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Consilience: The Journal of Sustainable Development
Vol. 8, Iss. 1 (2012), Pp. 128-141
High Dependency on Quacks – Is There a Gap in the
Public Health Care Delivery System?
Reflections from a District Located
in the Thar Desert (India)
Alok Chauhan Singh
Banaras Hindu University
Varanasi, India
alokres@gmail.com
Abstract
This paper tries to analyse the availability and role of public health care
services provided by the public sector in India. In addition, it also explores the
reasons behind the high dependency on quacks in the study area. Data was
acquired through in-depth interviews of 610 respondents with the help of a
structured questionnaire from September to December 2010. Here, an attempt has
been made to probe the pattern of utilization of health care services available at
public health facilities by the sample respondents. It has been assessed in relation to
socio-economic and demographic characteristics of the interviewees which exert
significant influence on the utilization of health care facilities. The study finds that
the number of CHCs/PHCs/Sub-centres in the study area is not adequate to meet
the health needs (medical advice or treatment) of entire the population. The results
recommend improving the availability and accessibility of health care facilities in
the area under study.
Author’s Note
Alok Chauhan received an M. Sc. in Geography from the Banaras Hindu
University, Varanasi in 2006. He is pursuing a Ph.D. in the Department of
Geography at the Banaras Hindu University, Varanasi. His research interests
include Population and Family welfare, Health Care Services, Maternal and Child
Health.
Keywords: public health care system, quacks, primary health centre, accredited social
health activists.
1. Introduction
Health remains the topmost priority in every individual’s life. Its importance
is evident in the old saying “health is wealth.” Health is not only essential for an
individual’s well-being; it is also necessary for all productive activities in a society
(Goel, 2002). Hence, it is an issue of common concern. In fact, all communities have
their own concept of health as part of their culture. According to the World Health
Organization (1964), health is defined as “a state of complete physical, mental and
social well-being and not merely the absence of disease or infirmity.”
Consilience Singh: Public Health Care Delivery
The Rajasthan State Population Policy in 1999 aimed to bring in a quantum
change in many health indicators by 2011 in the state of Rajasthan, the focus of the
present study. The State has ensured strong delivery of health and family welfare
services through a plethora of voluntary workers such as Anganwadi workers, Trained
Birth Attendants, Jan Mangal Couple and ASHA (Accredited Social Health Activists).
Consistent efforts are being made to provide primary health care to all,
acknowledging issues of inequity, gender imbalance, accessibility, availability,
affordability, and delivery of quality health care services. In order to improve the
effectiveness and quality of health care delivery systems, Rajasthan Health System
Development Project is being implemented in all the 32 districts of the State with
financial assistance from the World Bank. The primary goal is to strengthen
secondary level medical institutions.
One of the major challenges facing good medical care in India is the fact that
untrained/unqualified quacks can provide medicine with impunity. Quacks generally
do not possess a recognised practice in the field of medical science. Many of them
have served as assistants to a doctor and thus present themselves as a qualified
doctor. In the study area, a quack is a person either from the same village or nearby
villages who doesn’t possesses any professional qualification or practice but merely
knows of some fast relief medicines. Since the study area has a very strict patriarchal
society with limited rights to women, women are forced to use comparatively less
expensive and easily available medical assistance, which is commonly provided by
quacks. In a traditional Indian society women have very few rights, particularly in
rural areas (Haub and Sharma, 2006). Women get secondary position in food and
nutrition as well as in health care. They are not allowed to go for modern medical
help for illnesses unless the male members of the household, particularly the
husband, consider the modern medical help necessary. The inadequate freedom of
women limits the success of public health care delivery in the study area. Under the
prevailing conditions, women are forced to consult a quack for less expensive and
easily available medical help.
