A STUDY ON ROLE OF PRIMARY HEALTH CARE IN RURAL

A AREA IN CHERUVATHUR PANCHAYATH

INTRODUCTION

The concept of Primary Health Centre (PHC) is not new in India. The Bhore
Committe in 1946 gave the concept of a PHC as a basic health unit to provide as
close to the people as possible, an integrated curative and preventive health care to
the rural population with emphasis on preventive and promotive aspects of health
care .

This ideal model of healthcare was adopted in the declaration of the

international conference on primary healthcare held in Alma Ata, Kazakhstan. In
1978 (known as the “Alma Ata Declaration”)and became a central concept of the
goal of Health of the World Health Organization for everyone. The Alma-Ata
Conference mobilized a “ Primary Health Care movement” of professionals and
institutions, government and civil society organization, researchers and grassroots
organizations that committed to addressing “politically, socially and economically
unacceptable health inequalities” in all countries. There were many factors that
inspired the APS: a prominent example is china’s barefoot doctors.

The health planners in India have visualized the PHC and its sub-centre (SCs)
as the proper infrastructure to provide health services to the rural population . The
central council of Health at its first meeting held in January 1953 had
recommended the establishment of PHCs in community development blocks to
provide comprehensive health care to the rural population. These centre were
functioning as peripheral health service institutions with little or no community
involvement. Increasingly , these centres came under criticism , as they were not
able to provide adequate health coverage , partly , because they were poorly staffed
and equipped and lacked basic amenities.

The 6th Five year plan (1983-88) proposed reorganization of PHCs on the
basis of one PHC for every 30,000 rural population in the plains and one PHC for
every 20,000 population hilly, tribal and backward areas for more effective
coverage. Since then,23,109 PHCs have been established in the country (as of sep
2004).

PHCs are the corner store of rural health services a first part of call to a
qualified doctor of the public sector in rural areas for the sick and those who
directly report or referred from sub – centres for curative , preventive and
promotive healthcare . It act as a referral unit for 6 sub – centres and refer out
cases to community health centres ( CACs-30 bedded hospitals ) and higher order
public hospitals at sub-districts and district hospitals . It has 4-6 indoor beds for
patients .

PHCs are not spread from issues such as the inability to perform up to the
expectation due to : i) non-availability of doctors at PHCs ; ii) even if posted
doctors do not stay at the PHC ; iii) inadequate physical infrastructure and
facilities; iv) insufficient quantities of drugs ; v) lack of accountability to the public
and lack of community participation ; vi) lack of set standards for monitoring
quality cute etc.

Standards are a means of describing the level of quality that health care
organization are expected to meet or aspire to key aim of these standards is to
underpin the delivery of quality services which are fair and responsive to clients
needs , which should be provided equitably and which deliver improvements in the
health and well being of the population . Standards are the main driver for
continuous improvements in quality . The performance of health care delivery
organization can be assessed against the set standards . The National Rural Health
Mission (NRHM) has provided the opportunity to set Indian Public Health
Standards (IPHS) for health centre functioning in rural areas .

There are standards prescribed for a 30 bedded hospital by Bureau of

Indian Standard (BIS) . Recently , under NRHM , Indian Public Health Standard
have been framed for community health centre as the BIS is considered as very
resource – intensive at the present scenario . But no such standard have been laid
down for Primary Health Care Institutions . In order to provide optimal level of
quality health care , a set of standard are being recommended for Primary Health
Care to be called Indian Public Health Standards (IPHS) for PHCs.

The nomenclature of a PHC varies from state to state that include a Block
level PHCs ( located at block HQ and covering about 100,000 population and with
varying number of indoor beds ) and additional PHCs/New PHCs covering a
population of 20,000-30,000 etc.. The standards prescribed in this document are for
a PHC covering 20,000 to 30,000 population with 30 beds for providing
specialized services.

Setting standards is a dynamic process currently the IPHS for Primary

Health Centre has been prepared keeping in view the resources available with
respect to functional requirement for PHCs with minimum standards such as
building man power , instruments , and equipments , drugs and other facilities etc..
 Primary healthcare (PHC) is “essential healthcare” that is based on
scientifically sound and socially acceptable method and technologies. This makes
universal health care accessible to all individuals and families in a community.
APS initiatives allow for the full participation of community members in a
implementation and decision-making. Services are provided at a cost that the
community and the country can afford at a very stage of its development in a spirit
of self reliance and self determination. In other words, PHC is an approach to
health beyond the traditional healthcare system that focuses on social policies that
produce health equity. PHC include all areas that play a role in health, such as
access to health service, environment and lifestyle. Therefore, primary healthcare
and public health measures together can be considered the cornerstones of
universal health system. The World Health Organization or WHO, detail the
objectives of PHC defined by three main categories: “empowering people and
communities, multisectoral policies and actions; and primary care and essential
public health function at the core of integrated health services. According to these
definitions, PHC cannot only help a person after being diagnosed with a disease or
disorder, but can also actively contribute to preventing such problems by
understanding the individual as a whole.

The Ultimate goal of a Primary health care is to achieve better

health services for all. It is for this reason that the World Health Organization
(WHO) has identified five key element to achieve this goal:

1. Reduce exclusion and social disparities in health (universal coverage

reforms).
2. Organizing health services around people’s needs and expectations (service
delivery reforms).
3. Integrate health in all sector (public policy reforms).
4. Seek collaborative models of political dialogue (leadership reforms).
5. Increase stake holder participation.

Behind these elements lies a series of basic principles identified in the

Declaration of Alma Ata that must be formulated in national policies to
launch and sustain PHC as part of a comprehensive health system and in
coordination with other sectors.
Equitable distribution of health care: According to this principle,
primary care and other services to address major health problems in a
community should be provided equally to all people, regardless of gender,
age, caste, colour, urban location/ rural and social classes.
Community participation: to make the most of local, national and other
available resources. Community participation was considered sustainable
due to its grassroots nature and emphasis on self-reliance, as opposed to
targeted (or top-down) approaches that reply on international development
assistance.
Health human resources development: Comprehensive healthcare
depends on an adequate number and distribution of doctors, nurses, allied
health professionals, community health workers and other trained people
working as a health team and receiving support at the level local and
references.
Use of appropriate technology: Medical technology should be
provided that is accessible, affordable, feasible, and culturally acceptable to
the community. Examples of appropriate technology include refrigerators for
cold storage of vaccines. Less appropriate examples of medical technology
could include, in many settings, body scanners or heart-lung machines,
which only benefit a small minority concentrated in urban areas. They are
 generally not accessible to the poor, but they attract a large share of
resources.
Multisectional approach: recognition that health cannot be improved through
interventions within the formal health sector alone; other sectors are equally
important to promote the health and self-sufficiency of communities. These
sectors include, at a minimum: agriculture (e.g. food security); education;
communication(for examples, about prevailing health problems and methods
to prevent and control them); accommodation; public works (for examples,
ensuring an adequate supply of drinking water and basic sanitation): rural
development; industry; community organizations (including panchayats or
local governments, voluntary organizations, etc).
In summary, APS recognizes that health care is not a short-term
intervention, but rather an ongoing process to improve people’s lives and
alleviate the underlying socio-economic conditions that contribute to poor
health. The principle link health, development and promotion of political
interventions rather than passive acceptance of economic conditions.

OBJECTIVES

1. To examining the problem faced by the households in accessing healthcare

services providing by the PHC.
2. To analyze the Healthcare utilization patterns of rural households.