SUMMARY AND CONCLUSION

Transcription

1 168. Wahi, P. N. et.al., : Viral Hepatitis (Review), ICMR, New Delhi, Wilson, Robert, N., : The Social Structure of a General Hospital in Medicine and Society, The Annals of the American Academy of Political and Social Science, 346, 67, Yannawar, P.K. et.al., : Environmental Health, 12, 355, CPHERI, Nagpur, Zutshi, P.K., : Science Today, A Time of India Publication, October ***** SUMMARY AND CONCLUSION Inferences drawn in the body of the thesis are provided in the form of summary and conclusion in this chapter. Effort has been made to explain the concept of health care, historical development of health care services, rural health services, national planning and health care services and Social Welfare and Health Care Services which forms the core theme of the first chapter. The inferences drawn in the background of the study reveal the following: 1.Health care includes not only medical care, but services provided for promotion of health, prevention of disease, early diagnosis and rehabilitation also. 2.Since health has been declared a fundamental

2 human right, the State has the responsibility to provide health care services to its citizen. 3.Health services in India began in the middle of the 18 th Century. 4. The guidelines for organizing the health care services in India came from the reports submitted by the Bhore Committee, the Mudaliar Committee, the Chadha Committee, the Mukherji Committee, the Kartar Singh Committee and the Shrivastav Committee and Report of the Working Group in 1981 on Health For All by Besides, the National Health Policy 2002 has laid down the specific goals to be achieved by the following years 2005, 2007, 2010 and The functions of the Union Health Ministry have been set out in the 7 th Schedule and Article 247 of the Constitution of India under 2 heads the Union List and the Concurrent List. The Union List of functions include the administration of International Health, administration of Central Institutes, promotion of research, drugs control, census operations, regulation of labour and coordination with the States. The functions specified in the Concurrent List are the responsibility of both the Union and State Governments. These are prevention of spread of communicable diseases; prevention of food adulteration; control of drugs and poisons; vital statistics; labour welfare and economics and social planning. 7. The Central Council of Health was set up by a Presidential Order in 1952 to promote coordinated and concerted action between Center and the States in the implementation of health programmes and measures pertaining to health. 8. A similar Council also exists for family welfare. In recent years, these two councils have been meeting jointly to take coordinated decisions. 9. The Central Council of Health and Family Welfare also makes recommendations to the Central Government regarding distribution of grants-in-aid and reviews the work done through the utilization of these grants. Each State has evolved its own pattern of health administration. But in each State there is a Minister of Health and Family Welfare elected by the people and Directorate of Health Services (known in some States as the Directorate of Health and Family Welfare). A Minister of Health and Family Welfare heads the State Health Ministry.

3 The State Health Directorate is responsible for formulating and evaluating plans; directing the execution of approved plans and programmes. 12. The District in India is the pivot of the administrative structure. In some States, the District Health Organization is headed by a single Chief, the Chief Medical Officer of Health who is responsible for all community services in the District. In some States, there are 2 Chiefs District Medical Officer (DMO) or Civil Surgeon who is in-charge of medical services and the District Health Officer or District Health and Family Welfare Officer who is in-charge of health and family welfare. 13. In case of Tamil Nadu, three types of local self-government institutions are found in the urban areas. They are Town Area Committees (In areas with population ranging between 5,000 and 10,000), Municipal Boards (In areas with population ranging between 10,000 and 2 lakhs) and Corporations (With a population above 2 lakhs). 14. The services provided are usually confined to sanitation and public health because of limited financial position. 15. The present structure of local self-government in rural areas in Tamil Nadu State is based on a three-tier structure, known as the Panchayati Raj system. They are Gram Sabha and Village Panchayat at Village level, Block Panchayat/Panchayat Union Council at Block level and District Panchayat at District level. 16.The Panchayati Raj Institutions are entrusted with the responsibility of implementing programmes related to other health care services such are provision of good drinking water, provision of housing, etc., 17. The Government of India in 1977 launched a scheme known as Rural Health Service. 18. The rural health infrastructure to deliver the rural health care services is available at three levels. They are Village Level, Primary Health Sub Centre Level and Primary Health Centre Level. 19. There are three health functionaries at the Village level, namely Health Guides, Trained Dais and Anganwadi Workers. 20. The village Health Guides performs functions relating to vaccinations and give advice on simple health education measures such as construction of latrines, garbage disposal and disinfections of water supplies. 21. Trained Dais have a vital role in providing domiciliary midwifery services in rural areas. 22. Under the Integrated Child Development Services Schemes, there is one Anganwadi Worker for 1000 population. The services rendered by her comprise health check-up, immunization, supplementary nutrition, and health education and referral services. 23. The male and female

