(GIST OF KURUKSHETRA) Connecting Rural Health Services

[MAY-2022]

The National Rural Health Mission envisaged architectural correction of Ihe health system by building accountability to the community, management of human resources, convergence of efforts across departments, schemes and programmes, targeted innovations and interventions, flexible financing, as well as rigorous monitoring and evaluation for improvement of health indicators.

Capacity enhancement of Panchayati Raj Institutions (PRIs) to own, control and manage public health services,
Developing a health plan for each village through the Village Health Committee of the Panchayat,
Developing and implementing an inter-sectoral District Health Plan, including drinking water, sanitation and hygiene, and nutrition through the District Health Mission,
Strengthening effective curative care at rural hospitals and ensuring measurability and accountability through Indian Public Health Standards (IPHS),
Capacity development for promoting healthy lifestyles and adoption of preventive healthcare. Also, promoting collaboration with the non-profit sector, especially in underserved areas.

Experiences and evidences from different states in India and across the world can be leveraged to guide improvements in healthcare in rural India.

Rural India witnessed three times the percentage growth compared to urban internet users which increased 4 percent in 2020. Overall, internet users comprise 67 percent of the urban population and 30 percent of the rural population, according to The Internet and Mobile Association of India (IAMAI) Kantar’s ‘ICUBE 2020’ report.
This rapid expansion of mobile phones and the internet can be leveraged by taking advantage of technological advancements in delivering e-health services. Telehealth can be used to increase access to specialist consultations from an accessible PHC/CHC.

Information from the National Family Health Survey, Annual Health Survey, and Rural Health Statistics Report enables the Government of India to evaluate and course-correct policies and programmes related to population health and nutrition. Concurrent diagnosis and consolidated efforts in the monitoring of healthcare-related input, output, and outcome indicators can provide concurrent insights into the bottlenecks and areas for improvement with respect to increasing access to quality healthcare.
NRHM’s Management Information Systems (MIS) are intended to monitor the health indices of the population and the functioning of the healthcare system.

The objective of primary healthcare is to provide gate keeping functions and deliver a range of basic services. This would lead to appropriate utilisation of primary health facilities and reduce the burden at the secondary and tertiary levels of care by reducing unnecessary referrals. Creating cadres of health professionals from the rural areas themselves who can be trained to deliver essential and basic health services is of the essence.
An example of this is the Mid-Level Providers who are a key part of the team at Health and Wellness Centres being operationalised under the Ayushman Bharat programme.

In an ideal healthcare system, the primary care level serves as the first point of contact for patients and also integrates seamlessly with other levels of the health system. However, due to gaps in implementation, many patients first encounter the health system at the secondary or tertiary levels of care.
Community participation including household visits by health staff, group meetings for education and support on health issues, as well as outreach workers providing health services in the community can go a long way in bolstering community engagement.
Therefore, a focused approach toward community involvement integrated with strong referral mechanisms has the potential to revitalise the trust of communities in the public health infrastructure.

The Shyama Prasad Mukherji Rurban Mission (SPMRM) of the Ministry of Rural Development envisages the infrastructural development (technological and basic services) of village clusters that stimulate economic development in the area. Panagariya, 2014 provides consideration to a housing township wherein government employees of all the departments (health, education, water and sanitation, police, bank, road and transport, post and telecom) can be housed at the block level.
Provision of facilities like schools, playgrounds, community centres, supermarkets, etc. can provide a significant stimulus to the workforce which is otherwise discouraged to locate themselves in rural areas.

There are certain initiatives of the Government which also have a critical albeit indirect impact on strengthening access to health services for the rural population. For instance, the Pradhan Mantri Gram Sadak Yojana (PMGSY) has provided all weather road connectivity to around 1,55,719 habitations since its inception till 10 March, 2022.
In 2019, the Government launched PMGSY-III for consolidation of 1,25,000 km through routes and major rural links connecting habitations to hospitals, among other essential facilities.
Similarly, schemes which aim to alleviate poverty, deliver education and nutrition services as well as provide suitable economic opportunities play a crucial role directly and indirectly strengthening the linkages between people in rural areas and essential health services.

The Annual Rural Health Statistics Report throws light on gaps in manpower and infrastructure in rural areas which need to be addressed.
The 15th Finance Commission also recommended a strong focus on primary healthcare. Budgetary allocations and implementation of key initiatives like the National Health Mission, Pradhan Mantri Jan Arogya Yojana (PM-JAY) are prioritised.
An important step by the Government in this context has been the launch of the Pradhan Mantri Swasthya Suraksha Yojana (PMSSY) which aims to rectify the inequities in the availability of affordable healthcare facilities across the country.

Thus, while examples of efforts in connecting rural health services are ample across the nation, they are fragmented with regional successes.

The National Rural Health Mission through its Nationwide purview and with its financial and human resource can identify, adopt and scale such innovative solutions to address the equity gaps in rural areas. The 15th Finance commission also commended a strong focus on primary healthcare.