Health care should be cheaper and more accessible

N H ANTIA Director of the Foundation for Research in Community Health, Pune, Maharashtra is striving to promote the concept of better health care for the underprivileged sections of the society. He spoke to VIBHA VARSHNEY regarding his programme of community health system which is based on the principle of participatory training of the village women

Published: Friday 15 September 2000

What is the community health system?
The concept of the community health system evolved by the Foundation of Research in Community Health ( frch ), is based on decentralisation of the existing health care system. The concept was developed after extensive research and involves training of the village women to facilitate improvement of community health. This system will also aid the transformation of the villages into a self-sustaining entity, as the villagers will take care of both their medical needs as well as their environment. The health programme includes a four-tier system and the division depends on the increasing levels of population of various areas. The layers include: the community health functionary, the voluntary health functionary, sahyogini (referral centre) and the people's hospital.

What is the need to develop such a system?
The rural population is generally not able to reap the benefits of the public health services. They have to travel long distances to reach the nearest hospital, even in the case of minor diseases that can be taken care of in the village itself. Generally, doctors are not ready to render their services in rural areas and because of this villagers should be trained to solve their health problems on their own. Health care system should be cheaper and more accessible.

What is the criteria for selecting the health worker?
Natural aptitude and the willingness to serve would be the criterion for choosing the person. Married women who are 25-30 years old would be selected ideally by the village panchayat . Initially, a small group of women from different villages would be trained under the guidance of doctors. Some of these trained community workers would work towards spreading their knowledge to others. Though motivation is the main criterion, the ability to read and write in local language is also important. The community health worker should be educated till class 4-5 and the advanced level worker of sahyogini should be educated till class 9-10.

What will the training comprise of?
Active participation of the health worker would be an integral part of the training programme. The subjects broadly covered under the training will include human and veterinary health, community organisation and environment education. The training will comprise of field trips, seminars and workshops. It will prepare the health worker to take care of day-to-day medical problems of the villagers. Alongwith prescribing medicines for minor aliments, the health worker will also be trained for speclialised treatment such as splinting a broken limb. This will help in reducing the burden on doctors working in the public hospitals of cities.

Are there any chances of the community health worker cheating the villagers?
This is not possible, as the community health worker will be chosen from the community itself. The community will exercise control over the worker by fixing treatment charges. If the Villagers are not satisfied with the services of the worker then they can dismiss her. The major incentive for the health worker should not be money but community welfare.

Who will implement the system?
The whole programme is carried out by the people on their own initiative. The community health system can be termed as the people's programme as the government is not playing any part in it. The programme is funded by the community itself but donations from outside can be used if decision making still remains in the hands of the community. Non-governmental organisations are expected to play an important role in creating awareness regarding the programme.

Has the programme proved to be successful anywhere?
frch's community health programme has been successful in the Parinche Valley in Pune district, Maharashtra. Seeing this, state governments of West Bengal and Madhya Pradesh have asked frch to implement the system in their states.

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