The right to receive medical help by a qualified medical practitioner in times
of illness is one of the basic health-care rights to which all citizens are entitled
(WHO, 1978). Unfortunately, it is indeed very difficult for a sick person to decide
whether or not a person posing as a doctor is professionally qualified. The Rio
Declaration states that "Human beings are at the centre of concerns for sustainable
development. They are entitled to a healthy and productive life in harmony with
nature." This stresses the important inter-linkages between the social, economic and
environmental pillars of sustainable development, all of which are underpinned by
good health. Furthermore, Chapter 6 of Agenda 21 of the Declaration emphasizes
the fundamental commitment within sustainable development of "protecting and
promoting human health.” It is quite worrisome that despite so many representations
and efforts made by the Indian Medical Association, quacks continue to practice in
India.
The major aim of the present study is to examine various determinants of the
use of public health care delivery systems across different geographical regions and
population sub-groups in Hanumangarh district. The study includes socio-economic
variables, which affect the health care choices of the people in the study area. In
addition, the study also tries to identify the factors responsible for poor utilization of
public health care delivery systems and high dependency on quacks. The findings of
130 Consilience
the present study will also lead to an improved delivery and management of public
health care in the study area.
2. Data Base and Methodology
The present study is based on both primary and secondary data. Secondary
data have been collected from the Office of the Chief Medical and Health Officer in
Hanumangarh district. Intensive field work from September to December 2010 was
conducted to collect the primary data. The primary data have been collected through
sample surveys of 610 households selected from fourteen villages (two villages from
each tahsil) and two urban centres of Hanumangarh district. The villages under study
(possessing at least 50 households) have been selected according to their distance
from Primary Health Centres (PHCs). Two PHCs have been selected from each
tahsil. After selecting PHCs, villages in the vicinity of both PHCs were categorised
according to their distance from the nearest PHC. Out of these distance categories,
two villages from each tahsil have been selected in such a way that one village must
lie within a radius of 1km to the first PHC, while the second village must lie farther
than 7-8km from the second PHC. This technique has been applied in every tahsil
on a rotation basis so as to equal the sum of the distances of both villages from their
respective PHCs. To ensure accuracy, selected villages do not lie in the vicinity of
any other PHC/CHC/district hospital except the selected PHC.
While selecting villages, it was important to ensure that the entire sample
represented the physical, social, economic, cultural and religious characteristics of the
study area. Accordingly, selected villages included one that was more than 80 per
cent Muslim, one that was more than 80 per cent Sikh, one that was more than 80
per cent scheduled castes, and another that was more than 80 per cent from other
backward castes households. In each selected village, 35 respondents were chosen
for an in-depth interview through a structured questionnaire based on age, caste,
religion, education, occupation, and income. In total, 490 respondents were selected
from rural areas of all the seven tahsils of the study area.
Households have been categorised into three classes according to socio-
economic status: high, medium and low. 20 households were selected from each
socio-economic class in both urban centres. In total, 120 respondents were selected
from urban areas. Altogether, a total of 610 respondents have been selected from
various parts of the study area. The distance categories have not been considered
since the urban centres in the district have small spatial extension.
3. Results and Discussion
3.1 Distribution of health care facilities
In accordance to a WHO resolution of 1978, the Government of India
expanded health care facilities all over the country and established a good network of
primary health institutions. Health services are usually organized at three levels, each
level supported by a higher level to which the patient is referred. It was planned to
have a community centre for every 120,000 human population in plain area (on every
Consilience Singh: Public Health Care Delivery
Table 1: Tahsil-wise distribution of health facilities, 2010
Source: Office of the Chief Medical and Health Officer, Hanumangarh district, 2010.
Figure 1. Location of the Hanumangarh District in Rajasthan, India.
80,000 population in hilly and tribal areas), a primary health centre for every 30,000
population in plain area (on every 20,000 population in hilly area and tribal areas) and
a sub-centre for every 5,000 population in plain area (on every 3,000 population in
hilly area and tribal areas). Health care services in rural areas are being provided
through these health centers and district hospitals. Thus at the district level, there are
sub-centers (SCs), primary health centers (PHCs) and community health centers
(CHCs). District hospitals (DHs) have been set up as a first referral unit (FRU).
