Dr. Mohd Azharuddin
Email: drazharamu@gmail.com,
Mob. 9761194835, 8209425717
Abstract
Health is an important issue in our life. A person with good health will have peace of mind and will be able to contribute to nation-building. We cannot expect performance from an ill person with a low morale. This paper attempts to understand the ground realities of health-care facilities provided in Mewat district.It is internationally acknowledged that development should be viewed in terms of social, equity, and health care etc., indicators in addition to economic growth. Improvement in the health status is inter-linked with more productivity and economic growth. For development and social well-being, health infrastructure is essential to meet adequately the demands of the resident population. This paper is intended to provide an overview of Mewat district and a critical assessment of its health status.
Key Words: Mewat, Health Care, Infrastructural Amenities, Strategy,
Introduction
Good health is central to happiness and well-being. Healthy populations are found to live longer and be more productive. Health is an important constituent thrusting development. Improvement in the health status is inter-linked with more productivity and economic growth. For development and social well-being, health infrastructure is essential to meet adequately the demands of the resident population. This becomes fundamental for rural areas where people reside in unhygienic living conditions which are a major cause of deterioration of health status. Access to health care services is imperative to ensure health equity as well as increasing the quality of healthy life for everyone.
Haryana, a North Indian state that enormously benefitted by the Green Revolution process in the 1970s and 1980s, is considered one of the most developed states in India. It comprises of 21 districts, including Mewat. The population in Mewat district is predominantly Meo-Muslim, which falls in the category of Other Backward Classes (OBCs). Despite its proximity to the Capital, this Mewat region remained underdeveloped; around 90% of the population still lives in rural areas.
Mewat adopted its name from Meos, a Muslim peasantry caste. In Mewat, a large part of the population is landless and equal part of the population holds marginal land holdings. The region falls under semi-arid climatic zone. Agriculture and daily wage labour are the chief occupations of the people. Agriculture in Mewat is rain-fed. In the region single crop (Mustard and Millet) is grown with little possibilities for the second crop in case of timely rainfall. Approximately the district has 439 villages. The district is backward on almost all indicators of socio-economic development. The average household size in Mewat district is 7.6 and the average age for marriage 14 (girls) and 17 (boys). In Mewat, the reproductive health is poor for women with low awareness about preventive health care and a high reliance on untrained health providers. They are treated as unorganized labour both in fields and domestically.
The paper aims at the critical evaluation of the existing health infrastructure in Mewat District and to find out whether the health infrastructure and medical facilities existed in the Mewat district are adequate enough to cater the needs and requirements of the people. The paper also tries to find out the causes which prevent people from availing the health services in the district and to find out the level of awareness of people about the benefits of availing the government run medical institutions such as primary health centres, community health centres, district hospitals and others. The pregnant women are not enthusiastic enough to visits government medical facilities in case of deliveries and that is why most of the deliveries are done either at home or at the private clinic causing huge burden on their pockets. In order to complete the paper keeping in view the above mentioned aims and objectives, appropriate techniques and methods are used. Field survey is conducted as part of my research work to find out the actual existing health infrastructure and medical facilities in the district and to know the viewpoints and mentality of the people regarding these facilities. District level Household Survey conducted by the government is analysed thoroughly in order to come at the logical conclusion.
Health Infrastructure in Mewat District
The following table presents the complete status of health infrastructure in the Mewat district. During the past decade, only eight new medical institutions have been added to the health infrastructure available in the district (see table). There are 3 Community Health centres and 20 Primary Health centres in Mewat indicating an acute dearth of health institutions in the district. The worst situation exists in Mewat where there is only one hospital on a population of above ten lakhs. Increased burden on health facility deteriorates the quality of health services available to the intended beneficiaries. This puts a question mark on the health status of the residing population. Reproductive health is considered to be the most important aspect of assessing the health status of a society as it is considered to be an essential component of young people’s ability to become well adjusted, responsible and productive members of the society. Right age at marriage is specifically important in case of girls to ensure that the reproductive system is mature enough to function properly. The mean age at marriage for girls is low in Mewat while the mean age at marriage for boys is relatively higher. The table (fertility measures) reveals that about five percent of total births in Mewat are accounted to the women of age 15-19 years. Premature birthing is rampant at such an age.
