Let’s talk Healthcare basics: A look into the underserved segments of India

The healthcare practices, in a developing country like India, in the towns, villages and hamlets are part of the Government Health Directory. Does it serve its purpose, is a question that needs asking!

There is a hierarchy of medical care which are categorized as First Referral Units (FRU), Community Health Centers CHCs), Primary Health Centers (PHCs) and Sub Centers (SCs).

The SCs, which come under the PHC, are the first point of contact between the people living in the area and the Government appointed medical personnel. Many a times, these basic set-ups are depicted in our regional films. It is not something which would surprise us in India, if we were to come across a healthcare set up of this nature while travelling in the countryside. It’s an attempt to provide some sort of medical care beyond the first aid box type services.

The center is manned by one nurse/midwife, a male health worker and a female health worker. In the case of additional requirements, there is a protocol to hire another midwife on a temporary basis.

Most often than not, the people in charge here would be stern-faced individuals who deal with patients in a brusque and not very gentle manner. Right there is the primary reason, for being fearful at the thought of going to such a medical facility.

Percentage of Sub-Centers functioning in the Government buildings has increased from 43.8% in 2005 to 75.3% in 2019.

The PHC is the next point of call when health care needs are more than what the sub centers are equipped to provide. This facility has 6 beds with a medical officer and 14 paramedical staff. So, while this caters to a larger number of patients, the modus operandi is again one of “do as I say”. Unfortunately, there is a notion that when dealing with folks who have minimal or no education at all, there is no need to sit them down and properly explain the procedure or medical condition.

For every 6 SCs there is a PHC. It therefore, functions as a center which looks after the needs of patients beyond the care of the SC. Percentage of PHCs functioning in Government buildings has increased significantly from 69% in 2005 to 94.5% in 2019.

For allopathic doctors at PHCs, there is a shortfall of 7.6% of the total requirement for existing infrastructure as compared to manpower in position.

Next comes the CHC, which is bigger and has a specialized medical team on board: a physician, surgeon, gynecologist and pediatrician. These centers are also equipped with lab equipment for basic tests, X-ray machine, operation theatre and labor-room.

The people who come from underdeveloped parts of the country, which gives them little access to important medical information, cannot be blamed for their reluctance to clinical care.

Imagine, the young mother who is nursing postpartum depression, but has no clue why she cries and bears the brunt of her agony and the angst of other family members who may be just as clueless. In such a case, can you imagine the strength needed to seek outside help? It will not even be a thought process to begin with! What about the village elder who devoted his life to making pots and is now suffering from painful spondylitis; or the youngster with multiple ailments linked to his insomnia?

They need to feel at-ease to approach a center for help, rather than the scare of answering a barrage of questions related to other insignificant trivia. This gap definitely needs bridging.

One out of every 4 PHCs have a Community Health Centre to be referred to.

The percentage of CHCs in Govt. buildings has increased from 91.6% in 2005 to 99.3% in 2019.

The top tier of the healthcare program in underserved areas are the FRUs. The Unit is certified as a First Referral Unit if it matches certain specific criteria with regard to emergency services, newborn care, blood-storage facilities and other important measures to deal with urgent needs. As on 31st March 2019, there are 3204 FRUs functioning in the country. Out of these, 95.7% of the FRUs are having Operation Theatre facilities, 96.7% of the FRUs are having functional Labor Room while 75.3% of the FRUs are having Blood Storage/ linkage facility.

In geographical locations, which are far removed from modern amenities, the families themselves do not realize the importance of ensuring that the full-term expecting mother needs to be taken closer to an FRU because there is a lack of proper guidance from the medical personnel. It is one thing to run emergency services and a whole other, to do the same with a touch of human kindness.

Donating and receiving blood again is wrought with anxiety and stigma which has its roots in superstitious beliefs and not knowing exactly what it entails. Large machines and sterile rooms without familiar faces can be extremely daunting, especially for those who scarcely leave the confines of their homes except for immediate needs.

So, in effect, what we need to understand is that, in addition to providing physical healthcare, it needs to be complemented by empathy, in order for the system to work.

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References: https://vikaspedia.in/health/health-directory/rural-health-care-system-in-india