Medical care problems
Based, disease-oriented health care model has provided India has a national health policy. The existing hospital. Health benefits mainly to the urban elite. Approximately 80 per cent of health facilities are concentrated in urban areas even in urban areas, there is an uneven distribution of doctors. With large migrations occurring from rural to urban areas, urban health problems have been aggravated and Include overcrowding in hospitals, inadequate staffing and scarcity of certain essential drugs and medicines. The rural areas where nearly 65 per cent of the population live, do not health services. Many villages rely on indigenous systems of enjoy the benefits of the modern curative and preventive medicine. Thus the major medical care problem in India is in equable distribution of available health resources between urban and rural areas, and lack of penetration of health services to the social periphery. The primary health care approach which lays stress on equity, intersectoral coordination and community participation seek to redress these imbalances.
Health manpower
The term "health manpower" includes both professional and auxiliary health personnel who are needed to provide the health care. An auxiliary is defined by WHO as "technical worker in a certain field with less than full professional training". Health manpower requirements of a country are based on (i) health needs and demands of the population; and (ii) desired outputs. The health needs in turn are based on the health situation and health problems and aspirations of the people.
Health manpower planning is an important aspect of community health planning. It is based on a series of accepted ratios such as doctor-population ratio, nurse-population ratio, bed-population ratio, etc. They are given in Table 3. The country is producing annually, on an average 31,298 allopathic doctors; 9,865 Ayurvedic graduates: 1525 Unani graduates; 320 Siddha graduates and 12785 Homoeopathic graduates (26).
TABLE 3 — Suggested norms for health personnel
| Category of personnel | Norms suggested |
|---|---|
| Nurses | 1 per 5,000 population |
| Health workers (female and male) | 1 per 5,000 population in plain areas and 1 per 3,000 population in tribal & hilly areas |
| Trained dai | One for each village |
| Health assistants (male and female) |
1 per 30,000 population in plain areas and 1 per 20,000 population in tribal & hilly areas. Provides supportive supervision to 6 health workers (male/female). |
| Pharmacists | 1 per 10,000 population |
| Lab technicians | 1 per 10,000 population |
| ASHA | 1 per 1,000 population |
Although the averages are satisfactory on a national basis, they vary widely within the country. There is also maldistribution of health manpower between rural and urban areas. Studies in India have shown that there is a concentration of doctors (up to 73.6 per cent) in urban areas where only 26.4 per cent of population live. This maldistribution is attributed to absence of amenities in rural areas, lack of job satisfaction, professional isolation, lack of rural experience and inability to adjust to rural life.
The national averages of doctor-population ratio, population-bed ratio and nurse to doctor ratio in some countries are shown in Table 4.
TABLE — Health manpower in some countries (2010–2018)
| Country | Doctors per 10,000 population | Beds per 10,000 population | Nurses & Midwives per 10,000 population |
|---|---|---|---|
| India | 7.8 | 7.0 | 20.9 |
| Bangladesh | 5.6 | 8.0 | 2.2 |
| Sri Lanka | 9.6 | 36.0 | 16.4 |
| Myanmar | 8.1 | 21.0 | 20.8 |
| Thailand | 8.6 | 9.0 | 10.0 |
Health manpower requirements are subject to change, both qualitatively and quantitatively, as new programmes, projects and philosophies are introduced into the health care system. For example, there has been a change from unipurpose to multipurpose strategy. Then came the goal of Health for All. In addition, national health programmes such as tuberculosis control, leprosy eradication and control of blindness needed more trained workers and technicians. Thus during the past decade many new categories of health manpower have been introduced. They include village health guides, multipurpose workers, technicians, ophthalmic assistants, etc. Table 5 gives the total health manpower current stock under the "rural health scheme".