Tahsil/District
CHC
PHC
Sub-centre
Ayurvedic
Homeopathic
Unani
Sangaria
1
5
32
5
-
-
Tibi
1
3
29
12
-
-
Hanumangarh
1
7
45
18
1
-
Pilibangan
2
4
28
10
-
-
Rawatsar
1
5
43
9
-
-
Nohar
2
11
71
20
1
1
Bhadra
2
10
71
22
-
1
Total
10
45
319
96
2
2
132 Consilience
The area under study (Fig.1) is served by one district hospital, 10 CHCs, 45
PHCs and 319 SCs. There are 96 Ayurvedic, 2 Homeopathic and 2 Unani hospitals
providing health care services to the people (Fig. 2). Tahsil-wise distribution of
various health facilities is provided in Table 1. Spatial variations in health care
facilities have been analyzed at tahsil/district level with reference to PHCs. The
highest number of PHCs are found in Nohar (11) followed by Bhadra (10) and
Hanumangarh (7) tahsils. The Sangaria, Tibi and Rawatsar tahsils experience abject
conditions in terms of the number of PHCs (Table 4.3). It is notable that four tahsils,
namely Pilibangan, Tibi, Hanumangarh and Sangaria lie in the plain area while the
remaining three tahsils, Nohar, Bhadra and Rawatsar, lie in desert area. Since the
norms for establishment of an SC/ PHC/CHC are different for plain and desert
area, the availability of health care facilities is not strictly comparable between the
two areas.
The tahsil area varies notably in the study area. Thus, the availability (density)
of health care facilities has been analyzed in reference to per 100 sq. km of surface
area. Similarly, all the tahsils of the study area do not contain equal population so the
availability of health care facilities (e.g. PHCs and SCs) has been made in reference to
per 10,000 people.
Figure 2. Location of health care facilities in Hanumangarh District, Rajasthan, India.
Consilience Singh: Public Health Care Delivery
Table 2: Tahsil-wise distribution of PHCs and sub-centres, 2010
Source: Self computed.
Figure 3. Distribution of health facilities in Hanumangarh District, Rajasthan, India.
Table 2 presents the density of PHCs and SCs in terms of area and
population. It is apparent from Fig. 3A that the density of PHCs per 100 km2 of area
is highest in Sangaria tahsil and lowest in Rawatsar tahsil. The remaining tahsils have
moderate density of PHCs. While considering the availability of PHCs per 10,000
people it has been found that Nohar tahsil is best served while Tibi is the least served
tahsil. Nohar and Sangaria tahsils recorded high availability of PHCs per 10,000
people while Rawatsar and Bhadra showed moderate density. The remaining three
tahsils registered low density of PHCs (Fig.3B). It is clear from the preceding
Tahsil/District
PHCs
Sub-centres
Per 100 km2
of area
Per 10,000 of
pop.
Per 100 km2
of area
Per 10,000 of
pop.
Sangaria
0.76
0.47
4.88
2.98
Tibi
0.40
0.21
3.90
2.05
Hanumangarh
0.57
0.30
3.68
1.92
Pilibangan
0.42
0.28
2.92
1.93
Rawatsar
0.27
0.35
2.30
3.05
Nohar
0.45
0.49
2.91
3.16
Bhadra
0.58
0.45
4.14
3.22
District
0.47
0.37
3.32
2.63
134 Consilience
Table 3: Distance-wise distribution of villages from nearest PHC
Tahsil/District
Distance (km) from nearest PHC
Total
0-5
5-10
> 10
Sangaria
Number
42
40
97.00
179
Per cent
23.46
22.35
54.19
100.00
Tibi
Number
14
31
193
238.
Per cent
5.88
13.03
81.09
100.00
Hanumangarh
Number
33
58
290
381
Per cent
8.66
15.22
76.12
100.00
Pilibangan
Number
39
73
164
276.
