It is easy to see in the world that a “shortage of health workers and their inefficiency in functioning, especially in the public sector, is not a new phenomenon.” In fact, the World Health Organization in 2006 estimated that there is a shortage of 4.3 million healthcare workers in the world (Motkuri, 2011). This statistic speaks to the state of health care in India as well: a shortage of properly educated, accessible health care centres and workers.
In India, in the last decade, a response to the Millennium Development Goals (MDG’s) prompted a slew of new initiatives and health care reforms in order to try and meet them. The MDG’s were put forward by the UN with Global Partnership in hopes of eradicating poverty in its various forms. We have now passed the 15 year mark and though the goals may not have been completed, there has been improvement in health and healthcare in India which we see specifically in a decrease in infant mortality rate, decrease in maternal mortality, and increased life expectancy (CESS, 2012).
One of the new initiatives was the launch of the National Rural Health Mission in 2005 by the National Health Mission. Its aim is to provide accessible, affordable and quality healthcare to the rural population, especially the vulnerable groups in part through mobile medical units (NHM, 2013).
The NHM has set standards for the population based need for adequate public health and although there are existing government clinics in rural areas and villages, the rural health statistics of 2015 reveal a shortage in sub-centres by 20%, primary health centres by 22%, and community health centres by 32% (NHM). So, even with new initiatives to improve health care, there is still a shortage of workers, and moreso, there is an unequal allocation of those workers.
Let’s take a look at Andhra Pradesh more specifically: One third of the population consists of disadvantaged castes and the minority community. Furthermore, two thirds of the population lives rurally while one third live in the urban centres. (CESS, 2013). Unfortunately, the majority of healthcare resources fall in the opposite balance. In Andhra Pradesh the majority (54%) of the total health sector workforce is concentrated in urban areas. The number of health workers available in urban areas per lakh is 652 and in rural areas is only 212: a drastic difference in numbers (Motkuri, 2011).
Andhra Pradesh was the first state to use the private sector to assist state efforts in achieving health objectives and it accounts for a huge portion of delivery of health services: 72% of inpatient admissions and 85% of outpatient services. For private care the patient pays out of pocket for all care and medicines, which can be a huge burden for much of the common population, especially the rural and urban poor (Mallipeddi et al., 2009).
As the name suggests, one group of health workers operating in the private sector that we have concern for is the “non-qualified providers”. They are also often called Registered or Rural Medical Practitioners (RMPs), which are generally unqualified nurses or assistants to doctors who, after gaining substantial experience, begin to act as the first contact for health care in villages. This group of personnel is widespread in Andhra Pradesh and, since they are the most accessible and most affordable the disadvantaged and poor turn to their care for even serious ailments in adults and children.
Because of the wide coverage of these unqualified workers, it is hard to get real statistics of the quality of care they provide. There is some evidence that points to harmful practices reported in the State, indicating that there is an extensive use of unnecessary or inappropriate drugs in the care provided by these workers (Mallipeddi et al., 2009).
It makes sense what this group of providers does, being situated in the villages, treating people as they are able in the areas in which a primary health centre or other facility does not exist. It could be an effective arrangement and is similar to what Mummy’s Village is hoping to do. However, we seek to replace solely experience trained nurses with fully educated nurses so the disadvantaged and rural people will be appropriately and safely treated. Wouldn’t it be great to even have a partnership with some of the unqualified workers to help them complete their education and continue in what they already do?
Even with the progress already made and new initiatives taken, what we begin to see is that it is difficult to get sufficient day to day medical care for the rural living Indian. The workers are few and many are not properly educated to provide the care that they currently give. What we have learned by speaking with locals in the village of Namavaram and in Visakhapatnam is that for common people it is a great challenge to afford healthcare treatments or it simply is not available in the village setting.
With such a high percentage of the population living in rural settings we need more workers and more accessible care in those places. Mummy’s Village can be a contributing factor in decreasing the present need by training nurses to work in the rural settings that they and most of the population are already living in.
By: Mary Wakutz, BSc Nursing
- Author Unknown. (2012). Prepared by Centre for Economic and Social Studies. Approach to the 12th 5 Year Plan Andhra Pradesh. Retrieved April 29, 2017, from http://www.cess.ac.in/cesshome/pdf/Draft_Approach_to_12th_Plan_for_discussion.pdf
- Mallipeddo, R., Pernefeldt, H., & Bergkvist, S. (2009). Andhra Pradesh Health Sector Reforms A Narrative Case Study . Retrieved April 29, 2017, from http://www.resultsfordevelopment.org/sites/resultsfordevelopment.org/files/resources/Andhra%20Pradesh%20Health%20Sector%20Reform_A%20Narrative%20Case%20Study.pdf
- Motkuri, V. (2011). Access to Health Care in Andhra Pradesh : Availability of Manpower. 8-9. Retrieved April 29, 2017, from https://mpra.ub.uni-muenchen.de/47932/1/MPRA_paper_47932.pdf.
- National Health Mission. Retrieved April 29, 2017, from http://nrhm.gov.in/nrhm-components/health-systems-strengthening/infrastructure.html
- WHO and UN Partners. (2015). Country Statistics and Global Health Estimates. Retrieved April 29, 2017, from http://www.who.int/gho/countries/ind.pdf?ua=1