Bringing health care to people through sub-care centers | Lucknow News



CM Yogi Adityanath with a health worker at a vaccination center in Lucknow

The Covid-19 pandemic has succeeded in drawing attention to the broader issue of greater investment in the health sector. The government of India recently launched a very ambitious center sponsored health infrastructure mission for the same. This has shown that taking care of people close to their home is an important issue in responding to various health problems, including epidemics.
There are three characteristics of a good health system: accessibility, affordability and quality of care. We have seen in various parts of the country during the pandemic that early intervention and early medication have proven to be lifesaving. This brings the focus to the issue of accessibility of health facilities, which is the first requirement for people. It is only when a person is able to reach a facility that the question of affordability and quality arises. Since not everyone has transport and these facilities are not readily available in rural areas, the primary health care center should be close to people’s homes.
Primary health care is provided by primary health centers and secondary health centers, which are gradually being converted into health and welfare centers. A health sub-center remains the first port of call in rural areas. The norm is to have one sub-center for every 5,000 inhabitants in the plains and for 3,000 in the hilly and tribal areas. Thus, if a district has a rural population of 15 lakh in the plains, it should have 300 sub-centers, evenly distributed, in the district. Here is the trap. Even if this particular district has 300 sub-centers, this would not automatically ensure that every pocket in the district has good accessibility. This is due to a faulty planning process.
When we consider a district as the planning unit, the health facilities are located within the district but the distribution is most often skewed.
In addition, these sub-centers may not be built in the most suitable location. This happens because a health facility is treated as “social infrastructure” for which the land must be free. We can spend Rs 30 lakh to build a health and wellness center in a village, but cannot spend Rs 3-4 lakh to procure suitable land.
This is not the case with roads, bridges, power stations or irrigation canals which are supposed to be “real infrastructure”. After having built a sub-center on free land 2 km from the village dwelling, we wait for the auxiliary nurse-midwife (ANM) to stay there alone. This is the reason why in many places the sub-centers function sub-optimally and the MNAs do not reside there. The answer to the accessibility question isn’t rocket science and can be treated with some re-imagining.
First, we can decide that each gram panchayat will have at least one health sub-center. This will address the issue of equitable distribution of sub-centers. In fact, at UP, we are trying to solve the problem of prior asymmetric distribution by scientific placement of 5,000 new sub-centers.
Second, given that the 15th Finance Committee grant will fund the construction of rural health infrastructure, it makes sense to locate a facility in every gram of panchayat. When under Right to Education, we appoint a teacher for 25 students, is it too much to ask for one or two caregivers for the entire population of a gram panchayat?
Third, we need to liberalize the norm and get / acquire suitable land, close to the village dwelling, for the health sub-centers where the ANM can stay safely. This can be done by finding suitable public land or by obtaining a suitable coin through a land swap or even purchase.
Finally, since primary health care is discharged from secondary and tertiary establishments; therefore, investing in this strategy would prove to be a game-changer for the healthcare scenario and create space to increase the quality of care. This would not only help us in normal times and in the event of an epidemic / pandemic, but would also lead us towards universal health coverage.
(The author is an IAS officer, currently as the head of the adl, health and family welfare, UP government. The views expressed are personal)



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