Study on Bundelkhand of Planning Commission: Health - Government Infrastructure of Health Care Delivery:
Study on Bundelkhand of Planning Commission: Health - Government Infrastructure of Health Care Delivery:
Health
MP is one of the most backward states of India. It follows the same with respect to health. The state with one of the poorest literacy rates, lowest school enrollments, highest number of drop outs and lowest per capita income will have repercussions on health of the masses living within the boundaries of the state. Sample Registration System indicates that in 1993, while the birth rate of India was 28.5 per thousand population, it was 34.4 for MP. Similarly death rate in MP was 12.6 per thousand, much ahead of national average of 9.2. Infant mortality rate of MP with 106 is also high in comparison to 74 of India.
Within MP, the districts like Tikamgarh, Panna, Chhatarpur and Satna are among the most backward districts of the state, based on its development index. Datia is little better than those above mentioned districts. Health data also proves the same. There are variations within the districts of MP but the districts of northern MP are always on the worst side. In terms of life expectancy, while the best rate is that of district Indore (58.0 yrs), the worst three are of districts Tikamgarh (40.8), Panna (41.3) and Chhatarpur (41.6) respectively. Datia (44.3) and Satna (44.5) are little better.
In terms of crude birth rates, district Indore again has the minimum and the best rate with 29.6 while Chhatarpur (42.6).Panna (42.2) and Tikamgarh (42.1)respectively, have the third, fifth and sixth highest rates in the state. Satna (41.1) and Datia (39.5) are also high.
The fertility rate in MP is the best for the district Indore which shows the minimum and the best with 3.6 children per women. On the worst side Chhatarpur(6.6), Tikamgarh (6.1), Panna (5.9), Datia (5.8) and Satna (5.7), respectively have third, fifth, eighth, tenth and fifteenth highest rates in the state.
The case of infant mortality rate is no better for Bundelkhand districts. While the district Indore with rate being only 84, the highest and the worst is the case with district Tikamgarh (195), followed neck to neck by Panna (185), Chhatarpur (182) and Satna (181) districts Datia is little better with the figure of 156 infant deaths.
National Family Health Survey (NFHS) 1992 for MP has not collected district specific data collection but it has studied the nature of backward districts of the state and concluded that the backward districts closely parallel the situation in MP, as a whole, on every measure included in the survey. According to it, though the fertility has started to decline in MP but fertility rates continue to be high. Total Fertility Rate (TFR) for government designated backward districts (4.4) is slightly higher than the TFR for the whole state (3.9). Child bearing is highly concentrated in the age group 15-29, which accounts for 77% of the total fertility. In age group 15-19, 64% of the women in MP are married but marriage at very young age has been declining over time. Seventy nine percentage of currently married women wanted to either postpone their next birth or stop having children. Interestingly, the desire for spacing children is very strong for women who have fewer than three children. Thirty six percent of women with no children say that they would like to wait at least two years before having their first child. All these would have future bearings on the fertility rate of MP.
Government Infrastructure of Health Care Delivery:
In all the districts of MP, Sub Health Centres (SHC) are the units catering health services at the village level. It is established for the population of 5000 in general areas and 3000 in tribal areas. On each sub centre one male and one female multipurpose health worker is posted. At the sector level Primary Health Centre (PHC) is established for the population of 30,000 in general areas and 20,000 in tribal areas. One medical officer, one male and one female supervisors are placed in PHCs. Block level PHC is established with indoor facilities for 6 beds. To cater to the population of 120,000 in general areas and 80,000 in tribal areas, Community Health Centres (CHCs) are established with better medical facilities and act as primary level referral hospitals. Above it, District Hospital is established which functions as secondary level referral hospitals. The structure can be shown as follows:
District Hospital _____ Secondary level referral hospital
Population coverage ______Community Health Centre better facility:
80000 - Tribal areas (CHC) Primary referral hospital
120000- General
Population coverage Primary Health Centre One doctor,
Supervisor
30000 - in general (1male,1 female)Block level (facility for 6 beds)
20000- tribal areas
Population coverage Sub Health Centre Multipurpose Health
Workers
5000 - general (SHC) (MPW)-one
3000 - tribal areas Female,one male
MP has not been able to establish the required number of health centres at each levels to serve the health needs of its populace. The condition is further worse in the underdeveloped istricts of MP.
Community Health Centres (CHC) are much lesser in number than required as per the norms of the government to serve the total population. In MP 488 CHCs are required but together with the district and civil hospitals it comes to simply 309. In MP each CHC is catering the average population of nearly three and half lakh while a CHC is generally meant for almost half of this population. District Chhatarpur is one of the worst case where above 12 lakes population is served by a single CHC. Similarly the average population being served by a CHC in Panna, Satna and Tikamgarh is approximately seven lakh, five lakh and three and half lakh, respectively.
Similar is the case with Primary Health Centres (PHC). In the state of MP these centres are also not in the required number to serve the total population. Generally a PHC is supposed to serve the population of around thirty thousands. But in district Tikamgarh , Panna and Datia each PHC serves the average population of around forty-one thousand, thirty seven thousands and thirty-six thousand respectively. In Satna and Chhatarpur it serves the average population of nearly 25,000 and 23,000 respectively which is relatively a better situation. In Chhatarpur, the blocks namely Baxwaha, Badamalhara, Bijawar and Naugaon are worst served where each PHC has to cover approximately forty thousand population and that too when the sex ratio of these blocks is very low and requires special attention. In district Panna, the blocks namely Shahnagar, Pawai and Gunnaur have each PHC serving a population larger than forty thousands. In a less densely populated blocks like these, the service coverage is so wide that it is natural that most of the population would be out of the reach of these health centres. In district Satna, blocks Maihar and Nagod are poorly covered by health services. In Tikamgarh, except Newari which is relatively developed block and well connected with health services available in Jhansi (UP), all the other blocks are poorly served by PHCs, as the coverage of population is concerned. But as its linkages with the towns of Uttarpradesh is regular and well-connected, people are prone to use it for health services also. In district Tikamgarh, the coverage by Sub Health Centres (SHC) is also similarly poor and ranks amongst the worst, Satna is relatively better in comparison to concerned districts. (see table 3.1)
Workforce in health in northern MP districts is also not
large enough to reach to the masses. Blocks like Baxwaha in Chhatarpur district
have only two allopathic doctors and no nurses. Badamalhara, Bijawar, Gaurihar
and Londi blocks are no better. In Tikamgarh, blocks Palera, Jatara, Baldeogarh,
Prithivipur all have insufficient staff and doctors. In Panna, blocks Shahnagar,
Gunnaur, Ajaigarh all have small number of health workers. In Satna, blocks
Ramnagar, Rampur Baghelan, Uchehara, Amarpatan and Maihar have small number of
workforce to reach to the rural areas. (see table)