China and Sri Lanka 74 years and in it is 64 years.
        71% of rural families do not have sanitary latrines.
        In tribal India, 80% people are suffering from nutrition problem.
        20% TB patients of the world live in India.
        The number of doctors per 1,00,000 people in USA 279, England 164, China 162 and in India 48.
        The number of nurses per 1,00,000 people in USA 972, England 479, China 99 and in India 45.
        Brain drain of doctors is more in India, that is out of 31000 doctors who come out of 271 medical colleges only 6 are living in India.
        During Mao’s thousands of volunteers were given training to treat various diseases. They were called ‘barefoot doctors’. Those barefoot doctors served the rural areas and contributed a lot in nation building.
        Substitutes, false drugs and unnecessary medication are some other problems to rural India.
        Drastic changes have come in medicine but they are so costly, the common man cannot afford it. 
Medicine to all is of four types.
1.     Promotive- giving balanced nutritious diet improving hygienic and immunity power.
2.     Preventive – safe drinking water, sanitation, cleanliness of surroundings, protection from atmospheric pollution, vaccination, and bringing changes in living conditions.
3.     Curative – prevention of diseases, hospitals, medicines, operation facilities.
        As of now there are 1,37,271 Health Sub-Centres, 22,975 Primary Health Centres, and 2,935 Community Health Centres in the country.  Besides these, there are 5,435 Family Welfare Centres functioning.
4.     Rehabilitative – prevention of polio, measures after eliminating a disease.
        Poverty is the main thing that is paving way for ill-health.
State of Rural Healthcare in India-NRHM Report

        India's rural health centers are critically short of trained medical personnel. The country's 22,669 primary health centers are in sorry state of affairs increasing people's suffering. According to the recent National Rural Health Mission report nearly 8% PHC don't have a doctor while nearly 39% were running without a lab technician and about 17.7% without a pharmacist. The PHCs are supposed to have one medical officer supported by paramedical staff.
        To compound the problem PHCs in some states donot have adequate labour rooms and operation theatres.While not a single of UP's 3,660 PHCs have either a labour room or an operation theatre,the number stands at 208 labour rooms (13%) and 218(13%) OTs in Bihar's 1,641 PHCs,105 (20%) Lrs and 50 (10%)O Ts in Chattisgarh's 518 PHCs and 131 (4%) LR s and 108 (12%) O Ts in Kerala's 909 PHCs.

        The condition of 3,910 community health centers supposed to provide specialized medical care is equally appalling.Out of the sanctioned posts, about 59.4% of surgeons,45% of obstetricians and gynaecologists,61.1% of physicians and 53.8% of pediatricians were found to be vacant. Moreover there is a shortfall of 70.2% specialists at the CHCs. The report says there is a huge challenge to meet the shortfall for rural health infrastructure specially the manpower.
        According to Planning Commission figures India's CHCs require 3,910 surgeons. While only 2,372 are sanctioned, just 972 are in position creating a vacancy of 1,381 posts for surgeons and a shortfall of 2,376 surgeons in CHCs. As for physicians CHCs require 3,910 of them. There are only 832 in position with 1,296 vacant posts and a shortfall of 2,516 physicians. Of the 3,910 pediatricians required only 1,951 posts are sanctioned of which just 837 are in position. There is a vacancy of 953 posts and a shortfall of 2,511 pediatricians.
        Can technology be the route to bring affordable healthcare to millions of rural Indians? This question was explored during the session on healthcare at EmTech2009 in New Delhi. Telemedicine had already touched 2,000 villages and a foundation had been laid for a health superhighway to make the promise of universal healthcare a reality at last. The health superhighway envisages connecting a chain of hospitals -- both government and private sector -- through applications like telemedicine, mobile software and wireless networks so that doctors can connect with villages in India. Every single doctor in every corner of the country through a telemedicine network should be met  so that patients can not only get access to healthcare, but can get a doctor of their choice. Other prescriptions to bring 'good health' to a billion Indians included the adoption of a more 'pre-emptive' strategy. The doctors should  focus on awareness so that they can postpone the age of lifestyle diseases: if a man is getting a heart attack today at the age of 40, his age can be  pushed  to 60 by an awareness drive.
        The allopathic medicine, homeopathic medicine, Ayurvedic medicine and many other systems have entered the market on a large scale.
         India is one among the developing countries in the world. It is in the third world countries.
        India is the largest manufacturing country of intellectuals. Brain drain is more in India. Then what will be the alternative to serve the rural poor.
        India is a country, which gave great prodigies in medicine like Charaka, and Acharya Nagarjuna. And it also gave a great and valuable medicine called Ayurvedam to the world. Every villager knows something or the other of a medicinal value of a plant, seed, bark, or any other thing. This is really wonderful. In those days people knew that Acharya Nagarjuna  knew how to make gold. When requested by the students, Acharya Nagarjuna  explained the formula as;
Naagarasa bandhanam, baala ravi chumbanam,
Hema karo, hema karo, hema karo

        The corporate world is also entering this medicinal field in a large scale, in manufacturing Ayurvedic medicines. For example triphala, alovera, massage oils and many other combinations.
       
        Now a days, beauty parlors are using many Ayurvedic medicines manufactured by the multi-national companies.
        There are many magazines, and books which can help the common man, to know and understand the medicine for common ailments.
  1. Andhariki Ayurvedam
  2. Amrutam
  3.  Vydyudu leni chota
  4. Mandulu mana desa prajalu
and many others.
        These magazines and books also explain the reasons why such and such ailments take place. So prevention is better than cure. The medicine awareness of common man is enriching.
Seeds and other Food Items in Health
        Another important thing is seed. Hybrid and HYV seeds really filled the bellies of millions of our people. But if we take the health condition of millions of our Indians it is doubtful. Small children getting   Vandana Siva
Environmental pollution in Health.
Water- rivers - sentimental
Ganesh nimajjanam
Industrial wastes
Deforestation
Vehicular excretions.
Noise pollution on health

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