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Vinson Kurian

THIRUVANANTHAPURAM, July 29

A NATIONAL survey on health services has revealed that private facilities are used more often than Government facilities for treating major ailments in only five States - Kerala, Andhra Pradesh, Arunachal Pradesh, Meghalaya and Nagaland.

The survey, titled `State of India's Public Services: Benchmarks for the New Millennium' and conducted by the Bangalore-based citizen monitoring initiative, Public Affairs Centre (www.pacindia.org) , targeted five selected public services across 24 States.

Dr Suresh Balakrishnan, Executive Director, PAC, said that the public health service providers along with the private sector have succeeded in giving reasonably good access to a good part of the population.

But the pattern suggests that States with a greater degree of relatively remote habitations need to plan the locations of health infrastructure with great care, and develop mechanisms to ensure adequate presence of personnel at these locations.

"The mix of fees and bribe is a potent combination of weak service, which is being projected as highly subsidised or free. Even in the best of situations, these services do not evince high degree of complete satisfaction."

State Governments across the country have attached high priority to providing minimum health facilities.

A variety of facilities have been set up ranging from sub-centres and primary health centres at the village level to taluk, district and State level facilities.

The private sector also plays an important role in this area, including private hospitals and doctors, and practitioners of local medical traditions.

The overall assessment on health services across States was carried out on the following four parameters which served as separate benchmarks for each: access to a medical facility within 3 km from residence, usage of Government medical facility for treatment, presence of doctors at time of visiting Government health facility and satisfaction with behaviour of doctors.

Easy access to a health care provider - public or private - was reported by 73 per cent of households. Easy access was high in Sikkim, Mizoram and Punjab, and relatively low in Nagaland, Arunachal Pradesh and Meghalaya.

Households across the country use Government health facilities for treating major ailments (57 per cent) more than private sources. Use of a Government health facility to treat minor ailments (47 per cent) is, however, a little lower.

Government facilities were reported as the major source of care in case of major ailments in Mizoram, Sikkim, and Orissa. In contrast, households with major ailments depend much less on these facilities in Bihar, Nagaland and Punjab.

Paramedical personnel were more frequently reported as being present (83 per cent) than doctors (69 per cent) in Government health facilities.

Doctors available at time of visit to Government health facility was higher in Gujarat, Maharashtra and Punjab and lower in Andhra Pradesh, Tripura and Mizoram.

Paramedics were more often present at time of visit in Gujarat, Sikkim and Himachal Pradesh, and less in Tripura, Arunachal Pradesh and Andhra Pradesh.

While 40 per cent of inpatients reported paying some fee for service across the country, only 16 per cent of the outpatients reported having to pay.

Inpatient charges are collected more often in Punjab, Himachal Pradesh and Madhya Pradesh. Among outpatients, more pay for services in Government hospitals in Nagaland, Rajasthan and Punjab.

Full satisfaction with behaviour of doctors and paramedical staff was quite low across the country (14 per cent and 13 per cent). Satisfaction with medical personnel was higher in Tamil Nadu, Gujarat and Karnataka.

Relatively larger proportion of inpatients from these three States reported full satisfaction with doctors and with paramedical staff.

Full satisfaction with cleanliness of wards was extremely low across the country (12 per cent). Relatively higher proportions of users reported dissatisfaction with cleanliness of wards in Madhya Pradesh, Bihar and Orissa.

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