Rural Healthcare in India

• In Colonial India, most public health efforts were directed towards British residents and Indians who worked for them. Indians were also kept away from medical education and serving as mainstream doctors.
• India's traditional medical practices like Ayurveda and Unani with services of Vaidya and hakims were neglected for an exceptionally long time and suffered due to lack of funds and were constantly projected as inferior by western medicine practitioners.
• Despite years of reform and efforts, in 1983, the Government of India's first National Health Policy acknowledged that the efforts to expand western healthcare services had benefited only the upper- class people and failed to serve the urban poor or those in rural India.
• The policy recommended a decentralised health care system, encouraged community participation, and invited private sector participation.It is with this background that the National Rural Health Mission was launched in 2005.
• Because health care is a state responsibility, the central government can play a supplementary role only. It was a bottom-up approach where the onus and focus of health care delivery was on the villages and went up till the district level.
• The idea was to communitise, i.e., devolve funds, functions, and functionaries to local community organisations and Panchayati Raj Institutions (PRIs). In 2013, NRHM became a sub-mission under the over-arching National Health Mission with the addition of National Urban Health Mission (NUMH) as the other sub-mission of the programme.

Coverage and Access for Rural Healthcare

• Rural healthcare delivers services through a three-tier system of sub-centers (SC), primary health care centers (PHC) and community health centers (CHC). Between 2005 and 2019, there was an increase of 7.8 percent in the number of SCs, 7 percent in PHCs and 59.4 percent in CHCs.
• Accredited Social Health Activist (ASHA) is a grassroot level health worker who is selected from a village to serve that village. The ASHA works as a liaison between the local rural community and the public health system. As of March 30, 2019, there were 9.29 lakh ASHAs in the country, which is 34,175 more than the required numbers.

Some Programmes for Rural Health Care

• Janani Suraksha Yojanais a cash incentive programme designed to encourage women to use formal healthcare services for institutional deliveries. The objective is to reduce neonatal and maternal mortality among poor, pregnant women, especially those in rural India.
• Janani Shishu Suraksha Karyakram was launched in 2011 to eliminate the out-of-pocket expenditure for both pregnant mothers and sick infants upon accessing institutional health care. This programme provides free drugs, consumables, free diagnostic, free blood and free diet for 3 days during normal delivery and 7 days for caesarian section deliveries. This initiative also covers all ante-natal and post-natal emergencies.
• Pradhan MantriSurakshitMatritvaAbhiyan (PMSMA) was a similar programme launched in 2016 to provide quality antenatal care, free of cost and universally to all pregnant women on the 9th of every month in their 2nd and 3rd trimesters of pregnancy, that can be availed at all government facilities.
• Laqshya or the Labour Room and Quality Improvement initiative was launched in 2017 to as a focused and targeted approach to strengthen key processes related to the labour rooms and maternity operation theatres.
• Special Newborn Care Units (SNCUs) were established at district levels and sub-district level hospitals with an annual load of more than 3000 to provide care for sick newborns who did not need assisted ventilation or major surgeries.
• Rashtriya Kishore SwasthyaKaryakram targets adolescents between the age of 10 to 19 years. The aim is to provide adolescent-friendly health care services to improve nutrition, mental health, sexual and reproductive health, prevent injuries and violence, substance abuse and non-communicable diseases.
• RashtriyaBalSwasthyaKaryakram screens children under the age of 18 for four birth deficiencies - Defects at birth, Diseases, Deficiencies and Development Delays including Disabilities.
• The rural health care system also has family welfare initiatives that deliver family planning management services, education and use of contraceptives, menstrual hygiene schemes, sterilisation services and awareness campaigns through public programmes.
• Anemia is a cause of concern among rural Indian population. Anemia Mukt Bharat targets new borns and infants, school age children, adolescent boys and girls, women of reproductive age, pregnant and lactating women. It uses 6 interventions — provision of folic acid supplements, deworming, year-round behaviour change initiatives, communication campaigns, text alerts, mandatory provision of folic acid fortified foods in public health programmes and addressing non-nutritional causes of anemia in endemic pockets like malaria and fluorosis.

While the efforts of JSY and other schemes improved the number of institutional deliveries from 38.7 percent to 78.9 percent in the 10 years from 2005 to 2015, the maternal and newborn mortality rates were not affected significantly. The rural focus of the programme has gaps that must be bridged.

To begin with, focus on incentivising medical staff to serve the rural community is a starting point to ensure all programmes are efficiently delivered. As we move towards gaining from our demographic dividend in the next 20-30years, we must ensure quality and timely delivery of services across the country.