The Challenges and innovative solutions to rural health dilemma

ANNALS EDITORIAL the six decades of Indian independence have witnessed too many plans, papers and proposals giving top priority to the health issues in India. Unfortunately, despite huge economic growth, health continues to be the greatest predicament. Even the WHO slogans 'Health for All', 'Millennium Development Goals and more recently 'universal health care have not translated into meaningful action on ground. the accessibility of healthcare as well as utilization of available healthcare facilities, especially in rural areas, continue to be poor in India. Problems as opportunities While I am not undermining some improvisation indicated by better health indices, corporate participation, available resources through the National Rural Health Mission, but it has been too little and too late. the present health scenario is a toxic combination of uneven quality , high cost, frequent errors and limited access for marginalized population. It is observed that 70% of population has no access to specialist care as 80% of specialists live in urban areas. Only 13% of rural population have access to primary health centers, 33% to sub-center and 9.6% to a hospital (NFHS-II). Poor quality services at state-run hospitals force many people to visit private facilities. the overall health care utilization is also low, only half of (52%) of Indian mothers receive three or more ante natal checkups; Only 43.5% of children in India receive all vaccinations {(NHFS-3), 2005-06}. At one side our peripheral health centres are underutilized whereas on other side our tertiary and secondary (District) level facilities are often argued as overloaded with the work that could have been done at lower centres, resulting in compromise of quality. Others continue to argue that even these centres have not successfully exploited the skills of its specialists with only 2–3 OPDs/Ots per week per physician. the underutilization of peripheral centres is attributed to varied factors related to accessibility, quality, affordability, deficient human resource, poor monitoring , lack of community participation and ownership. Vast and diverse geographical locations of India inhibits proper penetration of health care delivery in such areas. Further, health care personnel are reluctant to work at block or below level areas , as they have to face two challenges, first the absence of reasonable living conditions (eg. proper housing, 24 hour electricity supply, good school for their children, social isolation etc) and second , the under functioning of majority of health care facilities in such areas and hence no opportunity to …