First Insight On The Health System Of Rural Uttar Pradesh

by | Sep 20, 2017

It was another fine day in ‘Amberpur Chauraha’ (of Sidhauli Block, Sitapur District of Central Uttar Pradesh). As I prepared to start my routine journey to work, I got to know of the sad demise of an 8-year-old girl from snake bite last night. Having had a lifelong phobia of snakebites, the shock of such an unfortunate event fueled my curiosity and anxiousness to know more about this incident. After hearing the story, I realized that the major cause of such a demise was the ignorance of the family in terms of first aid/healthcare and the inaccessibility of healthcare during the night-time. Later on, I heard several other instances of children dying due to common diseases such as cholera, sickness and infection. Several times, I came to know about how people went to local quacks/witch-doctors for the solution of these diseases and ended up getting into serious trouble ranging from infections to death.

This is the situation of community health services in the place where I am currently working – my project is around education with an organization called Milaan. While doing some research around health, I found that around 74% of the qualified doctors in India work in urban settlements which account for almost 31.16% of the population (census of India 2011). [1] Nearly 86% of all the health related travel are made by villagers with majority still traveling more than 100 km to avail healthcare facilities of which 70-80% of the cost is borne out of their pocket. [2] Although there is a lot of improvement in terms of health parameters since independence, we still lag behind on health parameters compared to WHO health standards i.e. infant mortality rate is still higher than most of developed countries. [3] If one looks at the present scenario of health systems in rural India, the problem seems to arise mainly form 3 issues: these are ‘lack of infrastructure’, ‘ignorance and superstitions’ and ‘lack of proper medication’.

Lack Of Infrastructure

Although health centers in government setups are doing a good job, one of the factors behind the death in the above incident narrated was the unavailability of doctors during the night. The nearby Public Health Centre (PHC) in Bhatpur village has medical staffs working from 8:00AM to 2:00PM except Sundays. One needs to go to  nearby block (in our case, Sidhauli) for any emergency. As per a report, it was shown that 143 public facilities had PHCs closed for 56% of the time due to absenteeism of doctors and other reasons. For 45% of time, doctors were found absent and often found indulged in discharging their duty as private doctors which is indicative of work conditions and resources and incentives offered by the government. [4] Many times, even government-run health centers including CHCs have problems such as lack of electricity, water supply, equipment and inadequate supply of medicines.

Ignorance And Superstition

I came to know about many cases where the concerned patient did not go to a medical practitioner, but instead they went to a local quack/witch-doctor who often do the treatment. These first few days’ treatment has often results into big infections While my  point is not to show contempt for derogate the traditional knowledge, but for the complications arising out of trusting quacks over doctors. For example, two of our community members got into big trouble by getting first aid by one so called quack which later led to an infectious disease. A study published last year in the journal BMJ Open has found out that 75 per cent of employees at rural pharmacies in India also practice as quacks[5].

Although in the light of the inability of attracting qualified doctors to rural India, governments in Adhra Pradesh, Maharashtra, west Bengal have taken the initiative to mitigate the problems of shortage of doctors by training the quacks for graduate level short-term training course. Critics may argue that as most of these quacks are not even 10th pass[6], having them go through a crash course only makes it dangerous to give these half-learned doctors the responsibility of working in rural villages. One may argue that it also indicates the attitude of the government to sometimes treat villagers as second class citizens in terms of facilities and giving them half-learned doctors.[7]

Lack Of Proper Medications

Many times, due to unavailability of medicines, one may have to go to the next health center, losing precious time in critical health cases. The availability of medicines in Punjab and Haryana was 45.2 % and 51.1 % respectively, as per a report [8].

Failure on these three fronts is, in my opinion, the main reason behind our country’s poor performance in health parameters. I think we can reverse this situation by increasing our health expenditures, making work conditions in rural health centers quite conducive through incentives and mandatory provisions and including courses on rural health to be made compulsory in medicine degrees. Also we need to be aware of myths surrounding diseases and their importance to a villager. Frequent and proper supply of medication and accessibility to multi-specialty clinics will be fruitful for the prevention of any casualty due to poor healthcare. With this, I would like to say that it has been great time living in Kantaian and working at Swarachna school, as it helps me develop insights from the community. I look forward to coming months with more excitement.

[1] Urban_2011.pdf
[2] Kumar R. Academic institutionalization of community health services: Way ahead in medical education reforms. J Family Med Prim Care. 2012; 1:10–9.
[3] mortality_2015/en/
[4] Bhandari L, Dutta S. India Infrastructure Report; 2007. Health infrastructure in rural India.
[6] IOSR Journal Of Humanities And Social Science (IOSR-JHSS) Volume 14, Issue 2 (Jul.-Aug. 2013), PP 44-53
[8] Prinja et al. BMC Pharmacology and Toxicology(2015) 16:43

Picture credits: Creative Commons.

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  1. Anupama Pain

    It was a good read Prafull! I like how you have looked at the episode of snake bite as a problem and have been able to put it in the context of a larger healthcare issue. What will also be interesting is to see you dabble with the more case study/nuance episode documentation as well – how exactly she got bitten, what happened in the face of treatment, what was the reaction of the community etc. Will look forward to your next 🙂

    • sureenoughtowrite

      Thanks for the feedback, Anupama! I think I did look into it but i did not want to focus on that…..To answer your question, Some villagers said that Girl’s family should not have killed the snakes. First aid that she got after bite was pretty bad.Doctor they went to, did not start girl’s treatment immediately. The doctor waited till the moment her father arranged money. Also Parents did not realize at first, it was a snake bite (they had to find the snake in the almirah where she was bitten by snake). Girl got bitten by a cobra snake which came to their home from the jungle behind their home. In all, it shows another issue of shrinking snake’s habitat. Also it also showcased the need of an affordable and accessible healthcare. Community was shocked as there was some Baba ( local name for saints) has given boon to people of kantain for not getting killed due to snakebite. However I should add one thing many witch doctors do manage to save lives of people from snakebite (most of snakebites are nonvenomous in india) which increases the complexity for solving the problem at attitude level.


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