Table-1 Health infrastructure in Mewat District
| Health Infrastructure | 2001 | 2011 | District Community Health Centres | |||||
| Number of functioning medical institutions in | 97 | 105 | CHCs | PHCs | Sub-Centres | |||
| Number of institutions per lakh of population | 12.3 | 9.6 | ||||||
| Number of institutions per 100 sq. Km | 6.4 | 7 | 3 | 20 | 138 | |||
| Number of Functioning Hospitals | 1 | 2 | ||||||
| Reproductive Child Health | Total | Rural | ||||||
| Mean age at marriage for Girls | 19.7 | 18.7 | ||||||
| Mean Age at Marriage for Boys | 21.7 | 20.9 | ||||||
| Fertility | Total | Rural | ||||||
| Birth to Women Aged 15-19 year out of Total Births (%) | 5 | 7.1 | ||||||
| Use of Family Planning (any method in %) | 23.5 | 15.7 | ||||||
| Women who received Antenatal Check-Up (%) | 45.5 | |||||||
| Women who use Institutional Delivery (%) | 51.2 | 40.3 | ||||||
| Child Immunization (full vaccination in %) | 27.3 | 20.8 | ||||||
| Under Five Years Infant Mortality (in numbers) | 858 | – | ||||||
| Under Five Years Infant Mortality (Female in numbers) | 512 | – | ||||||
| Under Five years Infant Mortality (Male in numbers) | 346 | – | ||||||
| Number of Dispensaries | ||||||||
| Rural | Urban | Total | ||||||
| 232 | 172 | 404 | ||||||
Source: District Level Household and Facility Survey IV
An analysis of the table-1 reveals that only 45 percent of women get antenatal check-ups which are very low. Antenatal check-up refers to regular medical and nursing care for women during pregnancy. It is important to ensure appropriate growth and development of foetus and elimination of unhealthy risks both, to the expectant mother and to the baby. The sorry state of affairs becomes worsened with reduced access to the institutional delivery mechanism. Only 51.2 percent women in the district use institutional delivery mechanism leading to increased risk both to the mother and to the baby. Lack of institutional delivery mechanism increases the risk of infant and maternal mortality. Lack of proper vaccination leads to the health risks in the infants. The analysis shows that only 27 percent Childs get full vaccination leaving three-fourth child population exposed to one or other health diseases.
Table-2 Health Facilities Availed by People
| Status of Health Facilities | |||||
| Blocks | Yes | %age | No | %age | Total |
| Firozpur Jhirka | 56 | 46.66 | 64 | 53.33 | 120 |
| Nuh | 43 | 35.83 | 77 | 64.16 | 120 |
| Nagina | 54 | 45 | 66 | 55 | 120 |
| Taoru | 24 | 20 | 96 | 80 | 120 |
| Punhana | 43 | 35.83 | 77 | 64.16 | 120 |
| Total | 220 | 36.66 | 380 | 63.33 | 600 |
Source: Field Survey
Analysis of table-2 reveals that government is providing various facilities under National Health Mission through CHC/PHC/SHC or general hospital. Only 36.66 percent respondents say that they are using medical/health facilities being provided by the government. In Firozpur Jhirka block 46.66 percent respondents use health facilities provided by the government followed by Nagina block. In Nuh, despite being the district headquarters, only 35.83 percent people are using government health facilities.
In fact, larger numbers of people are using private health facilities provided by private medical institutions or doctors. The reasons for not availing government medical facilities are mentioned in the table-3.
Table-3 Reasons for Not Availing Health Facilities
| Reasons for not Benefiting Health Facilities from Government | |||||||||||
| Blocks | No Proper Treatment | %age | Lack of Doctors | %age | Over-crowdedness of CHC/PHC/Hospitals | %age | No Free Medicines | %age | Others | %age | Total |
| Firozpur Jhirka | 20 | 31.25 | 20 | 31.25 | 6 | 9.37 | 2 | 3.12 | 16 | 25 | 64 |
| Nuh | 41 | 53.24 | 13 | 16.88 | 11 | 14.2 | 12 | 15.58 | 0 | 00 | 77 |
| Nagina | 26 | 39.39 | 22 | 33.33 | 0 | 00 | 14 | 21.21 | 4 | 6.06 | 66 |
| Taoru | 23 | 29.87 | 34 | 44.15 | 3 | 3.89 | 11 | 14.28 | 6 | 7.79 | 77 |
| Punhana | 39 | 40.62 | 36 | 37.5 | 9 | 9.37 | 10 | 10.41 | 12 | 12.5 | 96 |
| Total | 149 | 39.21 | 125 | 32.89 | 29 | 7.63 | 59 | 15.52 | 28 | 7.36 | 380 |
Source: Field Survey
Table-3 presents the reasons, given by the respondents, for not using government health facilities. Maximum numbers of respondents (39.21%) say that in government medical institutions including hospitals proper treatment is not provided. About 33 percent respondents say that there is dearth of Doctors and trained Nursing staffs in CHS/PHS/Hospitals of Mewat district which are unable to cater to the Medical needs of more than ten Lakhs population. 7.63 percent respondents are of the view that the CHS/PHS/Hospitals in Mewat are overcrowded which many times lead to indiscipline and sometimes noisy arguments between the patient’s attendants and Doctors.
