One of the key components of the mission is creating a band of female health volunteers, appropriately named “Accredited Social Health Activist” (ASHA) in each village within the identified States. These ASHAs would act as a ‘bridge’ between the rural people and health service outlets and would play a central role, in achieving national health and population policy goals. ASHAs are to be selected by community, out of residents within the community. They would work on voluntary basis, although compensation would be provided to them for specific activities and services. ASHA guidelines clearly lay down the accountability mechanisms. The induction training for ASHA would be completed in 23 days spread in five rounds over a period of 12 months to be followed by periodic re-training for about two days once every alternate month.
Outcome/Impact:Under the training program orient ASHAs to their roles and responsibilities, build skills of community rapport building and leadership, develop an understanding of the health system and rights based approach to health. All these are covered in Sessions 1-4. Other basic concepts of health, hygiene and illness, understanding of common health problems and infectious diseases form a part of Sessions 6 and 7. As a part of this training, ASHAs are also introduced to the important aspects of reproductive, maternal, new born, child and adolescent health. Sessions 8-14 have been designed so as to lay the foundation for learning complex skills which will be covered in subsequent training of ASHAs.
Healthcare is the right of every individual but lack of quality infrastructure, dearth of qualified medical functionaries, and non- access to basic medicines and medical facilities thwarts its reach to 60% of population in India. A majority of 700 million people lives in rural areas where the condition of medical facilities is deplorable. Considering the picture of grim facts there is a dire need of new practices and procedures to ensure that quality and timely healthcare reaches the deprived corners of the Indian villages. Though a lot of policies and programs are being run by the Government but the success and effectiveness of these programs is questionable due to gaps in the implementation. In rural India, where the number of Primary health care centers (PHCs) is limited, 8% of the centers do not have doctors or medical staff, 39% do not have lab technicians and 18% PHCs do not even have a pharmacist.
Rural women experience poorer health outcomes and have less access to health care than urban women. Many rural areas have limited numbers of health care providers, especially women’s health providers. Rural America is heterogeneous where problems vary depending on the region and state. Health care professionals should be aware of this issue and advocate for reducing health disparities in rural women.
India also accounts for the largest number of maternity deaths. A majority of these are in rural areas where maternal health care is poor. Even in private sector, health care is often confined to family planning and antenatal care and do not extend to more critical services like labor and delivery, where proper medical care can save life in the case of complications.
Rural women experience poorer health outcomes and have less access to health care than urban women. Many rural areas have limited numbers of health care providers, especially women’s health providers. Rural America is heterogeneous where problems vary depending on the region and state. Health care professionals should be aware of this issue and advocate for reducing health disparities in rural women.
Rural healthcare infrastructure in India is a three-tiered network comprising of a sub-center, primary health center (PHC) and community health center (CHC). Unfortunately, this setup is in shambles!
Qualitative and quantitative provisions for health in rural areas are far lesser than what the World Health Organization (WHO) defines as the minimum norm. As per Rural Health Statistics 2018, there is a shortfall of 18% for Sub-centers, 22% for Primary Health Centers and 30% for Community Health Centers. What makes this worse is the inaccessibility of these PHCs and CHCs. In some cases, these centers are quite far from the villages because of which people often turn to unregistered private healthcare practitioners to save time and energy. They are located in run-down dilapidated government buildings and are rarely open or equipped to address even basic illnesses. To add to this, the shortage of vaccines and essential medicines in rural areas makes the situation even more shameful. The gap between the demand and supply of these has not only risen in the last few years but has also led to increased levels of poor immunization and higher child mortality rates. Moreover, even when these drugs are available, patients are often unable to afford them.
Out-of-pocket (OOP) health expenses drove 55 million Indians--more than the population of South Korea, Spain or Kenya--into poverty in 2011-12, and of these, 38 million (69%) were impoverished by expenditure on medicines alone, according to a2018 report.
Despite being repeatedly flagged, these loopholes are seldom looked into.
Ineffectiveness of the primary health care created a breach in referral system which should serve as an entry point for the individual and continuous comprehensive coordination at all level of health care. Utilization of services has shown to be residence and educational level dependent with 70% of illiterate availing no ANC care when compared with 15% of literate with rural women (43%) less likely to receive the ANC services when compared with urban women (74%).
