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Raising Primary Health Concerns In India

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By Ranjani Ranganathan:

India is known for its high class medical facility with low cost. People from abroad come to India for their treatment. The “so-called” high end medication facility in India has not bothered to treat or take a mere notice of their own people who die with lack of (proper) medication and doctors, both in cities and rural areas.

The primary diseases that are haunting India are many and the few I managed to collect are:

Tuberculosis: Approximately 1.8 million new cases of which about 0.8 million are highly infectious smear positive are reported every year. About 4.17 lakh people die of TB every year in the country. The degenerate work culture within the primary health system is evident across India. In many primary health care and sub-centres visited in India, the health staffs fail to regularly turn up for duty. Patients who come to consume their TB medicine under the supervision of staff in the DOTS programme have to return without it, or wait for hours.

The absence of drugs for other simultaneous health problems leaves patients dissatisfied with the services they have received. Many government doctors are engaged in private practice and lower-ranking staff like the pharmacist and watchmen are engaged in the racket of injecting saline injections and charging patients for it. It is these factors that drag down the success of the TB programme. The failure to reach out to new TB cases is starkly evident in the neglected areas inhabited by the tribal people.

Leprosy: The leprosy prevalence rate for the country as a whole is estimated at 2.4 per 10,000 population during 2004.

HIV/AIDS: India accounts for 10 percent of the global HIV burden. An estimated 4.58 million men, women and children were living with HIV/AIDS in the country at the end of 2002, with an adult (15-49 years) prevalence rate of 0.8 percent.

Cataract/Blindness: Government is implementing the National Blindness Control Programme. About 4.5 million cataracts operation per year up to 2007 are envisaged.

Cancer: There are about 20-25 lakh cases of cancer and approximately 7-9 lakh cases come up every year. During the Tenth plan, the National Caner Control Programme has been made a Centrally Sponsored Scheme. There are various kinds like breast cancer, uterine cancer, mouth cancer, lung cancer and many more.

Filaria: It is identified in the 13 districts of 7 endemic states, namely, AP, Bihar, Kerala, Orissa, TN, UP, WB, covering about 41 million infected persons.

Environmental Sanitation Problems: Presently, 85 % of rural and 95% of the urban population has access to safe drinking water.

Kala-Azar: It is serious public health problem in Bihar and West Bengal. Kala-Azar cases reported- 17,806 cases with 72 deaths (’86); 14,753 with 150 deaths (2000); 12,120 cases with 212 deaths in 2001; ) and 11845 cases with 164 deaths in 2002. However, up to April 2003, 4161 cases and 49 deaths were reported.

Kala-azar can cause no or few symptoms but typically it is associated with fever, loss of appetite (anorexia), fatigue, enlargement of the liver, spleen and nodes and suppression of the bone marrow. Kala-azar also increases the risk of other secondary infections. The first oral drug found to be effective for treating kala-azar is miltefosine.

The term “kala-azar” comes from India where it is the Hindi for black fever. The disease is also known as Indian leishmaniasis, visceral leishmaniasis, leishmania infection, dumdum fever, black sickness, and black fever.

Dengue (Haemorrhagic) fever: It is a fatal viral disease caused by female Aedes aegypti mosquitoes. First reported in Delhi in 1996 with 10,252 infected cases and 423 deaths. In 2001, 3,188 cases reported and 53 deaths. It is spreading to new areas.

Japanese Encephalitis: It caused by flavivirus group. In the last five years, it has acquired serious magnitude in 11 states. In 1995, 2974 cases with 942 deaths and in 2002, out of 1464 cases 361 deaths, were reported.

Iodine deficiency disorders: About 100-150 micrograms of iodine is required daily for normal growth. About 71 million people are suffering from iodine deficiency.

Nutritional Problems: The major problems such as Protein Energy Malnutrition, Nutritional Anaemia, and Vitamin A deficiency disorder cases great morbidity and mortality amongst the children and young.

Immunization: The Universal Immunization Programme is aimed at reduction in mortality and morbidity among infants, younger children and pregnant mothers. Pulse polio immunization programme is for polio eradication. The incidence has come down from 4320 cases in 98 to 2810 in ’99. Pneumonia and diarrhoea are the other leading causes of death of infants.

Government, with the help of doctors and primary health centres should work hard to control the primary health centre. Because only Government can help the suffering poor to get medicines and health care facilities at a lower cost instead of spending lakhs of money in private hospital, not be affordable to everyone.

The issue of health care is one of the most alarming one in the country. A slow but steady progress in health research and communication will ensure the best of health and health care in India.

Credits: References/Credits:
http://www.earthinstitute.columbia.edu/cgsd/documents/bajpai_primaryhealth.pdf
www.emedicinehealth.com
www.globalforumhealth.org

Img: World Bank Photo Collection (flickr)

You must be to comment.
  1. Ashutosh Pandey

    It is very important indeed to provide good healthcare services to infants and neo-natals in India

  2. balaji utla

    i agree with ashutosh – one of the key issues is ensuring consistent and quality delivery.

    the operating mechanisms as one of the management guru’s talks about are slowy getting degenerated if not already in some states.

    i guess the solution is in democratizing the social-services – to be managed and delivered at the grass-root level – probably slightly higher than the village – block or mandal level. that would take some time but
    it is also critical to provide services to people in the interim where we get our act together.

    Andhra Pradesh pioneered the public-not-for-profit-private partnerships (a mouthful) to augment some of the primary health services at the grass root level.

    i believe that as a nation we should bring in as many helping hands that are possible to have – to reach the millenium development goals – we should explore multiple models of service delivery without getting caught in any kind of ideological abyss.

    it is also important that we do not allow ‘medicalization’ to hijack the agenda of health for the poor

    additionally we should look at the delivery architecture that any state has – and go for appropriate reform – a reform which is not driven by models blindly borrowed but which relates meaningfully with the ‘context’ of the problems that we face.

    while there may be multiple remedial measures in the interim – the critical issues are poverty – and health seeking behavior – and a reliable supply-chain of health-related services

  3. Kusuma

    India has world class Hospitals but primary and secondary care takes a back seat. This is mainly because the trianing of MBBS DOctors are not suited for geneal practice in India. I feel each medical college India must eb atatched to at least 5 CHCs . Then this problem will solved to some extend

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The long-term aim of the campaign is to develop an open culture where menstruation is not treated as a taboo. The campaign also seeks to hold the schools accountable for their responsibilities as an important component in the implementation of MHM policies by making adequate sanitation infrastructure and knowledge of MHM available in school premises.

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Harshita is a psychologist and works to support people with mental health issues, particularly adolescents who are survivors of violence. Associated with the Azadi Foundation in UP, Harshita became an MHM Fellow with YKA, with the aim of promoting better menstrual health.

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A student from Delhi School of Social work, Vineet is a part of Project Sakhi Saheli, an initiative by the students of Delhi school of Social Work to create awareness on Menstrual Health and combat Period Poverty. Along with MHM Action Fellow Sabna, Vineet launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society.

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A former Assistant Secretary with the Ministry of Women and Child Development in West Bengal for three months, Lakshmi Bhavya has been championing the cause of menstrual hygiene in her district. By associating herself with the Lalana Campaign, a holistic menstrual hygiene awareness campaign which is conducted by the Anahat NGO, Lakshmi has been slowly breaking taboos when it comes to periods and menstrual hygiene.

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