Large number of respondents, 15.52 percent, says that free medicines are not provided in health institutions to the patients Below Poverty Lines. Such poor patients are compelled to purchase medicines from local medical shops at exorbitant prices.
Table-4 Mobile Medical Van Visits
| Mobile Medical Teams and their Visits | |||||||||
| Blocks | Weakly | %age | Monthly | %age | Occasionally | %age | No visit | %age | Total |
| Firozpur Jhirka | 0 | 00 | 5 | 4.16 | 26 | 21.66 | 89 | 74.16 | 120 |
| Nagina | 0 | 00 | 6 | 5 | 48 | 40 | 66 | 55 | 120 |
| Nuh | 0 | 00 | 2 | 1.66 | 66 | 55 | 52 | 43.33 | 120 |
| Taoru | 0 | 00 | 1 | 0.83 | 77 | 64.16 | 42 | 35 | 120 |
| Punhana | 0 | 00 | 1 | 0.83 | 53 | 44.16 | 66 | 55 | 120 |
| Total | 0 | 00 | 15 | 2.5 | 270 | 45 | 315 | 52.5 | 600 |
Source: Field Survey
Table-4 presents the information about the visits of the mobile medical teams. Analysis of the data shows that Mobile Medical Vans are visiting villages rather occasionally and the least number of visits of mobile medical teams is recorded in Firozpur Jhirka block. Mobile medical teams are a useful tool in the hands of the government to make people aware about the health and sanitation and encourage them to avail the facilities being provided by the government. Different diseases are diagnosed and treated at the camps organized by the mobile medical teams. Respondents were asked about who calls the mobile medical teams in your village. Some respondents say that arrangements are made by the Village Panchayat while others say that NGOs and Companies sometime make arrangement for their visits. Whenever such kinds of visits take place people turned to them with interests and got treated.
Table-5 facilities used by Pregnant Women
| Facilities used by Pregnant Women | |||||||||
| Blocks | CHC/PHC/
Hospital |
%age | ASHAs | %age | Any other/ private doctor | %age | Not use | age | Total |
| Firozpur Jhirka | 43 | 35.83 | 17 | 14.16 | 11 | 9.16 | 49 | 40.83 | 120 |
| Nuh | 37 | 30.83 | 13 | 10.83 | 42 | 35 | 28 | 23.33 | 120 |
| Nagina | 53 | 44.16 | 21 | 17.5 | 13 | 10.83 | 33 | 27.5 | 120 |
| Taoru | 57 | 47.5 | 31 | 25.83 | 14 | 11.66 | 18 | 15 | 120 |
| Punhana | 47 | 39.16 | 15 | 12.5 | 32 | 26.66 | 26 | 21.66 | 120 |
| Total | 237 | 39.5 | 97 | 16.16 | 112 | 18.66 | 154 | 25.66 | 600 |
Source: Field Survey
Analysis at the block level reveals that in Taoru block 47.5 percent respondents were found using government health institutes during pregnancies followed by Nagina block with 44.16 percent respondents as shown in table-5.Yet, a large portion of rural women do not use any hospital either government or private during pregnancies. They call a local woman having little experience in delivering births at home. As the government data tells that just 37 percent women in rural Mewat use institutional delivery mechanism.
Thus, there is a need to increase institutional deliveries. Government should provide some attractive incentives in order to encourage people to use government health institutes during women pregnancies. The government should also organize awareness programmes to acquaint the people with the facilities provided by government during deliveries.
The health infrastructure and status analysis highlight the sorry state of affairs in Mewat district. Fundamentals such as education and health set the stage for the society to be equipped enough to thrust its own socio-economic development. Good health and education are necessary precursors to the employable population engaging in remunerative occupations and securing livelihoods. Considering a population growth of around 38%, these small additions (8%) are unlikely to meet the health demands of the inhabitants of the area. As the country undergoes demographic and epidemiological transition, it is likely that larger investments in health will be needed even to maintain the current health status.
Findings of the Study
It is found that even after 70 years of independence, people do not have access to basic medical care facilities in the rural areas and to some extent in semi-urban areas of Mewat district. The major stumbling block is inadequate infrastructure in health sector in thedistrict. Availability of medical facilities is fulcrum to comprehend the holistic development of the villages. The government data shows lack of adequate number of health institutions in the district. 51.2 percent women use institutional deliveries in the district with only 40.3 percent in rural parts. In Mewat people do not use family planning. Only 23.5 percent people use family planning with just 15.7 percent in rural areas. According to primary data only 36.66 percent people are using medical/health facilities being provided by the government. However, majority of respondents is found not using health facilities. Several reasons were cited by the villagers. In Firozpur Jhirka block maximum number of villagers are found using health facilities.
