Rural Health Services:
In order to improve the standard of living of people by creating conditions of economic and social progress for the whole community.
Community Projects were started by our government in 1952 under the First Five Year Plan.
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Community Development Projects, as Pt. Nehru said, are centres of human activity all over India like lamps, spreading their light more and more into the surrounding darkness.
Among the basic objectives of the Community Development Projects one was “fostering primary education, public health and land reclamation in villages.”
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Thus health services are a part of this programme. Under this programme India has been divided into 5000 blocks. There are 100 villages in a block, consisting of a population of about 66000.
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There is provision for one Primary Health Centre and three Sub-centres in each block. 5000 Primary Health Centres are already functioning in the country.
Primary Health Centres:
The Block Samities decide the location of the Primary Health Centre in areas where Panchayat Raj is in operation.
They take into consideration, factors like easy accessibility, health requirements of the living in the area etc. Accommodation is provided for consultation, dispensary, operation room, labour room and six rooms for maternity ward.
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The Primary Health Centres also provide child health services, family planning services and health education.
For the facility of the staff engaged in the Primary Health Centres accommodation is provided near the centre.
The following services are provided by the Primary Health Centres:
(1) Medical care
(2) Family planning
(3) School health
(4) Health education
(5) Maternal and child health
(6) Control of communicable diseases
(7) Collection of statistics
(8) Active co-operation in the implementation of national programmes like National Malaria Eradication Programme, small-pox eradication, control of T.B., leprosy.
As the Primary Health Centres alone do not meet the requirements of the rural areas, district hospitals have also been set up. The PHCs refer cases which they cannot handle because of lack of adequate resources.
For transporting the poor patients, some of centres have been provided with transport facilities also.
There are about 10 persons at PHC – one Medical Officer, one Pharmacist, one Public Health Nurse, four Auxiliary Nurse Midwives, one Sanitary Inspector and two other staff.
The Primary Health Centres are run in co-ordination with other medical hospitals or institutions within the block.
It is worthwhile to mention here that due to lack of resources and response from the people, projects under the Community Development have not achieved the amount of success these were expected to.
There were 5484 PHCs as on 1.4.1980, another 475 were opened in 1980-83 and the target for establishing PHCs during Sixth Plan was 756.
There were 12,289 PHCs and 87,819 sub-centres in June 1986.
Sub-centres:
Sub-centres were opened covering 5000-10,000 population per sub-centre. But under the Sixth Plan the target was to open a sub-centre for every 5,000 population generally and for the hilly areas and backward areas one sub-centre each for population of 3,000.
The sub-centres implement the family welfare programme and provide Nirodh, Oral pills, Jelly, Foam Tablets, insertion of IUD (this service was available at selected centres but was proposed to be made available at all sub-centres).
There were 47171 sub- centres in the country as on 1.4.1980. Additional 37940 sub-centres were proposed to be opened during Sixth Plan. The target for 1983-84 was 9010 sub-centres.
During Seventh Plan another 548S 3 Sub-Centres were proposed to be set up.
In addition, there were 2056 subsidiary Health-centres in the rural sector, 240 more were added in 1980-81, 244 were started during 1981-82 and 673 during 1982-83.
Target for 1984 was additional 804 subsidiary Health Centres.
The programme of converting existing rural dispensaries into subsidiary health centres by adding the public health components to them has received greater response.
These subsidiary health centres would by and large be converted into primary health centres so that there is only a three tier system.
E.S.I. Hospital and Medical Benefit
The Scheme provides full range of medical care, namely, (i) Outpatient services, (ii) Specialists’ services; and (iii) Hospital services; through a network or dispensaries, diagnostic centres and ESI Hospitals, etc.
Super- specialities are provided to the beneficiaries through the country’s most advanced medical institutions for which payments are made directly by the Employees’ State Insurance Corporation to the institution concerned.
An Insured Person and his family members become entitled to medical care from the date he enters the insurable employment and the entitlement continues as long as the insured person is in insurable employment or is qualified to claim sickness, maternity or disablement benefit.
Medical treatment to persons, who go out of coverage during the period of treatment, is not discontinued till the spell of sickness ends.
All Insured Persons and members of their families are entitled to full and comprehensive medical care consisting of;
(i) Out-patient treatment
(ii) Domilciliary treatment (treatment by visits at residence);
(iii) Specialist consultation;
(iv) In-patient treatment;
(v) Free supply of drugs, dressings, artificial limbs, aids and appliances;
(vi) X-ray and laboratory investigations;
(vii) Vaccination and preventive inoculations;
(viii) Ante-natal care, confinement and post-natal care;
(ix) Ambulance service or conveyance charges for going to hospitals, diagnostic centres, etc.
(x) Family welfare services and other national health programme services;
(xi) Medical certification; and
(xii) Special provisions including super-specialist facilities.
Infrastructure (Medical):
The Medical Care under the Employees’ State Insurance Scheme is provided both through the service (Direct pattern) as well as the indirect method using the panel system.
Under the service system, about 1442 dispensaries have been set up all over the country. In the panel system, 3076 private clinics of medical practitioners provide treatment to the beneficiaries.
Specialists’ services are available in the hospital out-patient departments or at separate diagnostic centres, in all common specialities.