Health Report 1 2005 Pratichi

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Transcript of Health Report 1 2005 Pratichi

The Pratichi Health ReportWith an introduction by Amartya Sen




When citizens cannot even get free medical diagnoses or blood tests, or obtain basic medication for clearly identifiable substantial illnesses, there is something deeply wrong with the framework of state health services. A far-reaching reorganization of public health services seems to be needed. Many of the changes that are needed are matters of better organization, rather than of larger expenditure. It is particularly important to bring the issue of responsibility in medical services into the spotlight of public attention, along with the prevalence of quacks and the explosion of expensive private practitioners to whom the patients tend to go because of the lack of elementary public health services. The remedy must also lie in more public discussion, in the media and elsewhere, about appalling exclusions in state health services, with disastrous impacts on the lives of the poor, along with non-performance by a substantial part of the public health care officials, including doctors. Amartya Sen


RS 1 0 0 ; $ 5 ISBN 81-88297-03-8

The Pratichi Health Report






First published in 2005 by TLM B OOKS in association with PRATICHI (INDIA) TRUST A 708, Anand Lok, Mayur Vihar I, Delhi 110091, India Phone/Fax: (91 11) 2275 2375 B O O K S Email: [email protected] Website:

All rights reserved. Reproduction, copy, transmission or translation of any part of this publication may be made only with the prior written permission of the copyright holder or the publisher. Parts of this publication may be reproduced without a fee for teaching purposes or for quotation in reviews or academic papers, but not for resale. For copying in any other circumstances, or for re-use in other publications, or for translation and adaptation, prior written permission must be obtained from the publisher and copyright holder, and a fee may be payable.

C O P Y R I G H T P R AT I C H I ( I N D I A ) T R U S T

E D I T O R S : S A M A N TA K D A S A N D A O D I I T I M E H T TA D E S I G N : AN TA R A D E V S E N C O V E R A R T : D H I R A J C H O U D H U R Y, 2 0 0 3 ISBN 81-88297-03-8 Printed at Aditi PrintoFast, New Delhi TLM BOOKS is an imprint of Indigo Publishing Pvt Ltd

The Delivery of Primary Health ServicesA STUDYIN





With an introduction by AMARTYA SEN

iv T H E P R A T I C H I H E A LT H R E P O R T, 1

ContentsIntroduction Preface 1. Overview 2. Study Areas and Methodology Birbhum General Health Dumka General Health Blocks Villages Methodology Selection of districts, blocks and villages Selection of the households Main study 3. Report Highlights Fact Sheet 4. Background: Households, Morbidity and Awareness Economic and Occupational profile of the sampled households Land holding size Income class of the sampled households Occupational profile of the sampled households 1 6 9-16 17-30






Gender of the respondents Literacy status of the respondents Family size and sex ratio Childrens profile Level of health awareness of respondents General morbidity and mortality 5. Health ailments, Healthcare and Some Related Issues Prevalence of ailments Extent of illness Period of suffering Those who remain uncared Reasons for not taking treatment Different medical service providers Quacks an introduction Different sources of medical treatment Different sources of treatment for different ailments Health ailments and gender division Income class, literacy and medical treatment Santal traditional medicines and sorcery Hospitalisation Medical abuses: Fatal disorders Social implications of health ailments Abstaining from work and related problems Negative effect on childrens education Loss of family income and cost involved Increase vulnerability to other diseases 6. Reproductive and Child Health Services Childbirth Assistance in childbirth Complications in delivery Cost involvement in childbirth Antenatal care Post natal care Stillbirth and abortion Infant and child mortality Fertility and family planning Problems of womens health Cost involvement in womens diseases Children health services Role of the ICDS Immunisation 44-67


vi T H E P R A T I C H I H E A LT H R E P O R T, 1

7. Cost of Medical Treatment and Its Implications 84-97 Occupation wise distribution of the sampled households Land holding pattern of the sampled households Annual income distribution of the sampled households Income class of social groups Expenditure pattern of the sampled households Expenditure on healthcare Income group wise cost of medical treatment of the households Cost of hospitalisation Service wise cost of treatment Ailment wise cost of treatment Management of cost of medical treatment Economics of medical expenditure cycle of poverty, ill health and impoverishment Health care and inequality 8. Delivery of Public Health Services Extent of realisation of preventive services Immunisation Doses of polio and DPT vaccines received Extent of full immunisation Place of vaccination Prenatal preventive care Generating awareness Quality of services at home Other preventive measures Measures to prevent diarrhoea Measures to prevent malaria Curative services Functioning of the public health services Bibliography List of respondents other than the selected ones Appendix Tables 98-113