Per cent
14.13
26.45
59.42
100.00
Rawatsar
Number
26
59
212
297
Per cent
8.75
19.87
71.38
100.00
Nohar
Number
35
23
146
204
Per cent
17.16
11.27
71.57
100.00
Bhadra
Number
32
51
115
198
Per cent
16.16
25.76
58.08
100.00
District
Number
221
335
1217
1773
Per cent
12.46
18.89
68.64
100.00
Source: Jansankhya Sthirata Kosh (JSK) (National Population Stabilization Fund),
district level health data, 2006.
discussion that five tahsils have a sufficient number of PHCs as per norm set by the
Government of India.
Density of sub-centres also varies in the study area. Sangaria and Bhadra
tahsils registered a high density of SCs per 100 km2 of area while Tibi and
Hanumangarh tahsils showed moderate density. Pilibangan, Rawatsar and Nohar
tahsils showed low density of SCs (Fig.3C). The density of SCs per 10,000 of people
is high in Nohar, Bhadra and Rawatsar tahsils while Sangaria and Tibi tahsils
recorded moderate availability of SCs.
Availability of sub-centres has been found low in Hanumangarh and
Pilibangan tahsils (Fig.3D). Although the study area has a sufficient number of PHCs
and SCs, accessibility and affordability are still major hurdles to universal health
provision. There is wide variation in density of health care institutions. The majority
of the settlements, particularly in the southern three tahsils, are scattered in nature.
These scattered habitats located in vast desert areas have very low rail and road
connectivity with the health care institutions. Poor accessibility and low availability of
health care institutions force people to seek medical help from a quack in case of
illness. Better accessibility and higher availability may in turn lessen the role of
quacks in the study area.
3.2 Distance of villages from PHCs
To analyse accessibility to PHCs, all the inhibited villages of the study area
have been categorised into three groups according to their distance from the nearest
Consilience Singh: Public Health Care Delivery
PHC (Table 3). It is evident from Table 3 that 12.46% of villages are between 0-5
km, whereas 18.89% of villages are between 5-10 km. More than two-thirds of the
total villages are located at a distance more than 10 km from the nearest PHC.
Clearly, for the majority of the villagers, distance to a PHC is a significant constraint.
It is very difficult to travel a distance of 10 km in the desert, particularly for poor
people who do not possess their own transport/vehicle.
3.3 Types of hospitals in the study area
There are altogether 96 Ayurvedic hospitals in the study area. Sangaria tahsil
has the lowest number of Ayurvedic hospitals while Bhadra has the highest number
(Fig.1). At the same time, there are two homeopathic hospitals in the study area, one
each in the Hanumangarh and Nohar tahsil. In the study area there are two Unani
hospitals, one each in the Nohar and Bhadra tahsil.
3.4 Utilization of health care facilities
The area under study is commonly served by public (government) health care
centers. However, a few specialized private hospitals and nursing homes located in
six urban centres of the study area also provide services. An attempt has been made
to probe the pattern of utilization of health care services available at public health
facilities by the sample respondents. It has been assessed in relation to socio-
economic and demographic characteristics of the interviewees, which exert
significant influence on the utilization of health care facilities. In addition, effort has
been also made to assess the magnitude of utilization of various medicine systems
with social, cultural and economic variables.
3.5 Socio-economic profile of the respondents
The study under reference covered 610 respondents (one from each
household) in the age group of 15-49 years in fourteen sample villages and two urban
centres. Of the sample households, 86.9% are Hindu while 5.7% and 7.4% are
Muslim and Sikh, respectively. According to social groups, 34.9% belong to general
castes while 44.3% and 20.8% per cent belong to other backward castes (OBC) and
scheduled castes respectively. The computed mean age of the male respondents is
33.20 years and 30.24 years for female respondents. The average monthly family
income was computed as Rs. 7432. The literacy rate of males is 88.2% while that of
females is 62.3%. The level of educational attainment of both male and female
respondents in the sample villages is depicted in Fig.4.4 and 4.5 respectively. Only
1% of female and 14.6% of male respondents have an education of 14 or more years
(graduation and above). Nuclear families account for 62.3% of the surveyed
population while the remaining 37.7% respondents belong to joint families. Most of
the male respondents are farmers (35.2%) whereas the majority of females are
agricultural labourers (20.8%).
