DISTRICT HEALTH SERVICE
A well function healthcare system working around people’s need, having competent and motivated health workers, a well maintained infrastructure, a reliable supply of medicines and quality equipments backed by adequate funding, robust data, strategic planning, monitoring and evaluation.
Health has been declared a fundamental human right. The health of the people should form major issue of importance in public policy deliberation and planning. Good health confers on a person’s well being, happiness and ability to realize one’s potential.
According to World Bank (2005), 50% of economic growth differentials between developed and developing countries are attributed to ill health and low life expectancy. Developed countries spend a high proportion of GDP on public healthcare because they believe healthy nation can serve as major driver for economic growth and development. Thus health is an important human capital and deserves attention on priority by our policy makers.
Across the world, countries are turning their attention to comprehensive primary health care which is affordable sustainable and effective and the right approach by which there is possibility of reaching health goals.
The important requisites to ensure comprehensive primary health care are:
- Bringing care closer to people.
- Giving primary health care providers the responsibility for the health of a defined population.
- Strengthening the roles of health care team.
Thus better health and health care do not have to wait for an improved economy of the state. The need is political will and bold decisions to reform and make healthcare delivery system works.
Phek district has 70 health units spread unevenly across the district. The health units are:
District Hospital – 1
Community Health Centre -3
Primary Health Centre – 23
Sub Centres – 43
The three pillars of rural healthcare services CHCs, PHCs and SCs including District Hospital are carrying out various health programmes. Important health programmes are
- National Health Mission
- National Vector Borne Disease Control Programme (NVBDCP)
- District AIDS prevention and Control unit (DAPCU)
- Revised National Tuberculosis Control Program
- Integrated Disease Surveillance Program
The District Hospital Phek is a 100 bedded hospital headed by the Medical Superintendent. There are presently two senior specialist, two senior medical officers, two junior specialists, two Medical officers, one medical officer (AYUSH) and two Dental Surgeons. There are sixteen staff nurses, four auxiliary nurse midwifery and two lady health visitors.
In the periphery there are only 2 doctors in each 3 Community Health Centre and 17 medical officers against 23 Primary Health Centre and auxiliary nurse midwifery are posted in all the Sub-Centre.
The existing infrastructure in many sub-centre and primary health centre are in poor condition. There are no quarters for staff in many health units.
Problems and Prospects.
The major problems in delivering health care services in rural area are Shortage of skilled manpower, poor infrastructure and lack of staff quarters, inaccessibility due to unsuitable location of center, shortage of essential drugs and equipment’s, no proper human resource management, no transport policy for delivering health services and no reliable data.
Manpower in health units.
In District Hospital there are 11 Existing strength doctors and 29 Indian Public Health Standards doctors, Community Health Centre have 2 existing strength doctors and 10 Indian Public Health Standards doctors and in Primary Health Centre there is only 1 existing strength doctor and 1 Indian Public Health Standards doctor.
The district has good number of health units. Some of the health units need relocation and re-organization to reduce or remove inaccessibility and bring within physical reach of larger population. A regular maintenance of existing health units is necessary. Construction of quarters especially in remote areas is a basic necessity to ensure presence of health workers.
There are a number of factors responsible for shortage of health workers in rural areas. To ensure their stay and maximize performance, skilful use of human resources through proper personnel management is needed. Several issues like lack of quarters, posting and transfer issue, poor road and communication, and lack of transport facilities affect their performance. A demoralized worker can never function well even in a well equipped centre. Similarly a highly competent and motivated worker cannot function in an under equipped and dysfunctional system. Therefore it is high time the department comes out with effective human resource management policy to cure ailing healthcare system.
National Health Mission.
The National Rural Health Mission (NRHM) launched in 2015 has made significant progress in the health care infrastructure, manpower and other logistic. However the improvement has been uneven in remote rural areas. The main drawbacks are inaccessibility, unsuitable locations of health units, shortage of health workers and non-availability of essential drugs, funds and ineffective management of human resources. Rural health care services suffer mostly not due to lack of fund but due to leakage of funds and delays of funds. Plugging the leakages, timely fund release and proper accountability can infuse fresh lease of life to the ailing health units.
