The challenge before the Governments lies in bringing in innovations, moulding the technologies to reach maximum people who are still in the rural India. With the kind of efforts being put in all over the country accessible, affordable and quality healthcare to all citizens is round the corner, says S Krishna Chaitanya, Mission Director, Nation Health Mission, Department of Health & Family Welfare, Dadra and Nagar Haveli, in conversation with Elets News Network (ENN).
Q How have you ensured affordable, accessible and quality healthcare delivery in Dadra & Nagar Haveli?
Dadra Nagar Haveli is a tribal majority Union Territory, with 52 percent of tribal population. Specific interventions were done for ensuring affordable, accessible and quality healthcare delivery like: Strengthening of health infrastructure by a network of district hospital, sub district hospital, two Community Healthcare Centres (CHC), nine Primary Healthcare Centres (PHC) and 71 Sub Centres. These are facilitating healthcare delivery in all villages of the Union Territory. In addition, mini Sub- Centres are also being establised to cover remote, inaccessible hamlets.
Strengthening of Rogi Kalyan Samiti at District Hospital and Sub District Hospital for ensuring decreased and nominal costs of high end services such as C T Scan, MRI, and laboratory investigations.
100 percent implementation of schemes such as Janani Shishu Suraksha Karyakaram (JSSK), Janani Suraksha Yojana (JSY) providing free of cost services to all Antenatal care (ANC), Prenatal care (PNC) mothers and children up to one year.
Prescription of generic medicines only in the healthcare facility. Increase in the number of ambulances and schemes such as Peheli Savari and 108 services for emergency cases. We have recorded one of the best response times in emergency care.
Capacity building of employees with respect to quality monitoring processes such as Kayakalp and National Quality Assurance System (NQAS) with District Hospital being NQAS certified and Sub-District Hospital under certification process.
Empanelment of private hospitals under UT-run Sanjeevani Swasthya Bima Yojana as referral centers under the scheme for availing free of cost specialised surgeries. This scheme offers wider health insurance coverage in terms of packages and families covered than the SECC families covered in various schemes across the country.
Because of all the above initiatives, the Government Hospitals provide 90 percent of the health services in Union Territory of Dadra Nagar Haveli and the Union Territory has received the award for least Out-of-Pocket expenditure for IPD and OPD services among the UTs.
Q What kind of challenges do you face while implementing Government-run healthcare programmes in rural areas?
The literacy rate of the rural population is low. Hence, preventive knowledge and risk awareness of various diseases is low. Even after wide publicity and Information, Education and Communication (IEC), the issues of ignorance in terms of availing timely services is seen in rural population.
Some people in rural areas still seek help from traditional healers instead of availing the healthcare facilities. Health professionals like super specialists do not opt to work in rural areas due to remoteness of territory and difficult terrain and attrition rate is high even among those who join due to above mentioned disadvantages.
Access to technology such as internet facility is still a challenge in few hilly and forested areas. Scattered hamlets are sometime very difficult to access for repeated visits by health functionaries.
Prevalence of early marriage and the practice of live-in relationships at an early age noticed in few villages leads to increase in number of teenage pregnancies and this coupled with the malnutrition problem in rural areas is a challenge to reduce the rates of vital indicators like infant mortality rate etc.
The bank accounts of few beneficiaries in rural areas are dormant or inactive, the mobile numbers of few beneficiaries are different than those in the bank accounts or have gone inactive and hence it is difficult to disburse the benefits of various Government schemes in rural areas.
Q The union territory has seen an alarming rise in leprosy cases in recent years. It has the highest proportion of childhood leprosy cases in India after Lakshadweep. What steps are being taken to improve the situation?
The Union Territory has seen rise in leprosy cases due to efforts and commitment by team of health functionaries through quarterly surveys and intensive active case detection campaign. We are determined to decrease the prevalence of leprosy which being a dormant disease is difficult to diagnose. The UT has implemented successful house-to-house survey and screening of families which initially led to increase in detection of cases. Over the years, the same has been managed by giving Rifampicin and now the prevalence has decreased from 6.77 in 2015-16 to 4.9 in 2017-18.
Due to massive industrialisation, the Union Territory has a large number of migrant labour population. The health administration is carrying out screening of all industrial labour to detect prevalence of leprosy. In 2018-19, we are targeting to bring down the prevalence level to less than 3.5 and are confident that we will achieve the same.
Q How do you analyze Indian healthcare system in terms of technology, innovations and delivery of services?
India has come far in terms of technological marvels such as healthcare information systems, picture archiving systems, laproscopic surgeries and technologies such as telemedicine. Telemedicine in rural areas ensures optimum management of post-operative cases availing follow up services by treating doctors without travelling to other cities indirectly cutting down the out-ofpocket expenditure. Still, there is scope in India for introduction of new technologies from other parts of the world for better healthcare facilities.
India has one of the largest public healthcare systems and is home to many innovations by Central government and State Governments in healthcare sector like National Health Mission, Save the Girl child scheme, 108 services through Public-Private Partnership, 104 helpline, radiological centres and dialysis centres through PPP, Paripakva Mata Niyojit Bal Yojana, Arogya Sri Scheme of health insurance and these innovations have helped in bettering the healthcare services in India.
The delivery of healthcare services in metropolitan centres of India is amongst the best and most affordable in the world contributing to medical tourism from all parts of the world.
On the other hand, the health services in semi-urban and rural areas of the country need to be improved and the access to these interiors of India rests on government systems and a number of socio-economic factors also have to be addressed.
The challenge before the Governments lies in bringing the innovations, moulding the technologies to reach maximum number of population, still living in the rural India and with the efforts being put in all over the country accessible, affordable and quality healthcare to all citizens is round the corner.