136 Consilience
3.6 First visit in case of illness
Table 4: Religion and first visit in case of illness
Source: Based on personal survey, 2010.
Note: The figures in parenthesis indicate the number.
Availability, affordability, accessibility and reliability of health care facilities
decide the first visit in cases of illness. In the study area out of 610 households, 341
(55.9%) sought help from quacks while 102 (16.7%) respondents visited
CHCs/PHCs/SCs, 69 (11.3%) respondents consulted registered medical
practitioners (RMP), 91(14.9%) visited private hospitals and 7 (1.1%) sought help
from traditional healers in cases of illness. Easy availability, convenience, low
expense and frequent visits to household members are the main reasons behind the
high dependency on quacks. Distance to health facilities coupled with poor
transportation resulted in low use of health care facilities.
3.7 Socio-economic characteristics and first visit in case of illness
The socio-economic and demographic variables discussed in this section
include religion, social-group (caste), family structure, monthly income of
households, age, education and occupation of the respondents. Since information
regarding health care behaviour of the household has been collected from the
husband, only husband’s age, education and occupation have been considered.
3.8 Religion
Use of health care facilities is associated differently with religion in the study
area (Table 4.). A high percentage of Hindus and Muslims consulted quacks while
Sikhs visited private hospitals in cases of illness. A perusal of Fig.4.6B reveals that
traditional healers were not consulted by the Muslim or Sikh populations while a
small number (1.3%) of Hindus visited traditional healers during illness.
Religion
CHC/PHC/Sub-
centre
Private
hospital
RMP
Quack
Traditional
healer
Total
Hindu
16.8%
(89)
13.6%
(72)
10.8%
(57)
57.5%
(305)
1.3%
(7)
100%
(530)
Muslim
5.7%
(2)
11.4%
(4)
17.1%
(6)
65.7%
(23)
-
100%
(35)
Sikh
24.4%
(11)
33.3%
(15)
13.3%
(6)
28.9%
(13)
-
100%
(45)
Total
16.7%
(102)
14.9%
(91)
11.3%
(69)
55.9%
(341)
1.1%
(7)
100%
(610)
Consilience Singh: Public Health Care Delivery
3.9 Social-group
Table 5: Social-group and first visit in case of illness
Source: Based on personal survey, 2010.
Note: The figures in parenthesis indicate the number
80% of the total population in the study resides in rural areas. In Indian
villages, caste strongly influences the life style of the people and symbolizes their
social and economic status. The Central Government of India classifies some of its
citizens based on their social and economic condition as Scheduled Caste (SC),
Scheduled Tribe (ST), and Other Backward Class (OBC) (Premi, 2003). The castes,
which were the elite of the Indian society, were classified as high castes. The other
communities were classified as lower castes or lower classes. The lower classes were
listed in three categories. The first category is called Scheduled Castes. This category
includes communities of untouchables. The untouchables call themselves Dalit,
meaning depressed. The second category is Scheduled Tribes. This category includes
those communities who did not accept the caste system and preferred to reside away
from the main population in the jungles, forests and mountains of India. The
Scheduled Tribes are also called Adivasi, meaning aboriginals. The third category is
called Other Backward Classes or Backward Classes. In the constitution of India,
OBCs are described as "socially and educationally backward classes," and
government is enjoined to ensure their social and educational development. All the
castes in the study area have been broadly grouped into three social-groups, i.e.,
general, other backward castes (OBCs) and scheduled castes (SCs). There is no
scheduled tribe population in the study area. All the social-groups showed a high
dependency on quacks in general and scheduled castes in particular. Scheduled castes
belong to lowest strata of the society and possess comparatively lower socio-
economic status because a very high proportion (89.45%) of scheduled castes is
engaged as agricultural labourers. Poverty and illiteracy are the main reasons, which
resulted in very high (69.3%) dependency on quacks among scheduled castes (Table
5). All the social-groups, however, showed a high dependency on quacks except the
scheduled castes, which possess comparatively lower socio-economic status and are
mainly engaged as agricultural labourers, registered high preference (69.3%) in
consulting quacks in case of illness (Table 5).
