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Thinking through rural healthcare
Healthcare is the foundational need of any society. Any approach on rural healthcare systems, therefore, has to be made holistic for better results
There comes a stage in managing development where concepts have to be clarified and if need be, redefined. Concepts gradually become categories and, therefore, become the bedrock of developmental planning. It follows that, revisiting them periodically is a necessity.
Much has been claimed in the Budget presented this month, on healthcare. Aspirationally, it's a dream situation, unprecedented in its range and depth. Hence, it would be the time to revisit the categories and concepts of healthcare in India.
The word ‘rural' is one such word whose concept needs to be revisited periodically. Add to it, the concept of healthcare and it becomes a little more complex. First, the word ‘rural'. Whenever the word rural is used, almost simultaneously emerges the concept of a ‘village'. It is my recall that the first serious studies on Indian village were published over four decades ago by MN Srinivas and SC Dube. Both the authors published their books under clear Western influence. Irrespective of that, both the versions of ‘Indian village’ set useful patterns of approaching the subject matter.
There is an obvious overlap between ‘rural environment’ and ‘village environment’. At one stage, social geography used to define a rural settlement as a habitat which had less than 5,000 inhabitants. Gradually, this concept evolved.
In India, there is a clear need for a scientific definition of rural society, which would meet not only the needs of governance, but also the requirements of the planning process. The problem is not that no definitions are there. The problem is that there are several definitions, sometimes leading to confusion of sorts. This situation is not unique to rural studies but there is obviously a case for agreeing upon a definition which has almost universal acceptability of the knowledgeable.
An illustration on the definition of poverty would make the point more clear. For years, there were squabbles on the definition of poverty till Tarlok Singh defined it as “involuntary deprivation to known standard of living”. The definition may not be perfect but it certainly has large acceptability.
To begin with, one needs to recognise that all rural areas need not necessarily be agricultural in nature. Communities of horticulture, craftsman and indeed forest land, could constitute rural areas. It would be helpful to grasp this variegated nature of rural areas to understand what health care could actually involve in such areas.
Healthcare is clearly the foundational need of any society. It is central to keeping the body and the soul together in some manner for anything else to happen. Keeping the body and the soul together by itself may be crucial but it must be in a manner which keeps the person as a functioning entity. If a person is not a functioning entity, is weak or challenged, then there is a problem at hand. Nothing, not even education, is relevant to a sick person.
Further, health itself has several forms of manifestation. To put it simply, there is physical health, there is mental health, there is emotional health and the list can be added on to. Any of these categories when ignored, will imperil not only the individual but the society in which the individual functions.
Consider a community with large incidence of mental health issues. It will show aggression, depression, negativism, contentiousness and much else. It goes without saying that thinking on rural healthcare systems has to be made holistic, if results are to show.
To lay it at the door of just economics, financial investment or even infrastructure would be over simplifying the problem. For rural healthcare, no less than elsewhere, number crunching alone will not help. It has to be a holistic approach, being conscious of its multiple layers and intricate web of concerns.
The present Government at the Centre is working together with like-minded Governments at the States and indeed the governance structure at the local level may come to grips with the issue. Some important preliminary steps have been marked through significant inoculation campaigns. There is an attempt to combat some epidemics. Now insurance cover is talked of. Obviously, long distances will need to be covered. Advocacy and grassroot involvement of people will help.
(The writer is a well-known management consultant)
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