114 118 120




Tables 1.1 1.2 2.1 2.2 2.3 2.4 2.5 4.1 4.2 5.1 5.2 5.3 5.4 5.5 5.6 5.7 5.8 5.9 5.10 5.11 6.1 6.2 6.3 7.1 8.1 8.2 8.3 8.4 8.5 8.6 Select health indicators Health infrastructure in West Bengal and Jharkhand Public health facilities in Birbhum Staff strength in Birbhum health department Some major communicable diseases Public Health Facilities in Dumka Strength of health staff in Dumka district Distribution of households by social groups Distribution of households by landholding size Prevalence of ailments Health problems in last one year Prevalence of ailments (with gender break up) No treatment and gender inequality Distribution of medical treatment by ailment Source of treatment by gender Income class and educational level Educational status and source of treatment Extent of hospitalisation Loss of work owing to illness in terms of days Effect of illness on childrens attendance in the schools Cases of abortion Family planning services delivered Nutrition of children under three years of age Expenditure pattern of the sampled households Extent of vaccination Sources of vaccination Periodicity of visits by health workers Services sought after (from public health system) Functional status of the public health delivery system Service availability in the public health system 11 13 18 19 20 23 23 36 37 45 45 46 49 54 55 57 57 59 64 65 75 77 81 86 100 101 103 109 111 111

viii T H E P R A T I C H I H E A LT H R E P O R T, 1

Storyboxes Here a quack ther a quack Churkis story Urmilas story An Adivasi Food Calendar Barik and Ajijul The Debt Trap Sah the Moneylender A Health Assistants Dilemma The Doctors Honour 53 74 78 80 89 95 96 104 108

Graphic tales 1.1 5.1 5.2 5.3 5.4 5.5 6.1 6.2 6.3 6.4 6.5 7.1 7.2 7.3 7.4 7.5 7.6 7.7 8.1 Communicable diseases in West Bengal: 1995-2001 Period of suffering Different sources of medical treatment Class and source of treatment: Birbhum Class and source of treatment: Dumka Period of absence in the primary schools due to illness Expenditure on childbirth Whether received iron folic tablets or not Whether tetanus injection received during pregnancy Frequencies or pregnancies Distribution of women according to childbirth Average annual income of the households Item wise expenditure pattern of the households Caste wise average annual health expenditure Health expenditure of different income groups Service wise cost of treatment Average cost of medical treatment, by ailment Management of cost of medical treatment Use of different public health services 12 47 52 56 56 66 71 72 73 76 77 85 86 88 88 90 92 94 107




Abbreviations AIDS ANM APHC ARI BDO BPHC BPHN BPL CMIE CMOH DOT ENT FPW GNM HA(F)/ HA (M) HIV HS(F)/ HS (M) ICDS ICMR ICPD ICSSR IIPS MH&FW NFHS NGO NSSO ORS PHC PHN RCH RMP SC ST TB UMP Acquired Immune Deficiency Syndrome Auxiliary Nursing Midwife Additional Primary Health Centre Acute Respiratory Illness Block Development Officer Block Primary Health Centre Nurse of Block Primary Health Centre Below Poverty Line Centre for Monitoring Indian Economy Pvt. Ltd. Chief Medical Officer of Health Direct Observation and Treatment Eye, Nose and Throat Family Planning Worker General Nursing Midwife Health Assistant (Female)/ Health Assistant (Male) Human Immune Deficiency Virus Health Supervisor (Female)/ Health Supervisor(Male) Integrated Child Development Service Indian Council for Medical Research International Conference on Population and Development Indian Council for Social Science Research International Institute of Population Sciences Ministry of Health and Family Welfare National Family Health Survey Non-Government Organization National Sample Survey Organisation Oral Rehydration Salt Primary Health Centre Nurse of Primary Health Centre Reproductive and Child Health Registered Medical Practitioner Scheduled Caste Scheduled Tribe Tuberculosis Unqualified Medical Practitioner

IntroductionAmartya Sen

has be