Providing accessible health care to developing countries has become an important goal towards eradicating poverty. Countries such as India, have implemented government mandated programs that intend to provide rural communities with health care. The National Rural Health Mission (NRHM) was established in 2005 and aimed to provide quality health care that was both accessible and affordable to the most vulnerable populations in India.
A recent article published by the Hindustan Times, “Provide Accessible healthcare in Rural Areas, CAG tells Rajasthan govt.”, discusses issues on compliance by the state governments in providing proper health facilities. Following the rules and regulations brought on by the NRHM, the Comptroller and Auditor General India (CAG) requested the Rajasthan state government to comply with the Indian Public Health (IPH) standards to provide rural areas with accessible health care facilities. Based on the data collected by the CAG, fewer number of health centers were implemented in tribal areas as compared to non-tribal areas. The report provided by the CAG states that the Rajasthan state government was unable to provide basic facilities in 75.77% of rural health centers. The CAG also reported that health centers that were constructed for the tribal areas were built in “inaccessible and uninhabited locations”. Overall, this report mentioned that the requirements of Community Health Centers (CHCs), Primary Health Centers (PHCs) and sub-centers as per IPH standards in non-tribal areas were provided in excess as compared to tribal regions where the number of these health centers fell short of IPH standards. Additionally, many of the health centers that were implemented in tribal areas faced severe deficiencies in facilities and quality of care.
Two Sides to the Problem: Supply vs. Demand
Many studies have been conducted to form concrete reasons behind the disproportionate number of health care facilities in rural/tribal areas. There are two sides to this growing issue, the supply side and the demand side. The problem from the supply side stems from recruitment and retention problems, of highly educated health care professionals. Many health care providers may not want to work in rural areas due to inadequate staffing of hospitals and health facilities. The doctors do not want to take on the burden of treating hundreds of patients alone. Therefore, they do not accept job offers in rural/tribal health facilities. In a 2008 paper, The Quality of Medical Advice in Low-Income Countries, written by Jishnu Das, Jeffrey Hammer, and Kenneth Leonard, discuss a particular story in Delhi. At this particular facility, there were only two working doctors who provided care to more than 200 patients per day. This greatly decreased the average amount of time the doctors could spend on each patient. On average, the doctors asked “3.2 questions, and [performed] an average 2.5 examinations (Das et al., 2008).” The numbers presented in this study show that a sufficient amount of time was not being spent on each patient to properly diagnose them.
Consequently, the supply side problem leads to the demand side problem. The quality of care provided to low-income countries are considered to be inferior to other developed nations. Das et al., discussed that doctors employed in health facilities in developing countries and regions have lower education levels than their counterparts. This effects the quality of care provided to the patients. However, it was found that these doctors administer an even lower quality of care than they are trained to provide. The poor quality of care can affect the decision making process of the individuals living in these rural areas. First and foremost, most of the health care facilities located in tribal areas are stationed in remote regions away from the villages. In addition, if the residents of the rural villages are aware that traveling the great distance does not guarantee proper health care, they do not have any incentive in making the extensive trip.
The incentive to travel to far located health facilities are also affected by the availability of doctors. In many instances, after patients have traveled long ways to see a doctor, they come to find out that the doctor is not present or the entire facility had closed for the day. A 2011 paper written by Pascaline Dupas, “Health Behavior in Developing Countries”, referred to a supplemental study completed by Banarjee et al. (2010) in Udaipur India, which showed that public facilities that provided free immunization for children had a very high rate of staff absences. It was found that “45% of the health staff in charge of immunizations [were] absent from work on any given day, being neither at the health center nor on their rounds in surrounding villages (Banarjee et al., 2010).” Due to these uncertainties many families do not complete the full round of immunization for their children. It was found that if health facilities properly advertised the hours of operation for immunization camps, the immunization rates drastically increased. The immunization rates increased form 49% of children completing one round of immunization shots when supply was unreliable to 78% when the supply became reliable. The consensus of the studies showed that if proper health care was supplied to the patients, there would be a high demand in health care.
Conclusions and Possible Outcomes
As previously mentioned, the low number of health care facilities provided in rural/tribal areas are due to both supply and demand side issues. However, based on the data it can be seen that if rural families are provided with reliable and quality health care, take up increases drastically. It is important for the health care facilities to be fully staffed with well qualified doctors so that residents of rural areas have access to quality health care. Spending more time with each patient will increase the likelihood of correctly diagnosing the patients and therefore increase their chances of a healthy life. In addition, correctly advertising the operating hours of the health care facility will allow the residents of the rural areas to know exactly when the correct times are to go to the facility. If individuals from tribal areas know that the health centers will be open when they arrive, their incentive to make multiple trips throughout the year will increase. Improving these different components, will increase the value of expected returns in receiving medical care for the tribal area residents. It is possible that if one individual had a decent experience at the health center they will spread the word throughout their community, therefore making other people more likely to visit the health facilities. Overall, increasing the supply of proper health care will create more incentive for people to make frequent visits. This will ensure the increase in the demand in health care in tribal regions as well.
Banerjee, Abhijit, Esther Duáo, Rachel Glennerster, and Dhruva Kothari (2010). Improving Immunization Coverage in Rural India: A Clustered Randomized Con-trolled Evaluation of Immunization Campaigns with and without Incentives. British Medical Journal 340:c2220.
Das, J., Hammer, J., & Leonard, K. (2008). The Quality of Medical Advice in Low Income Countries. The World Bank, 1-38. Retrieved April 16, 2017.
Dupas, P. (2011). Health Behavior in Developing Countries. Annual Review of Economics, 3, 1-39. Retrieved April 16, 2017.
Provide accessible healthcare in rural areas, CAG tells Rajasthan govt. (2017, April 01). Retrieved April 16, 2017 from http://www.hindustantimes.com/jaipur/provide-accessible-healthcare-in-rural-areas-cag-tells-rajasthan-govt/story-4zDflT3SA2WMDBmROjo8hI.html
Universal Health Coverage. (n.d.), Retrieved April 16, 2017, from http://in.one.un.org/task-teams/universal-health-coverage/
Top image by Ejaz Kaiser, Ruchir Kumar and Subhendu Maiti from the Hindustan Times