This table clearly reveals that the public health system is not popular in the
study area among the weaker sections of the society. About one-fourth of the
Social-
group
CHC/PHC/
Sub-centre
Private
hospital
RMP
Quack
Traditional
healer
Total
General
16.9%
(39)
23.5 %
(50)
18.3%
(39)
41.3%
(88)
-
100%
(213)
OBC
15.6%
(42)
13.0%
(35)
8.9%
(24)
61.1%
(165)
1.5%
(4)
100%
(270)
SC
18.9%
(24)
4.7%
(6)
4.7%
(6)
69.3%
(88)
2.4%
(3)
100%
(127)
Total
16.7%
(102)
14.9%
(91)
11.3%
(69)
55.9%
(341)
1.1%
(7)
100%
(610)
138 Consilience
Table 6: Family structure and first visit in case of illness
Source: Based on personal survey, 2010.
Note: The figures in parenthesis indicate the number.
interviewees from general castes visited private hospitals, while the proportion of
interviewees is only 13% and 4.7% for OBCs and SCs, respectively.
3.9 Family structure
Family structure also plays a significant role in the use of various health care
facilities, though a very large proportion of respondents consulted quacks
irrespective of their family structure. There is no significant difference in visits to
CHCs/PHCs/Sub-centres and RMPs, but there is a wide variation in utilization of
services of private hospitals between the two family structures (Table 6). Only 8.3%
of respondents belonging to joint families visited private hospitals, while 18.95% of
respondents from nuclear families visited the private hospitals in case of illness. In
joint families, expenditures are decided by the head of the households so there is less
freedom for choices.
3.10 Income
Income of the household to a large extent decides the use of available health
care facilities. It is clear from Table 7 that the percentage of respondents visiting
private hospitals increases with the increase in household income. Visits to
CHC/PHC/Sub-centre increases with higher income up to a certain limit; thereafter
it shows a negative relationship with the income. It is apparent that those
respondents whose monthly family income is less than Rs 1000 have the highest
(90.8%) dependency on quacks, while the proportion of respondents who visited
private hospitals in case of illness, is highest in the income category of above Rs
15000.
3.11 Age
An individual’s age affects health care behavior as well. Table 8 shows the
relationship between age of the respondents and their use of health care facilities. It
is apparent from Table 8 that as age increases, the percent of respondents who
sought help from quacks decreases due to the inability of quacks to cure some
specific old age diseases. The percentage of respondents who visited private hospitals
during illness increases up to the age group of 40-44 years; thereafter it declines
Family
structure
CHC/PHC/
Sub-centre
Private
hospital
RMP
Quack
Traditional
healer
Total
Nuclear
17.4%
(66)
18.9%
(72)
10.8%
(41)
52.4%
(199)
0.5%
(2)
100.0%
(380)
Joint
15.7%
(36)
8.3%
(19)
12.2%
(28)
61.7%
(142)
2.2%
(5)
100.0%
(230)
Total
16.7%
(102)
14.9%
(91)
11.3%
(69)
55.9%
(341)
1.1%
(7)
100.0%
(610)
Consilience Singh: Public Health Care Delivery
Table 7: Income and first visit in case of illness
Source: Based on personal survey, 2010.
Note: The figures in parenthesis indicate the number.