This study offers some insight into the status of healthcare infrastructure in Mewat district specifically in rural parts. It seems that in some interior areas of Mewat district, people rely more on their fate than then these health-care services.
An overall analysis of data both government as well as primary survey indicates toward Mewat’s grim health situation. With lack of health institutions coupled with inadequate and untrained staff in the existing institutions, the situation becomes worse. In case of emergencies people have to go Rajasthan, Delhi or other districts of the state. As mentioned above people with low earning could not afford medical facilities offered by the private health institutions.
Recommendations and Suggestions
It is an acknowledged fact that healthy mind learns better. The NITI Ayog Report declared Mewat district the most backward in India. Due to lack of formal and established income sources people could not afford proper health and educational facilities. Thus adds salt on the wound.
Thus, in order to address the problems of health care, there is compelling need to improve physical health infrastructure including establishing more health centres and revamping the existing ones. There is also need to expand child health services like ASHAs, ANM and TBA etc.
The government should take steps to increase awareness about. ASHAs, ANM and Panchayat Personnel should devise new ways of increasing health awareness programmes. Instead of introducing more and more schemes, village clinics should be set up with trained doctors at village level. Medicines and other medical facilities such as medical tests should be provided either free of costs or on reasonable prices.
Mobile medical team initiative with specialists should be started on a regular basis. People are travelling to long distances to access basic health care facilities. Distance forced them to take services of untrained and unauthorized doctors. This can be curbed by providing them with primary treatment at their doorsteps with the help of mobile medical teams. Each mobile medical team should be accompanied by two MBBS doctors; one male and one female, one compounder, one driver and one community mobilizer. The need of female doctors arises as women in the village feel uncomfortable with male doctors. The medical team must visit each village once a week. It will help villagers to access expert treatment on a regular basis. The problems reported by the villagers should be diagnosed and treated properly. These mobile medical teams should be connected to the nearby private as well as government hospitals so that they can refer patients suffering from major illnesses. The timing and place for mobile medical teams should be decided by the Village Panchayats in consultation with villagers.
The institutions of ASHAs and Anganwadis should be strengthened because with these workers pregnant women can be identified and encouraged for the institutional deliveries. Maternity help should also be given to the pregnant women so that they can seek treatment from the private clinics also. Implementing agencies including Gram Panchayats should use pamphlets, wall paintings, street plays, public meetings etc. to aware the villagers about the importance of institutional deliveries.
The government should enact a law on the right to health care so that people could get relieved of the huge spending on health and have better access to health care amenities. It is a known fact that government spend a considerable amount of money on health care facilities per year, yet the families are spending thousands of rupees every year for treatment of ailments. It is estimated that about lakhs of people slide into poverty because of this catastrophic out-of-pocket expenditure every year in Mewat district. A lot of this expenditure is in the private medical establishments, but the patients are also spending money in the state health institutions. Thus, the state government should make a commitment for ensuring the right to “health care” rather than health, as the latter includes social and economic determinants such as food, housing, water and sanitation.
Since the social determinants are outside the purview of the Medical and Health Department, it would be prudent to initially give statutory recognition to the right to health care in order to guarantee quality health care to all citizens in the state.
Various governments claim that they are spending millions of rupees on health-care service, but the benefits are not being felt by the masses. We are sure that our attempt to highlight the scenario of health-care services in the Mewat district will be an eye opener and will compel the various stake holders to introspect their involvement in the health-care services provided in the district.
Health and education are central in the growth and progress of a nation. A county can’t progress unless and until it provides quality health and educational facilities to its people. Government of India is spending millions and millions of rupees on health and education, yet results are not being observed on the ground. Thus, the government should reanalyze its schemes, find out fault lines and introduce specific target based health and educational schemes. Mewat is one of the districts where the government should put urgent focus and undertake some concrete steps to bring it out from poverty, grim health conditions and worse educational backwardness.
It is said that health and education are tenets of a society. If they are good, the country is good; if they are bad, the country is backward. So, utmost attention should be focused on Mewat district to ensure health for all.
References
- Sheghal Foundation, Identifying Backwardness of Mewat Region in Haryana: A Block Level Analysis. Sponsored by Research Division, NITI Ayog, Government of India, Gurgaon, 2015. p. 6
- Institute of Rural Research and Development and Sheghal Foundation: An Assessment of Development Indicators in Rural Mewat, 2015. P.12-13
- Seeking Modern Applications for Rural Transformations (SMART), A Study to Assess the Impact of the Community Radio Station on the Panchayats in Mewat, 2013. p. 2
- District Census Handbook Mewat, Haryana, Census of India 2011. p.37
- Atul Gupta, Chandra Mohan Patnaik&Niharika Patel, Health Care Infrastructure Amenities –An empirical Examination of Indian perspective, Journal of Technology Management in China, 9 Issue: 3, pp.245-262, 2014