4 health workers are multi-purpose workers trained for definite tasks and functions, which comprise the following treatment of minor illnesses, maternal and child health, family planning, control of communicable diseases, Immunization, dais training, nutrition (distribution of iron and folic acid tablets, and vitamin A, etc.), record keeping and referral services. It has been proposed that facilities for insertion and simple laboratory investigations like routine examination of urine for albumin and sugar would be established at each Primary Health Sub-Centre. The female Health Assistance supervises the work of female health workers. 24. The functions of a Primary Health Center are medical care, maternity child health and family planning, school health, improvement of environmental sanitation, control and surveillance of communicable diseases, collection and reporting of vital statistics, National Health Programmes (e.g. malaria, tuberculosis, diarrhoeal diseases, leprosy, universal immunization programmes, control of blindness, etc.), health education, training of auxiliary health personnel and referral services. 25. Health planning is based on the health demands of the population. The goal of health planning is the achievement of the optimal level of health. 26. For purposes of planning, the health sector has been divided into different sub-sectors. They are water supply and sanitation, control of communicable diseases, medical education, training and research, medical care including hospitals, dispensaries and primary health centers, public health services, family planning and indigenous system of medicine. 27. All the above sub-sectors have been given due consideration in the nation s Five Year Plans. However, the emphasis has changed from Plan to Plan depending upon the felt-needs of the people and technical considerations. The Health Plan is implemented at various levels National, State, District, Block and Village. 28. Health care services have been extended to the people of rural areas through social welfare services. The social welfare services are intended to cater to the weaker sections of the population. These include women, children, handicapped, aged, scheduled castes and tribes. 29. The Ministry of Welfare, Government of India, has been formed by pooling subjects related to welfare of the disabled, programmes of social defence, welfare of the scheduled castes and tribes and minorities. The welfare of women and child development is looked after by a separate Department of Women and Child Development set up in the Ministry of Human Resources Development. The various health care services in India are carried out through Health Services

5 Organizations located at National, State and District levels. These services are extended through local governments. Since the present research is confined to analyze the health services organization in Theni District, details relating to the profile of Theni District, medical care services provided through Health Services Organizations and other health care services such as adequate food and housing, safe drinking water, protection against communicable disease, etc. extended through Municipalities and Panchayati Raj Institutions are explained in the third chapter. Administration of Medical Care Services in Tamil Nadu with reference to Theni District, is analysed in the fourth chapter. It is understood that in rural areas health care services are provided through various health services organizations, such as primary health care centers and Government Hospitals. Their prime responsibility is to provide proper medical care services to the people. Data drawn from field survey forms the basis of this chapter. Hence the nature and composition of the cross sections of the respondents are provided in a nutshell. Accordingly, about 52% of respondents belong to the age group of 21 to 40 years and among them about 52% are males. Regarding their occupation, nearly 90% of them are agriculturist and agricultural labours. About literacy level, nearly 76% of them have less than middle school education. About 85% of the respondents are Hindus; and around 54% of there belong to Backward Community. Nearly 71% of respondents have income below Rs.20,000 per annum. In so far as the Health Care facilities available in rural areas for different kinds of illness, the study reveals the fact that majority of the respondents are not satisfied with the medical care facilities available in Health Services organizations. The simple reason is that the medical and paramedical personnel are not easily available for treatment. Not only that since most of the Government Hospitals do not have adequate facilities, they are forced to depend upon private hospitals for treatment. The Government of Tamil Nadu has been implementing several programmes to provide medical care facilities to its rural population. They are Pre-Conception And Pre-Natal Diagnostic Techniques (Prohibition Of Sex Selection) Tuberculosis Control Programme, Pulse Polio Immunization

