(Here, Biswajit shares his experience and reflections from his district immersion in Alwar, Rajasthan as part of the ‘Realising India’ programme.)
Majorly, most of our healthcare system is concentrated in urban areas. In the town where I live, if I ever need to access medical treatment, the closest place to get it would be the district hospital – which is either free or quite inexpensive, but is questionable in terms of the quality of healthcare. And for the many years I resided in a village in West Bengal, the closest hospital or clinic was over 30 kilometres away. Needless to say, rural populations, who have significantly lower incomes, have to spend a lot more to access even basic medical care.
A large factor in considering the development of a country is the quality and ease of access to healthcare which is usually regulated to ensure total public provision. India falls way behind in this area. In our country, there are only 20 doctors and nine hospital beds available per 10,000 people.
Along with the fellow members of my ISDM cohort, I got the opportunity to travel to Alwar, Rajasthan, to get exposure on what the grassroot development needs are. The Rajasthan government has improved their provision of public health services in the last 10 years. Alwar has 760 health sub-centres (HSCs), 120 primary health centres (PHCs), 36 community health centres (CHCs) and 1 district hospital. Totally, this covers approximately 3.6 million people. However, this is still not sufficient.
As I travelled around the district of Alwar, I began to realise more about the problems faced by the people there. An old woman I met on a bus while traveling to Jhiri village told me that she had come to the PHC for a check-up, but there wasn’t any doctor at the centre. After many hours, she finally had to leave without a consultation to catch the last bus back to her village. This is just one of the many examples of the plight of the people in Alwar.
A significant portion of the rural people in Alwar choose to access private health facilities. However, there is very low awareness regarding mental disabilities and how it impacts the learning of children. Children who suffer from mental disabilities have limited treatment, due to the lack of awareness and facilities among the community and health institutions which puts them constantly at risk.
When it comes to maternal health, 1.6% of deliveries in the district occur at home due to poor medical care and limited transport options. I came across a man at a PHC who had brought his pregnant wife for her delivery, and then had to shift her to a private hospital over 50 kilometres away, due to no medical staff being present at the centre. Another woman and her unborn baby died on the way to a private hospital because of similar difficulties. Due to the failure of the public healthcare system, more and more people have to put their trust in private institutions.
After hearing these stories, I strongly feel that our health-service delivery model needs to shift from a population-based model to a mobility-based model. Despite the availability of healthcare facilities, when there are insufficient transport options, it is the people in the remote areas who suffer the most, and many die in the process.
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