Taking care of UP’s health

At a time when Uttar Pradesh is still to recover from the shock of the multi-crore rupee scam in the National Rural Health Mission on the one hand and the gruesome murder of three chief medical officers on the other, a recent study conducted by the Giri Institute of Development Studies (GIDS) has now given very alarming picture of the health sector.

The young socialist chief minister of UP, Akhilesh Yadav, faces an uphill task in dealing with matters pertaining to the crucial health sector.

The study reveals that planning for the health sector is offset by the lack of up-to-date data, which only become available after a lag of at least 4-5 years. The latest available data presenta a dismal picture of health in UP.

Nearly 67,000 maternity deaths take place in the state each year. Sadly, most of these deaths are preventable. Hemorrhage and anaemia account for 38 per cent and 34 per cent of these deaths respectively.

A major reason for the steepness of maternal mortality is the delay in reaching hospital by pregnant women – a problem caused by inadequate infrastructural facilities – and a further delay in initiating appropriate medical care to the expecting mothers in hospitals. Additionally, the proportion of institutional deliveries is very low.

Infant mortality rate, at a staggering 63 per cent, rank amongst the highest in all of India. Almost seven lakh children die in the state within one year of birth. Out of the total deaths of children, 36 per cent of the deaths are caused by severe infections and 25 per cent are due to premature birth of children. The study also reveals that early motherhood is a major cause of death, of both the mothers and children in the northern state.

Full inoculation covers only a small percentage of children. The progress in health indicators is slow and the millennium development goals are likely to be missed by a big margin. The public health system is able to cater to only 10 per cent of the rural population in UP. Due to a lack of ab adequate public health system, a large proportion of the rural population has no other means but to go to the quacks or so-called jhola chhap doctors.

The absence of trained doctors and other medical staff in the hospitals is the main reason given by patients for not visiting health centres and hospitals for treatment. Even in government hospitals, most of the expenses are borne by the patients. There is high absenteeism among doctors and other medical staff as they are overburdened with other responsibilities and campaigns. The working of NRHM has suffered in the state due to ineffective monitoring and supervision and large-scale leakages.

During the 12th plan, steps will have to be taken for providing sufficient medical staff to hospitals, expansion of medical facilities in inaccessible areas and for initiating mobile medical facilities. The presence of doctors and supporting medical staff in the hospital has to be ensured. The private sector may also be involved in running health centres on the basis of memorandum of understandings between the public and private medical enterprises.

However, the supply deficit of doctors and paramedical staff can only be overcome over a long period. Meanwhile, short-term medical courses may be started to compensate for the present crisis. The large number of compounders, pharmacists and even the
jhola chhap
doctors can be utilised for providing preliminary medical care in rural areas through proper training. There should be appropriate district plans for health care provisions. From the viewpoint of planning for human development, the availability of medical and health data is an absolute necessity.

The emphasis should shift from curative to preventive measures. Health care should be linked to nutrition, health awareness, safe drinking water and sanitation. This requires the coordination and convergence of efforts by different departments and organisations as well as greater community participation.

The working of the Integreted Child Development Services is far from satisfactory and needs to be improved by addressing the shortcomings and deficiencies in the programme.
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