By Reeti Mahobe:
Gandhiji rightly said that if one wants to know India, one must visit her villages. This remark still holds good even decades post independence. Rural India has a population of more than 800 million and there are around 6 lakh and 40 thousand villages that show an increase of approx 20,000 (no. of villages) from the last census conducted in 2001.
India continues to be dominantly agriculture dependent. India was the first country to launch family planning programme, and Malaria control programme had begun way back in 1953. We have flagship schemes such as that of NRHM and Janani Shishu Suraksha Yojana; still the situation in rural areasÂ isn’tÂ all motivating. This is all evident through some vital health parameters including increasing infant mortality rate, maternal mortality rate, poor state of sanitation, and prevalence of chronic diseases, non availability of qualified doctors and paramedical staff and so forth. These are particularly lagging behind in comparison to the situation in urban areas.
Many of the villages still don’t have proper infrastructure for sub-centres and PHCs or CHCs. Even if they are there, they face unavailability of doctors or the staff, beds, basic medical equipments, drinking water supply and sanitation; any or at times all of them are in scanty numbers. The recent UP, NRHM scam unveils the serious irregularities in the ‘prime policies’ of the government at all levels from ministerial to executive. No concerted efforts have yet been made to raise the standards of sub-centres. There’s lack of diagnostic centres in villages; due to which patients, especially the serious ones have to be carried along long distances that results in their deteriorating condition or even death. Moreover, ‘bad roads’ impede the movement of ambulances or any vehicle during emergencies. Inconvenient transport system is also a major concern. Shortage of funds is a major drawback in public health system.
Generic drugs need to be given a boost up to help the poor and even the middle class in some way to save their pocket. In rural areas nutrition seems to be a big challenge. Girls and women often suffer from anaemia, malnutrition and poor health condition in general. It is so either because they lack resources even to feed themselves two meals a day or due to lack of awareness arising out of illiteracy. In many states ‘Nasha Mukti Abhiyan’ was instituted mostly by the women of villages; such measures need to be promoted. Anti smoking (bidi) programmes and anti tobacco programmes must also be campaigned for. In spite of the ‘big’ schemes such as earlier mentioned, NRHM and others conditions haven’t improved to satisfactory levels that underline the lack of ‘will’, motivation and other implementation roadblocks.
Recently on the occasion of Independence Day the National Health Mission was announced that seeks to kind of ‘merge’ rural and urban areas to bring about improvements and development in the overall health sector. It’s a welcome move given the condition that what’s there in black and white gets converted into action.
Sanitation problems are being resolved through ‘Total Sanitation Campaign’. Still rural areas suffer from grave insanitation both due to ill implementation of policies and lack of awareness with serious issue of ‘open defecation’. Pollution is something which is seen to be a problem of cities. But it has intruded to the villages too with excess and improper use of fertilizers and pesticides making lands toxic as well as spreading to the water sources. Water borne diseases are on the rise here, sometimes scaling up to the level of epidemic. Health even after being ‘state’ subject has been sidelined in several states.
We do have the schemes, policies and programmes in our hand, but even after repeatedly being brought into notice and concern, the implementation has been pitiful. It’s much hoped and needed that a proper feedback mechanism and audit be instituted and timely watched with a ‘political will’ in place. So that then rural India that constitutes around 70% of population is not ailing but smiling.