After initial enthusiasm of the commoditization there is slackness and complacency in communitized health units. There is need to identify gaps and challenges, strengthen managerial capacity and coordination. Community participation is now recognized a major component of health care system. The major thrust is on provision of comprehensive health care service shifting focus from medical care to health care.
Medical Equipment at health units.
The status of equipment and consumables in units speak volumes of inactive procurement and supply mechanism. The fact that even after 50 years of statehood and yearly procurement of equipments, most of the health units continue to be under-equipped due to poor planning and lack of quality control and maintenance. Besides question of quality of equipments, most supplies are not need based and result in redundancy in non essential items and deficiencies in much needed equipments.
With digital revolution, there are good quality and affordable state of the art medical equipments available with good maintenance policy. The private hospitals are capitalizing on this digital revolution with limited investment. Revamp the ineffective system and the health units have potential to be equipped better than the private hospitals even with the present budgetary allocation.
The District hospital, Phek is a 100 bedded hospital. Since its inception, the hospital was unable to function as secondary referral unit for the district. The major problems are shortage of specialist doctors, lack of equipment, drugs, diagnostic and other consumable. The only O.T in the district is functioning with outdated equipments and low quality equipments. The hospital is in dire need of good quality equipments for various surgical specialties and anaesthesia.
Therefore till such time a new delivery mechanism is brought in to replace existing procurement and supply system, these health units will continue to be ill-equipped even in the coming year.
Building competencies in manpower.
The present trend of recruiting nurse in state service on seniority leave a huge gap in knowledge, skills and motivation to work. Workers are the heart of health centre. So when a worker enter into service after gap of 10 to 15 years of skills training, one can imagine the impact it has on the health care delivery system especially in rural areas. Fresh recruitment policy is needed to bring in productive and competent workforce to maximize performance and quality of care.
Leadership reforms are also required for strategic planning, innovation, and effective implementation of health programmes. Similarly update of knowledge and upgrade of skills through regular training, workshops, and continuing medical education are required for frontline health worker.
It is far cry ask for cutting edge technology in rural health care center but definitely the department can build up a committed, competent, compassionate workforce which in itself is a cutting edge strategy.
The district suffers from lack of reliable scientific data of its own especially sensitive health indicator like infant mortality rate, maternal mortality rate and life expectancy. Taking advantage of better information technology, health data mechanism can be optimized to obtain reliable vital data of the district which will reflect health status and help in strategic planning.
Taking advantage of booming it and better connectivity in the district, telemedicine can deliver specialized services at remote place thereby extending low cost consultation and diagnosis to the rural areas.
With increasing awareness on oral hygiene there is increasing demand for dental related services. However the dental units has been reduced to mere consultation and extraction works for want of upgrade equipment and good functioning dental chair. With investment on minimum essential equipments like light cure machine, scalar machine, airotor hand piece and burs, and filling materials, the dental units can carry out most of treatments and procedures in the hospital which will greatly benefit rural people.
Mental health programme envisages provision of basic mental health care at the community level through creating awareness and acceptance by the public about mental illness, early detection and treatment of mentally ill people and integration of mentally ill people into the society. Mental health awareness will be through health talks, seminars, workshops , focused group discussion, etc. sensitization of all health worker , teachers, community workers, etc. on mental health. Involvement of local bodies, NGOs, other departments, etc. on spreading awareness. Strengthening existing referral systems for tertiary care.
There is great need for social security and health insurance for families below poverty lines and vulnerable groups of people to reduce out of pocket expenses in hospital. The Rashtriya Swasthya Bima Yojana (RSBY) should be made to cover entire district. There is need to spread awareness about the benefit of health insurance among beneficiaries in remote areas. The RSBY scheme aims to mitigate risks due to disability, health shocks, maternity and old age which all unorganized workers get exposed to and are likely to suffer from.
Towards a healthy rural community.
Phek district has considerable number of health units to reach remote areas. There is growing health awareness among general population, changing attitudes towards preventive and promotive health and demand for better health care facilities.
Taking advantage of these strong fundamentals, a bold political action for reforms in health delivery system and effective human resource management backed by active community participation and robust monitoring and evaluation system are keys to transforming health care services and progress towards a healthy rural community.