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A similar experiment of the Jan Swasthya Rakshak, currently operating in Madhya Pradesh, has not brought about much improvement in the healthcare indices. Some authorities note that it has, instead, led to the creation of a new rural political cadre as well as a new class of
informal private practitioners. There is also concern that instead of becoming a community activist, this person may end up as an auxiliary to the ANM.

Improving the access of the poor to affordable healthcare services has to be seen in the context of the health systems development projects that are being implemented in many Indian states. These World Bank-supported projects have a set of simplistic prescriptions for improving health service delivery. There is a fee for service and public-private partnerships which include a range of options from contracting out hospital services to promoting private practitioners. There are examples from African countries where fees for services have further reduced the access of the poor to essential healthcare services like safe delivery services and getting formally trained private healthcare providers to serve rural India, especially in some states, is not a feasible option, because if it were, they would already have been there. Thus, the challenge of providing quality and affordable healthcare services remains, particularly because many earlier experiments need to be reversed.

There are stark disparities in the healthcare services available to rural and urban Indians. While world-class five-star hospitals have sprung up in various cities across the country, encouraging the new growth industry of medical tourism, facilities in rural India languish. A country-wide study conducted a few years ago (RCH Facility Survey 1st Round) found that less than 50 per cent of primary health centres (PHCs) had a labour room or a laboratory, and less than 20 per cent had a telephone. Less than a third of these centres stocked iron and folic acid, a very cheap but essential drug. Rural healthcare service delivery is, thus, severely compromised.

Despite major advances in medical science, people continue to die in large numbers from preventable illnesses like tuberculosis, gastroenteritis and malaria. Five lakh succumb to tuberculosis alone. Emergency services for delivery complications are unavailable outside cities, and, as a result, maternal death rates in the northern states rival those of sub-Saharan African countries. India accounts for a fourth of all maternal deaths world-wide, and the numbers are increasing. Uttar Pradesh, with its huge population base and very poor health system, contributes a large proportion to the overall preventable mortality and morbidity in the country. But its healthcare delivery system is preoccupied with the pulse-polio campaign and with chasing family planning targets.

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Dr. Gursharan Singh Kainth started his career as Lecturer at Post Graduate Dept. of Economics, Government College, Gurdaspur, and later at Khalsa College; Amritsar, specializes in Quantitative & Development Economics. Has the distinction of serving Punjab Agricultural Univ, Ludhiana, for more than 2 decades and remained Director-Principal of Saint Soldier Management & Technical Institute, Jalandhar. Currently, heading GAD Institute of Development Studies, Amritsar, a self-financed research institute. Has been honoured with various awards, including Guru Draunacharya Samman, Vijay Rattan Award, etc.
Article posted on December 14, 2008.