By Prof. Aftab Anwar Shaikh and Dr. Gulnawaz Usmani
Health is an important factor for the overall physical, mental and social development. According to Amartya Sen (2014), healthcare is not something that is supported by economic growth but something that supports economic growth. Healthcare means not only medical care but also all other pro-preventive care aspect. The report by the High-Level Group on the Lisbon Strategy for Growth and Employment (2004) states that health and healthcare play a major role in generating productive workforce, employment, social cohesion and hence economic growth. Healthy population will serve the nation more efficiently, as it promises increased production capacity.
Health standard depends on the healthcare system. Proper and well-managed healthcare system caters to the targeted population more efficiently. Healthcare infrastructure in India consists of primary, secondary, and tertiary healthcare. The healthcare at these levels is provided by both public and private healthcare providers. At the primary level of healthcare, we include community health centres (CHCs), primary health centres (PHCs), and sub-centres (SCs). While the sub-district hospitals come under the category of secondary healthcare and the tertiary level of healthcare includes the district hospitals and medical colleges.
Though India is having a robust healthcare system yet the health standards are not very impressive especially in case of rural areas. Health differentials in rural-urban areas are persisting on a very large scale. Population below 15 years as a percentage of total population is higher in the rural areas as compared to the urban areas with 28.1 per cent and 23.1 per cent respectively. Good health to this age population is very essential for their overall development which ultimately affect the development process significantly.
Twenty-seven per cent of rural women with age group 20-24 years married before the age of 18 years against the 14.7 per cent of urban women of the same age group. While this case is in an improved condition when it comes to the male counterparts. The percentage of rural men in the age group 25-29 years married before 21 years is 21.1 and for urban men this percentage is 11.3.
Total fertility rate is higher among rural women as compared to urban women with 1.6 and 2.1 respectively. The reasons are the lower literacy level of female in rural areas. As per the NFHS-5 report, only 33.7 per cent of rural women are having 10 or more years of schooling against 56.3 per cent of urban women.
Rural areas face higher burden of child mortality as compared to urban areas. The three components of child mortality namely: neonatal mortality; infant mortality; under 5 mortality were recorded very high in rural areas. Neonatal mortality in rural areas is 27.5 per cent as compared to 18 per cent in urban areas. Infant and under 5 mortality was recorded at 38.4 and 45.7 in rural and urban areas.
In terms of maternal care and healthcare delivery, huge differences are persisted in the rural and urban areas. 86.7 per cent of births were recorded as institutional births in rural areas against 93.8 per cent of urban areas. Rural areas recorded higher number of delivery at home with 3.7 per cent against just 2.1 per cent in urban areas conducted by skilled health personnel.
Antenatal Care (ANC) during the first trimester recorded at 67.9 for the rural mothers and 75.5 per cent for urban mothers. Moreover, only 54.2 per cent of mothers had at least 4 ANC visit while for urban mothers this percentage is slightly higher with 68.1 per cent. One interesting note is that the 96.3 per cent of pregnant mothers are registered under MCP (Mother and Child Protection). Perhaps, 75.4 and 84.6 per cent of mothers received postnatal care from a trained healthcare personnel within 2 days of delivery in the rural and urban areas respectively. This percentage remains the same in case of children also. 76.5 per cent of rural children received postnatal care within 2 days of birth from a trained doctor/ nurse/ midwife or any other healthcare staff member as compared to 85.7 per cent of urban children.
Differences in health standard between the rural and urban populations makes rural population more vulnerable. Primary healthcare system functioning very poorly as though we have the healthcare centres but availability of healthcare centres is not adequate and are less equipped with doctors/ nurses/ paramedical staff/ other healthcare personnel.
The Government should try to strengthen the public healthcare facilities especially the rural healthcare facilities. A well-designed and managed rural healthcare system can improve the health standard in rural areas. Improved health standard increases the efficiency of the targeted population which results in better economic growth and development.
[Prof. Aftab Anwar Shaikh is Principal and Dr. Gulnawaz Usmani is Assistant Professor in Poona College of Arts, Science & Commerce, Camp Pune, Maharashtra, India]