Dearth of men power, reluctant community participation and intersect-oral coordination make the condition nastiest. There is a threat to collapse of the higher health care machinery owing to overcrowding by health care seekers which are bypassing the first level of contact and this is the major problem Indian health care system is facing. Low faith in public health services could be a reason for this by pass evident from the existing data.
The only way which could lead to the goal of health inclusion is by incorporating impoverish needy rural population through community participation. It is a common complaint of people that government health functionaries are struck with non-availability of medical staff. In one of the study, it was indicated that 143 public facilities found absenteeism of 45% doctors from PHCs with 56% of time found to be closed with an unpredictable pattern of closure and absenteeism during regular hour visit. A survey report from Madhya Pradesh in 2007 states that out of 24,807 qualified doctors and 94,026 qualified paramedical staff mapped in the survey in the state, 18,757 (75.6%) and 67,793 (72.1%) were working in the private sector respectively highlighting the government failure to provide basic infrastructure to doctors and other health care workers in rural areas. This could be tackle by focusing on skill up gradation, capacity development and capability re invigoration and limiting the scope for practice of illicit and unqualified practitioners. Thus, primary health care in India needs to be re-evaluate and immediately warrants reforms and concrete steps to be taken, otherwise this tug of war between growth and human resource development remains will continue forever.
Government reluctance toward the health care appears in that the roughly 0.9% of the total gross domestic product is allocated for health care. Spending average 14% of the household income on health care by the poor house hold varying from 1.3% in Tamil Nadu to about 37% in Jalore (Rajasthan) suggests people's reluctance toward health care putting it in a side corner then other priorities. Only 0.5% of the rural enjoy basic sanitation facilities with a major population affected by the various health ailments owing to lack of sanitation coupled with polluted waters. Felling seriously ill they either head toward the urban setup or the backward communities look for the witchcraft and hermits, placing them in the grip of lechers (money lenders), creating a physical.
Ineffectiveness of the primary health care created a breach in referral system which should serve as an entry point for the individual and continuous comprehensive coordination at all level of health care. Utilization of services has shown to be residence and educational level dependent with 70% of illiterate availing no ANC care when compared with 15% of literate with rural women (43%) less likely to receive the ANC services when compared with urban women (74%).
Dearth of men power, reluctant community participation and intersect oral coordination make the condition nastiest. There is a threat to collapse of the higher health care machinery owing to overcrowding by health care seekers which are bypassing the first level of contact and this is the major problem Indian health care system is facing. Low faith in public health services could be a reason for this by pass evident from the existing data.
The supply of primary care providers per capita is lower in rural areas compared to urban areas, according to Supply and Distribution of the Primary Care Workforce in Rural America: 2019. Travel to reach a primary care provider may be costly and burdensome for patients living in remote rural areas, with sub specialty care often even farther away. These patients may substitute local primary care providers for sub specialists or they may decide to postpone or forego care. Compares access to care and use of services for rural and urban adults and children with Medicaid coverage and shows that from 2013-2015 34% of urban adults utilized the emergency room (ER) for care compared to 43.5% of rural adults who utilized the ER. The high number of ER visits can be an indicator that the patient lacks a usual source of care or has developed emergent health problems due to foregone care.
According to the 2014 RUPRI Health Panel report Access to Rural Health Care - A Literature Review and New Synthesis, barriers to healthcare result in unmet healthcare needs, including a lack of preventive and screening services and treatment of illnesses. A vital rural community is dependent on the health of its population. While access to medical care does not guarantee good health, access to healthcare is critical for a population's well-being and optimal health.
Healthcare workforce shortages impact healthcare access in rural communities. One measure of healthcare access is having a regular source of care, which is dependent on having an adequate healthcare workforce. Some health services researchers argue that evaluating healthcare access by simply measuring provider availability is not an adequate measure to fully understand healthcare access. Measures of no use, such as counting rural residents who could not find an appropriate care provider, can help provide a fuller picture of whether a sufficient healthcare workforce is available to rural residents.
Health literacy can also be a barrier to accessing healthcare. Health literacy impacts a patient's ability to understand health information and instructions from their healthcare providers. This can be especially concerning in rural communities, where lower educational levels and higher incidence of poverty often impact residents. Low health literacy can make residents reluctant to seek healthcare due to fear or frustration related to communicating with a healthcare professional. Additionally, navigating the healthcare system can be difficult without health literacy skills.