Even after 75 years of independence many rural hamlets and tribal belts have no access to health care. In the previous article, it was mentioned that many patients and pregnant women are being carried in “Doli” in the hill areas where there is no road connectivity. Access (to healthcare) is defined by the Oxford dictionary as “The right or opportunity to use or benefit from (healthcare)” Again, when we look beyond the somewhat well-connected urban populations to the urban underprivileged, and to their rural counterparts, the question “What is the level of access of our population to healthcare of good quality?” is an extremely relevant one. A research paper published in 2002 revealed that access is a complex concept and aspects of availability, supply, and utilization of healthcare services are crucial factors in determining access. Barriers to access in the financial, organizational, social, and cultural domains can limit the utilization of services, even in places where they are “available.”
What is encouraging is that efforts to enhance awareness levels have generally shown promising results. For instance, a study in Bihar and Jharkhand demonstrated improved levels of awareness and perceptions about abortion following a behavioral change intervention. A review of the effectiveness of interventions on adolescent reproductive health showed a considerable increase in girls’ understanding of health problems, environmental health, nutritional awareness, and reproductive and child health following intervention.
The sex ratio in India in 2022 was 1.075 male births per female birth, whereas the sex ratio of the population was 1020 females per 1000 males in 2019-2021, according to the National Family Health Survey. In 2024, India’s Sex Ratio is 1020 females per 1000 males. In Rural areas, the sex ratio is 985 females to 1000 males. Prior, the census which was held in 2011, shows India’s total sex ratio was 943 females per 1000 males. These figures support the change in the behavior of the families and their perception towards girl children has been changing due to regular awareness camps and health education programs that are going on in the country by the government as well as non-governmental organizations. The message is clear that we must strive to raise awareness in those whom we work with and must encourage the younger generation to believe in the power of education for behavior change.
Physical reach is one of the basic determinants of access, defined as “ the ability to enter a healthcare facility within 5 km from the place of residence or work” Using this definition, a study in India in 2012 found that in rural areas, only 37% of people were able to access in-patient facilities within a 5 km distance, and 68% were able to access out-patient facilities in Krishna and Ananthapuram districts. Further, the paper postulates that in general, the more rustic (rural) one’s existence and not interested in moving from their birthplace, the other group would like to live in towns. The greater are the odds of disease, malnourishment, weakness, and premature death across many populations in the country.
Even if a healthcare facility is physically accessible, what is the quality of care that it offers? Is that care continuously available? While the National (Rural) Health Mission has done much to improve the infrastructure in the Indian Government healthcare system, a 2012 study of six states in India revealed that many of the primary health centers (PHCs) lacked basic infrastructural facilities such as beds, wards, toilets, drinking water facility, clean labor rooms for delivery, and regular electricity. However the government of India, the Ministry of Health, and the Ministry of Ayush under the leadership of the Hon’ble Prime Minister of India Sri. Narendra Modi is coming out with Novel acceptable strategies in health care for every common man.
As thinkers in the disciplines of community medicine and public health, we must encourage discussion on the determinants of access to healthcare. We should identify and analyze possible barriers to access in the financial, geographic, social, and system-related domains, and do our best to get our people and peers thinking about the problem of access to good quality healthcare.
It is necessary to consider the human power crisis in healthcare. Any discussion on healthcare delivery should include arguably the most central of the characters involved in the human workforce. Do we have adequate numbers of personnel, are they appropriately trained, are they equitably deployed, and is their morale in delivering the service reasonably high? These characteristics have to be assessed and evaluated from time to time keeping in mind the emerging public health issues and new infectious diseases. Environmental pollution is already posing enough health hazards, in case if this is not immediately attended to and discover remedial measures the pollution from the domestic sector to industrial complexes grow day by day to dimensions of a ghostly magnitude. (To be con