6 Campaign Programme, Hepatitis B Vaccination Programme, Rubella Vaccination Programme, Special Programme For Pregnant Women, School Children Health Programme, Control of Communicable Diseases Programme, Prevention of Food Adulteration Act, Malaria Control Programme, National Filaria Control Programme, Japanese Encephalitis Control Programme, Leptospirosis Control Programme, Dengue Control Programme, Avian Influenza (Birds Flu) Prevention Programme, Chikungunya Prevention, Transmission and Control Programme, National Leprosy Eradication Programme, National Iodine Deficiency Disorder Programme, Model Dental Health Programme, Varumun Kappom Thittam, Noon Meal Programme and Integrated Child Development Programme, Maternal and Child Health Programme, Family Welfare Programme, Cradle Baby Scheme, 108 Emergency Helpline, Tamil Nadu Government Insurance Scheme for Life Saving Treatments, Palli Sirar Iruthaya Pathukappu Thittam and Palli Sirar Kannoli Kappom Thittam. From the analysis about the awareness and implementation of the various medical care programmes, it is evident that majority of the respondents are not adequately aware of them implemented to benefit the people. Hence those who require such services are unable to avail these medical care services. Hence it is suggested that the Government should initiate steps to create sufficient awareness about these services implemented through various programmes. Thus, the benefit may reach all those deserving people. More or less the same is the situation about other health care services like food and housing, safe drinking water, protection against communicable disease, etc., which are provided through Municipalities and Panchayati Raj Institutions. In so far as the administration of other health care services are concerned, they are carried out through Municipalities and Panchayati Raj Institutions in Tamil Nadu. The state government has been implementing several programmes for the benefit of the rural community. Some of them are Indira Awass Yojana, Jawahar Gram Samridhi Yojana, Siddha Maintenance Grant, Employment Assurance Scheme, State Finance Commission Grant, Swarnajayanthi Gram Swarozgar Yojana, Maternity Grant, Central Rural Sanitation Programme, Finance Commission Grant, Member of Parliament Local Area Development Scheme, Pradhan Mantri Gram Yojana (PMGY), Biogas Scheme, Member of Legislative Assembly constituency Development Scheme and Anna Marumalarchi Thittam. About this apect, the study indicates that the awareness among

7 the rural mass are not adequate enough to avail and utilize these services to their benefit and advantage. Evidently as such, the rural community which requires these services are placed in a disadvantageous condition. It may be concluded, that despite the lofty ideals behind such innumerous schemes meant to uplift rural India, since the real beneficiaries are not properly sensitized about them, the purpose behind all these programmes, are beyond the reach of rural India in its entirety. The success of any such schemes meant for rural mass depends so much on its effective and successful implementation. i World Health Organization, Technical Report Survey No.428, ii Government of India, Report of the Health Survey and Planning Committee, Ministry of Health, New Delhi, iii Government of India, Report of the Health Survey and Planning Committee, Ministry of Health, New Delhi, iv King, Maurice, Medical Care in Developing Countries, World, Butter Wards, v Government of India, Report of Chaddha Committee, Ministry of Health, New Delhi, vi Government of India, Report of Mukerji Committee, Ministry of Health, New Delhi, vii Government of India, Report of Kartar Singh Committee, Ministry of Health, New Delhi, viii Government of India, Report of Shrivastav Committee, Ministry of Health, New Delhi, ix Government of India, National Health Policy, x Government of India, National Health Policy, xi xii Siegersit, Henry, A History of Medicine, Vol.I, Oxford University Press, London, R.J. Dubos, Man, Medicine and Environment, New American Library, New York, xiii O.P. Jaggi, Indian System of Medicine, Atma Ram & Sons, Delhi, 6, 1978.