Table 8: Age of respondents and first visit in case of illness
Source: Based on personal survey, 2010.
Note: The figures in parenthesis indicate the number.
significantly. It is clear from Table 8 that after the age-group of 35-39, respondents’
dependency on Registered Medical Practitioner (RMP) increases significantly.
Percentage of respondents who visited CHCs/PHCs/Sub-centers increases as the
age of respondents increases. The highest percentage of respondents who visited
CHCs/PHCs/Sub-centers is in the age-group of 45-49 years.
Monthly
income (Rs)
CHC/PHC/
Sub-centre
Private
hospital
RMP
Quack
Traditional
healer
Total
< 1000
4.6%
(4)
-
-
90.8%
(79)
4.6%
(4)
100%
(87)
1000-5000
15.5%
(17)
3.6%
(4)
2.7%
(3)
77.3%
(85)
0.9%
(1)
100%
(110)
5000-10000
20.5%
(60)
12.0%
(35)
14.7%
(43)
52.1%
(152)
0.7%
(2)
100%
(292)
10000-15000
17.3%
(19)
40.9%
(45)
19.1%
(21)
22.7%
(25)
-
100%
(110)
> 15000
18.2%
(2)
63.6%
(7)
18.2%
(2)
-
-
100%
(11)
Total
16.7%
(102)
14.9%
(91)
11.3%
(69)
55.9%
(341)
1.1%
(7)
100%
(610)
Age-
group
CHC/PHC/
Sub-centre
Private
hospital
RMP
Quack
Traditional
healer
Total
20-24
4.0%
(4)
16.0%
(4)
16.0%
(4)
64.0%
(16)
-
100%
(25)
25-29
18.4%
(28)
11.8%
(18)
5.3%
(8)
63.2%
(96)
1.3%
(2)
100%
(152)
30-34
10.9%
(16)
15.0%
(22)
13.6%
(20)
60.5%
(89)
-
100%
(147)
35-39
20.4%
(42)
16.0%
(33)
8.3%
(17)
52.9%
(109)
2.4%
(5)
100%
(206)
40-44
16.4%
(9)
21.8%
(12)
16.4%
(9)
45.5%
(25)
-
100%
(55)
45-49
24.0%
(6)
8.0%
(2)
44.0%
(11)
24.0%
(6)
-
100%
(25)
Total
16.7%
(102)
14.9%
(91)
11.3%
(69)
55.9%
(341)
1.1%
(7)
100%
(610)
140 Consilience
Table 9: Educational attainment and first visit in case of illness
Source: Based on personal survey, 2010.
Note: The figures in parenthesis indicate the number.
3.12 Education
A perusal of Table 9 reveals a strong association between educational
attainment and use of health care facilities. It is interesting to note that health
services rendered by quacks are found to be very high in illiterate respondents
(69.4% per cent) as well as in respondents with primary level schooling (72.3%).
With an increase in educational level, services provided by the qualified practitioners
increases rapidly, while a declining trend is found in use of services provided by
quacks. However, visits to a CHC/PHC/Sub-centre in case of illness have no direct
relationship with educational attainment, indicating that educated as well uneducated
respondents are not satisfied with government run health care institutions. Use of
private hospitals is highly significant in respondents who have higher education
(graduation and above). Educated persons generally earn more and are more aware
of the quality of health care facilities. A very small percentage of illiterate (6.9%) and
poorly educated respondents (3.08%) sought help from traditional healers during
their illnesses.
3.13 Occupation
The occupation of individuals reflects their economic status, which in turn,
influences the health care behaviour of the household. In general, the occupational
structure of India’s population reveals the backwardness of the economy since more
than 60% of the total work force is engaged in agriculture (Ramachandran, 2008). A
similar situation exists in the case of the study area where over three-fourths of the
working population is engaged in agriculture-related activities.
Education
CHC/PHC/
Sub-centre
Private
hospital
RMP
Quack
Traditional
healer
Total
Primary
12.3%
(8)
1.5%
(1)
10.8%
(7)
72.3%
(47)
3.08%
(2)
100%
(65)
Middle
21.4%
(44)
10.2%
(21)
5.3%
(11)
63.1%
(130)
-
100%
(206)
High School
9.9%
(9)
18.7%
(17)
11.0%
(10)
60.4%
(55)
-
100%
(91)
Intermediate
20.7%
(18)
12.6%
(11)
20.7%
(18)
46.0%
(40)
-
100%
(87)
Graduate and
above
13.48%
(12)
43.8%
(39)
25.8
(23)
16.8%
(15)
-
100%
(89)
Illiterate
18.6%
(13)
2.78%
(2)
2.78%
(2)
69.44%
(50)
6.94%
(5)
100%
(72)
Total
16.7%
(102)
14.9%
(91)
11.3%
(69)
55.9%
(341)
1.1%
(7)
100%
(610)
Consilience Singh: Public Health Care Delivery
Table 10: Occupation and first visit in case of illness
Source: Based on personal survey, 2010.
Note: The figures in parenthesis indicate the number.
The occupations shown in Table 10 represent both high-skilled as well as
low-skilled jobs. Table 10 shows that respondents who are cultivators (72.6%),
agricultural labourers (93.5%) and construction workers (100.0%) have a high
dependency on quacks. This may be attributed to their low level of educational
attainment and poverty coupled with poor awareness about the services available at
health care institutions. It has also resulted in low use of CHCs/PHCs/Sub-centers
and private hospitals. Those respondents who are engaged in the service sector
registered the highest percentage (39.0%) of private hospital visits in case of illness.
4. Conclusion
The study found that public sector health care facilities are neither adequate
nor easily accessible in the study area. Poverty, poor levels of literacy, and lack of
proper transport facilities contribute to the role of quacks in primary health care. The
utilization pattern of health care facilities in the study area reveals that the people of
the study area, irrespective of their background characteristics, are highly dependent
on quacks in terms of medical help. The problems faced by the public health care
system in the study area are the result of interplay of different social, economic,
demographic and infrastructural factors.
This research may assist in formulating policies and programmes by
identifying critical variables, target groups, and grey areas for effective management
of public health care delivery systems. To achieve the goal of universal health care,
Occupation
CHC/PHC/
Sub-centre
Private
hospital
RMP
Quack
Traditional
healer
Total
Cultivators
4.2%
(9)
13.5%
(29)
8.4%
(18)
72.6%
(156)
1.4%
(3)
100%
(215)
Agri. lab
6.5%
(2)
-
-
93.5%
(29)
-
100%
(31)
Indus. lab.
66.7%
(8)
-
-
33.3%
(4)
-
100%
(12)
Business
37.5%
(54)
13.2%
(19)
15.3%
(22)
34.0%
(49)
-
100%
(144)
Construction
-
-
-
100%
(18)
-
100%
(18)
Service
14.3%
(15)
39.0%
(41)
25.7%
(27)
21.0%
(22)
-
100%
(105)
Transport
22.7%
(5)
9.1%
(2)
9.1%
(2)
59.1%
(13)
-
100%
(22)
Others
14.3%
(9)
-
-
79.4%
(50)
6.3%
(4)
100%
(63)
Total
16.7%
(102)
14.9% (91)
11.3%
(69)
55.9%
(341)
1.1%
(7)
100%
(610)
142 Consilience
future strategies and initiatives must recognize critical variables and target groups and
grey areas that pose challenges to adherence of proper use of public health care
facilities. Availability and affordability of health care facilities as well as accountability
and responsiveness of health care providers must be incorporated into policy
formulation and implementation to make health care facilities more effective at the
grass-root level. Such measures will surely help to reduce gaps in public health care
systems, which consequently decrease high dependency on quacks in the study area.
Consilience Singh: Public Health Care Delivery
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